超声三维斑点追踪成像评价蒽环类药物对乳腺癌化疗患者心脏亚临床损伤的价值

Value evaluation of three-dimensional speckle tracking imaging to cardiac subclinical injury caused by anthracyclines in breast cancer patients with chemotherapy

目的 :探讨超声三维斑点追踪成像(3D-STI)评价蒽环类药物(ATC)对乳腺癌化疗患者心脏亚临床损伤的价值。方法:选择60例乳腺癌化疗患者为研究组,同时选择20例健康女性志愿者为对照组。2组均行心电图、二维超声心动图及3D-STI检查。通过ROC曲线评价3D-STI检测心脏亚临床损伤的价值。结果:2组化疗前后的常规二维参数中仅E/A值差异有统计学意义(P<0.05)。研究组化疗中期及后期的整体面积应变(GAS)、整体纵向应变(GLS)值,较对照组及研究组化疗前、化疗初期均增加(均P<0.05);研究组化疗后期的整体环形应变(GCS)值,较对照组及研究组化疗前、化疗初期均增加(均P<0.05)。绘制ROC曲线可知,GAS和GLS的AUC> 0.7,当GAS截断值为-31.51%时,评价ATC对心脏亚临床损伤的敏感度和特异度分别为87.11%、92.91%;当GLS截断值为-17.48%时,评价的敏感度和特异度分别为65.99%、78.59%。Pearson相关分析显示,GAS与ATC累积剂量的相关性较显著(P<0.01)。结论:乳腺癌化疗过程中GAS检测ATC心脏毒性的敏感度和特异度较高,可通过超声3D-STI评价ATC对乳腺癌化疗患者的心脏亚临床损伤情况。

Objective:To evaluate the value of three-dimensional speckle tracking imaging(3D-STI) to cardiac subclinical injury caused by anthracycline(ATC) in breast cancer patients with chemotherapy. Methods:60 patients with breast cancer treated by chemotherapy were selected as the study group,and 20 healthy female volunteers were selected as the control group. Electrocardiogram,2D echocardiography and 3D-STI were performed in both groups. ROC curve was used to evaluate the value of 3D-STI parameters in the detection of cardiac subclinical injury. Results:Only the E/A value was different between the two groups before and after chemotherapy(P<0.05). The values of GAS and GLS in the middle and late stages of chemotherapy in the study group were increased compared with those in the control group and in the study group before and at the beginning of chemotherapy(P<0.05).The GCS value of the study group at the late stage of chemotherapy was increased compared with that of the control group and the study group before chemotherapy and at the early stage of chemotherapy(P<0.05). ROC curve showed that AUC of GAS and GLS was more than 0.7. When the cut-off value of GAS was-31.51%,the sensitivity and specificity of ATC to cardiac subclinical injury were 87.11% and 92.91%,respectively. When the GLS cut-off value was-17.48%,the sensitivity and specificity were 65.99% and 78.59%,respectively. Pearson correlation analysis showed that the correlation between GAS and ATC cumulative dose was significant(P<0.01). Conclusions:GAS has a high sensitivity and specificity in detecting ATC cardiotoxicity during chemotherapy for breast cancer,so it can be used to evaluate cardiac subclinical injury in patients undergoing chemotherapy for breast cancer by detecting ATC ultrasound 3D-STI.