实时三维斑点追踪成像对乳腺癌化疗患者心脏毒性的早期预测价值分析

The value of RT3D-STI in early prediction of chemotherapy-induced cardiotoxicity in breast cancer patients

目的:探讨实时三维斑点追踪成像(RT3D-STI)对乳腺癌化疗患者心脏毒性的预测价值。方法:选取2016年1月—2019年4月本院住院并拟行术后化疗的120例乳腺癌术后患者作为研究组,所有患者均采取6个周期的AC化疗。从同期于本院进行体检的健康女性中随机选取120例作为对照组。研究组患者于化疗前、化疗3个周期后和化疗6个周期后的48 h内进行常规超声心动图及RT3D-STI监测。对照组均于签署知情同意书后接受常规超声心动图及RT3D-STI监测。比较对照组和研究组化疗前、化疗3个周期和6个周期的48 h内的超声心动图及RT3D-STI检查结果。Pearson相关法分析常规超声、RT3DSTI与药物剂量的相关性,绘制RT3D-STI预测蒽环类化疗患者心脏毒性的ROC曲线。结果:研究组化疗6个周期的Em、Em/Am低于化疗前、化疗3个周期和对照组(P<0.05)。对照组和研究组患者不同时间点的GRS、GCS、3D-LVEF的差异无统计学意义(P>0.05)。研究组患者化疗3个周期的GAS、GLS、LVtw、MCI低于化疗前、对照组(P<0.05);研究组化疗6个周期的GAS、GLS、LVtw、MCI低于化疗前、化疗3个周期、对照组(P<0.05)。Em和Em/Am与药物剂量无明显相关(P>0.05),GAS、GLS、LVtw、MCI与药物剂量呈负相关(P<0.05)。120例患者随访期间共22例(18.33%)患者出现心脏毒性。根据患者1年随访结果(出现心脏毒性=1、未出现心脏毒性=0)绘制RT3D-STI参数预测乳腺癌化疗患者心脏毒性的ROC曲线,结果显示MCI预测心脏毒性的ROC曲线下面积为0.864(95%CI:0.773~0.971),当截断值为-197.28时,敏感度和特异度分别为0.859、0.781;LVtw为0.842(95%CI:0.723~0.962),当截断值为10.87时,敏感度和特异度分别为0.828、0.797;GAS的ROC曲线下面积为0.804(95%CI:0.670~0.938),当截断值为-32.62时,敏感度和特异度分别为0.781、0.844;GLS的ROC曲线下面积为0.722(95%CI:0.562~0.883),当截断值为-16.76时,敏感度和特异度分别为0.734、0.875。结论:乳腺癌患者化疗期间积极检测RT3D-STI参数可早期预测蒽环类药物所致心脏毒性的发生风险,且是无创性检查,重复性高。

Objective:To explore the predictive value of real-time three-dimensional speckle tracking imaging(RT3D-STI)for chemotherapy-induced cardiotoxicity in breast cancer patients.Methods:One hundred and twenty postoperative breast cancer patients who were hospitalized in our hospital from January 2016 to April 2019 and planned to undergo postoperative chemotherapy were selected as the study group.All patients received 6 cycles of AC chemotherapy.One hundred and twenty healthy women who underwent physical examination in our hospital during the same period were randomly selected as the control group.Patients in the study group were monitored by routine echocardiography and RT3D-STI before chemotherapy,after 3 cycles of chemotherapy,and within 48 hours after 6 cycles of chemotherapy.The control group received routine echocardiography and RT3D-STI monitoring after signing the informed consent.The results of echocardiography and RT3D-STI were compared between the control group and the study group before chemotherapy,3 cycles of chemotherapy and within 48 hours of 6 cycles.Pearson correlation method was used to analyze the correlation between conventional ultrasound,RT3D-STI and drug dose,and draw the ROC curve of RT3D-STI to predict the cardiotoxicity of patients with anthracycline chemotherapy.Results:The Em and Em/Am of the 6 cycles of chemotherapy in the study group were lower than those before chemotherapy,3 cycles of chemotherapy and the control group(P<0.05).There was no significant difference in GRS,GCS and 3D-LVEF between the control group and the study group at different time points(P>0.05).The GAS,GLS,LVtw,and MCI of the study group for 3 cycles of chemotherapy were lower than those before chemotherapy and the control group(P<0.05),the GAS,GLS,LVtw,and MCI of the study group for 6 cycles of chemotherapy were lower than those before chemotherapy and 3 cycles of chemotherapy,control group(P<0.05).Em and Em/Am were not significantly correlated with drug dose(P>0.05),and GAS,GLS,LVtw,MCI were negatively correlated with drug dose(P<0.05).During the follow-up period,22 patients(18.33%)had cardiotoxicity.According to the patient’s 1-year follow-up results(cardiotoxicity=1,no cardiotoxicity=0),the ROC curve of RT3D-STI parameters for predicting chemotherapy-induced cardiotoxicity in breast cancer patients was drawn.The results showed that the area under the ROC curve of MCI for predicting cardiotoxicity was 0.864(95%CI:0.773~0.971),when the cut-off value was-197.28,the sensitivity and specificity were 0.859 and 0.781 respectively,LVtw was 0.842(95%CI:0.723~0.962),when the cut-off value was 10.87,the sensitivity and specificity were 0.828 and 0.797 respectively,the area under the ROC curve of GAS was 0.804(95%CI:0.670~0.938),when the cutoff value was-32.62,the sensitivity and specificity were 0.781 and 0.844 respectively,the area under the ROC curve of GLS was 0.722(95%CI:0.562~0.883).When the cut-off value was-16.76,the sensitivity and specificity were 0.734 and 0.875.Conclusion:Active detection of RT3D-STI parameters in breast cancer patients during chemotherapy can early predict the risk of cardiotoxicity caused by anthracyclines,and it is a non-invasive examination with high repeatability.