基于3D-STI技术应用心肌综合指数评价化疗对肺癌患者的心脏毒性

Evaluation of cardiotoxicity in lung cancer patients receiving chemotherapy by using myocardial composite index based on three-dimensional speckle tracking imaging

目的应用三维斑点追踪成像(3D-STI)技术获得左室整体心肌应变及扭转,计算左室心肌综合指数(MCI),评价其对肺癌患者化疗后所致心脏毒性的临床监测价值。方法追踪观察拟行化疗的肺癌患者56例,分别在其化疗前、化疗3周期及化疗6周期后行常规超声心动图和3D-STI数据的采集,应用后者获得左心室整体面积应变(GAS)、整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)及扭转(LVtw)等参数,计算MCI,应用受试者工作特征(ROC)曲线评价左室整体心肌应变、LVtw及MCI对心脏毒性的临床监测价值。结果与化疗前、化疗3周期后比较,MCI、GAS、GLS、GCS和LVtw在化疗6周期后明显减低;与化疗前比较,MCI、GAS、GLS和LVtw在化疗3周期后下降显著,差异均有统计学意义(P<0.05)。ROC曲线显示,MCI的曲线下面积为0.931,以-244.1(%×°)为截断值时,判断化疗药物对左室心肌功能损害的特异性为91.7%,敏感性为85.7%。结论MCI在判断化疗药物对肺癌患者心脏毒性方面的特异性、敏感性较高,为判断化疗患者的早期心肌毒性及指导预后提供较为可靠的参考依据。

Objective To investigate the clinical value of myocardial composite index(MCI)in evaluating the influence of chemotherapeutic agents on left ventricular myocardial systolic function in patients with lung cancer by three-dimensional speckle tracking imaging(3D-STI).Methods A total of 56 patients with lung cancer were included.Conventional echocardiography and 3D-STI derived parameters were measured in the group before chemotherapy,after 3 chemotherapeutic cycles,and after 6 chemotherapeutic cycles.Their left ventricular global area strain(GAS),global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),left ventricular twist(LVtw),MCI were obtained by 3D-STI.The receiver operating characteristics(ROC)curve was constructed to determine optimal sensitivity and specificity for the prediction of future cardiotoxicity.Results Compared to the group“before chemotherapy”and“after 3 chemotherapeutic cycles”,MCI,GAS,GLS,GCS and LVtw were lower in the group“after 6 chemotherapeutic cycles”,with statistical significance(P<0.05).Compared to the group“before chemotherapy”,MCI,GAS,GLS,LVtw were significantly lower in the group“after 3 chemotherapeutic cycles”(P<0.05).The area under ROC curve of MCI was 0.931,and its optimal cut-off value was-244.1(%×°),with a specificity of 91.7%and sensitivity of 85.7%.Conclusion MCI is more sensitive for detection of subclinical left ventricular myocardial systolic dysfunction immediately after chemotherapy.