左室压力-应变环评价不同剂量蒽环类药物对乳腺癌患者左室心肌的做功

Evaluation of left ventricular myocardial work in breast cancer patients treated with different doses of anthracycline by left ventricular pressure-strain loop

目的探讨采用无创性左室压力-应变环(left ventricular pressure-strain loops,LVPSL)技术评价乳腺癌患者在不同剂量蒽环类药物作用时左室心肌做功的变化情况。方法选取拟接受蒽环类药物化疗的新发乳腺癌术后患者36例,健康对照者30例,分别采集并存储左室心尖四腔、三腔、二腔至少(3~5)个心动周期,使用工作站脱机分析图像,获得数据包括左室舒张末期内径(LVDd)、左室收缩末期内径(LVds)、左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)。结果在蒽环类药物累计剂量达240 mg/m^(2)及360 mg/m^(2)时,GLS及GWI较化疗前明显减低,GWW较化疗前升高,差异有统计学意义(P<0.05);随蒽环类药物累计剂量的增加,GLS及GWI呈逐渐减低趋势,GWW呈逐渐升高趋势;相关分析发现:GLS与蒽环类药物剂量累计剂量显著相关(r=0.653),GWI及GWW与蒽环类药物累计剂量低度相关(r=-0.485,r=0.308)(P<0.05)。结论LVPSL的整体做功指数和整体无用功可评价乳腺癌患者蒽环类药物治疗所致的轻微的左心室心肌功能障碍,且有蒽环类药物剂量依赖性。

AIM To evaluate the changes of left ventricular myocardial work in patients with breast cancer treated with different doses of anthracycline by non-invasive left ventricular pressure-strain ring(LVPSL).METHODS Thirty-six postoperative patients with new breast cancer who were going to receive anthracycline chemotherapy and 30 healthy controls were selected.At least 3-5 cardiac cycles of left ventricular apical four-chamber,three-chamber and two-chamber were collected and stored,and the images were analyzed offline by workstation.Left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVds),left ventricular ejection fraction(LVEF),left ventricular endsystolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)were obtained.RESULTS When the cumulative dose of anthracyclines reached 240 mg/m^(2) and 360 mg/m^(2),GLS and GWI were significantly lower than those before chemotherapy,while GWW was higher than that before chemotherapy.With the increase of the cumulative dose of anthracyclines,GLS and GWI decreased gradually,while GWW increased gradually.Correlation analysis showed that GLS was highly correlated with the cumulative dose of anthracycline(r=0.653)(P<0.05),while GWI and GWW were lowly correlated with the cumulative dose of anthracycline(r=-0.485,r=0.308)(P<0.05).CONCLUSION The global work index and global useless work of LVPSL can be used to evaluate the mild left ventricular myocardial dysfunction caused by anthracycline therapy in breast cancer patients and it is dose-dependent.