超声心动图对乳腺癌患者左房功能的评价

Evaluation of left atrial function in patients with breast cancer by echocardiography

目的:应用二维斑点追踪技术(2D-STI)与实时三维成像(RT-3DE)分析乳腺癌患者化疗后左房功能的变化。方法:选取乳腺癌术后化疗患者40例,主要化疗药物为表柔比星(EPI),在化疗前和化疗2、4周期后分别测量常规参数左室收缩末期内径(LVEDs)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)、左房内径(LAD);应用2D-STI测量并计算左房参数舒张早期平均峰值应变率(mSRe)、舒张晚期平均峰值应变率(mSRa)、收缩期平均峰值应变率(mSRs)、舒张早期峰值应变率(sRe)、舒张晚期峰值应变率(sRa)、收缩期峰值应变率(sRs);应用RT-3DE测量并计算左房主动射血分数(LAAEF)、被动射血分数(LAPEF)、整体射血分数(LATEF)、收缩前容积(LAVpre)、最小容积(LAVmin)、最大容积(LAVmax),并分析左房容积参数与应变参数相关性。结果:与化疗前相比较,应变参数中除mSRa在化疗2周期后减低不显著外,其余参数在化疗后均明显减低,差异有统计学意义(P<0.01);容积参数中LAVmax变化无统计学意义,化疗2周期后LAVmin增大,差异有统计学意义(P=0.05),化疗4周期后LAVmin、LAVpre明显增大,LATEF、LAPEF、LAAEF均减小,差异有统计学意义(P<0.01)。结论:2D-STI与RT-3DE可较早反映蒽环类化疗药物对左房功能的损伤。

Objective:Two dimensional speckle tracking imaging(2D-STI)and real-time three-dimensional imaging(RT-3DE)were used to analyze the changes of left atrial function in breast cancer patients after chemotherapy.Methods:40 cases of breast cancer patients with postoperative chemotherapy were selected,epirubicin(EPI)was the main chemotherapy drug,the conventional parameters left ventricular end systolic diameter(LVEDs),left ventricular end diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF)and left atrial diameter(LAD)were measured before chemotherapy and after 2 and 4 cycles of chemotherapy.The mean early diastolic peak strain rate(mSRe)of left atrial parameters,mean late diastolic peak strain rate(mSRa),mean peak systolic strain rate(mSRs),early diastolic peak strain rate(sRe),late diastolic peak diastolic strain rate(sRa),peak systolic strain rate(sRs)were measured and calculated by 2D-STI.The left atrial active ejection fraction(LAAEF),passive ejection fraction(LAPEF),total ejection fraction(LATEF),pre systolic volume(LAVpre),minimum volume(LAVmin),maximum volume(LAVmax)were measured and calculated by RT-3DE,the correlation between the left chamber volume parameter and strain parameter was analyzed.Results:Compared with before chemotherapy,the other parameters were significantly reduced after chemotherapy,except MsrA which was not significantly reduced after 2 cycles of chemotherapy,the difference was statistically significant(P<0.01).In volume parameters,LAVmax had no significant change,after 2 cycles of chemotherapy,LAVmin increased,the difference was statistically significant(P=0.05).After 4 cycles of chemotherapy,LAVmin and LAVpre increased significantly,while LATEF,LAPEF,LAAEF decreased,the difference was statistically significant(P<0.01).Conclusion:2D-STI and RT-3DE can reflect the damage of left atrial function caused by anthracycline chemotherapy earlier.