2D-STI联合3D-HM在蒽环类药物对乳腺癌患者左心室功能损害评估中的应用

Application of two-dimensional speckle tracking imaging combined with threedimensional echocardiography HeartModel in evaluating anthracycline induced damage to left ventricular function in breast cancer patients

目的探究二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)联合三维超声心动图全自动左心定量(three-dimensional echocardiography HeartModel,3D-HM)技术在蒽环类药物(anthracycline,ATC)对乳腺癌患者左心室功能损害评估中的应用价值。方法选取2021年3月至2022年6月于金华市人民医院接受化疗的乳腺癌患者55例,根据化疗第4周期内心电图情况将患者分为心电图正常组(n=19)和心电图异常组(n=36)。分别于化疗前(T0)、化疗第2周期(T1)及第4周期(T2)采用常规超声心动图获取左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左室收缩末期容积(left ventricular end-systolic volume,LVESV)等参数;2D-STI技术获取左室整体纵向应变(global longitudinal strain,GLS)参数,3D-HM技术获取3D-LVEF、3D-LVEDV、3D-LVESV等三维参数。结果T2时,两组患者LVEF水平较T0、T1时均显著下降(P<0.05);两组患者T0、T1、T2时的LVEF、LVEDV、LVESV参数比较,差异均无统计学意义(P>0.05);T0、T1时,两组患者的GLS水平比较,差异均无统计学意义(P>0.05);T2时,两组患者GLS水平较T0、T1时均显著下降(P<0.05),且心电图异常组患者GLS水平显著低于心电图正常组(P<0.05);T0、T1时,两组患者的3D-LVEF水平比较,差异均无统计学意义(P>0.05);T2时,两组患者3D-LVEF水平较T0、T1时显著下降(P<0.05),且心电图异常组患者3D-LVEF水平低于心电图正常组(P<0.05)。两组患者T0、T1、T2时的3D-LVEDV、3D-LVESV参数比较,差异均无统计学意义(P>0.05)。受试者操作特征曲线分析结果显示,GLS、3D-LVEF及其联合检测评估心电图异常患者左心室功能改变的曲线下面积分别为0.767、0.739和0.788(P<0.05)。结论乳腺癌ATC化疗患者无论心电图是否存在异常,均出现左心室功能受损,且心电图异常患者左心室功能受损更明显,2D-STI、3D-HM技术可敏感识别患者左心室功能的改变,二者联合可提高对心电图异常患者左心室功能损伤的预测价值。

Objective To investigate the application value of two-dimensional speckle tracking imaging(2D-STI)combined with three-dimensional echocardiography HeartModel(3D-HM)in evaluating anthracycline(ATC)induced damage to left ventricular function in breast cancer patients.Methods A total of 55 breast cancer patients who received chemotherapy at Jinhua People's Hospital from March 2021 to June 2022 were selected and divided into normal electrocardiogram group(n=19)and abnormal electrocardiogram group(n=36)according to the electrocardiogram in the 4th cycle of chemotherapy.Parameters such as left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were measured by conventional echocardiography.Left ventricular global longitudinal strain(GLS)was measured by 2D-STI.3D-LVEF,3D-LVEDV and 3D-LVESV were measured by 3D-HM.Results At T2,the level of LVEF decreased significantly in both groups compared with that at T0 and T1(P<0.05);the differences in LVEF,LVEDV and LVESV parameters at T0,T1 and T2 in both groups were not statistically significant(P>0.05);at T0 and T1,the differences in GLS levels in both groups were not statistically significant(P>0.05);at T2,the GLS levels of patients in both groups decreased significantly compared with those at T0 and T1(P<0.05),and the GLS levels of patients in the abnormal ECG group were significantly lower than those in the normal ECG group(P<0.05);at T0 and T1,there was no statistically significant difference between the 3D-LVEF levels of patients in both groups(P>0.05);at T2,the 3D-LVEF levels of patients in both groups decreased significantly compared with those at T0 and T1(P<0.05),and the 3D-LVEF levels of patients in the abnormal ECG group were lower than those in the normal ECG group(P<0.05).The differences in 3D-LVEDV and 3D-LVESV parameters at T0,T1 and T2 between the two groups were not statistically significant(P>0.05).Receiver operator characteristic curve analysis showed that area under the curve of GLS,3D-LVEF alone and in combination to evaluate changes of left ventricular function in patients with abnormal electrocardiogram were 0.767,0.739 and 0.788,respectively(P<0.05).Conclusion Breast cancer patients undergoing ATC-based chemotherapy have impaired left ventricular function regardless of whether the electrocardiogram is abnormal or not,and impaired left ventricular function is more obvious in patients with abnormal electrocardiogram.2D-STI and 3D-HM can sensitively identify the changes of left ventricular function.Combination of the two can improve the prediction of impaired left ventricular function in patients with abnormal electrocardiogram.