实时三维斑点追踪成像评价左乳腺癌放疗患者早期左室心肌应变

Real-time three-dimensional speckle tracking imaging on assessment of myocardial strain in left breast cancer patients treated with radiotherapy in early stage

目的:探讨应用实时三维斑点追踪成像技术(RT3D-STI)评价左乳腺癌放疗患者早期左室心肌应变的价值。方法:对37例乳腺癌术后进行左乳腺区放疗的患者进行RT3D-STI检查,获得患者放疗前后三维左心室舒张期容积(LVEDV)、收缩末期容积(LVESV)、左室射血分数(LVEF)、心输出量(CO)、左室球形指数(SpI)等一般参数及左室整体纵向应变(GLS)、左室整体周向应变(GCS)、左室整体面积应变(GAS)、左室整体径向应变(GRS),并比较组间参数的差异性。结果:两组间LVEDV、LVESV、SV、CO、左室舒张末期质量(EDmass)、左室收缩末期质量(ESmass)、SpI差异无统计学意义(P均>0.05),放疗后组LVEF明显降低((59.47±4.47)vs.(63.20±4.86),r=2.48,P<0.05),放疗后组GLS、GCS、GAS、GRS均降低(P<0.05),其中GAS组间差异最为显著。GLS、GCS、GAS与GRS间相关系数分别为r=-0.710、r=-0.645、r=-0.814(P均<0.05),GAS与GRS相关性最好,GLS、GCS、GAS、GRS与LVEF间相关系数分别为r=-0.653、r=-0.627、r=-0.724、r=0.693,GAS与LVEF相关性最好。结论:左乳腺癌放疗早期常规超声检查结果在正常范围时,RT3D-STI可准确提供左室心肌各径向的收缩功能具体参数变化,其中GAS变化更有价值,从而协助临床医生评价放疗早期患者心脏受损情况。

Objective:To explore the value of real-time three-dimensional speckle tracking imaging(RT3D-STI)in the evaluation of left ventricular myocardial strain in left breast cancer patients treated with radiotherapy in early stage.Methods:Totally 37 cases of left breast cancer patients with radiotherapy underwent three dimensional echocardiography.Left ventricular diastolic volume(LVEDV),left ventricular systolic volume(LVESV),left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular sphericity index(SpI),etc,and left ventricular global longitudinal strain(GLS),left ventricular global circumferential strain(GCS),left ventricular area strain(GAS),left ventricular radial strain(GRS)were acquired by RT3D-STI before and after radiotherapy respectively.The differences of parameters between the two groups were compared.Results:There was no significant difference in LVEDV,LVESV,SV,CO,end-diastolic mass(EDmass),end-systolic mass(ESmass),SpI between the two groups(P>0.05),LVEF was significantly reduced((59.47±4.47)vs.(63.20±4.86),r=2.48,P<0.05).GLS,GCS,GAS,GRS were all decreased after radiotherapy(P<0.05),especially GAS.The correlation coefficients of GLS,GCS,GAS and GRS were r=-0.710,r=-0.645,r=-0.814,respectively(P<0.05),GAS was closely related to GRS.The correlation coefficients of GLS,GCS,GAS,GRS and LVEF were r=-0.653,r=-0.627,r=-0.724,r=0.693,respectively.GAS was closely related to LVEF.Conclusion:In the early stage of the radiotherapy of left breast cancer,RT3D-STI can accurately provide the changes of specific parameters of left ventricular systolic function in different directions when the results of general parameters are in the normal range,and the changes of gas parameters are more valuable,so as to assist clinicians to evaluate the heart damage of patients in the early stage of radiotherapy.