蒽环类药物治疗乳腺癌患者左右心室心肌纵向力学的变化

Changes of longitudinal mechanics of left and right ventricular myocardium in patients with breast cancer treated with anthracyclines

目的探讨三维超声心动图(3DE)及斑点追踪成像技术(STI)评估蒽环类药物对乳腺癌患者心功能影响的价值。方法对2020年7月-2021年11月首诊并术前接受蒽环类化疗的乳腺癌患者38例进行前瞻性研究,对术前乳腺癌患者化疗前、第2次化疗后24 h内、第4次化疗后24 h内、化疗周期结束后进行超声心动图检查,对超声心动图常规参数、3DE及STI获得心功能的各参数进行比较。采用Pearson相关性分析心功能各参数与药物剂量的相关性。结果LVGLS、RVGLS及RVFWLSap与蒽环类药物累积剂量呈负相关性。与化疗前比较,蒽环类药物化疗后各周期LVEF、3D-LVEF、3D-RVEF、LVGLS、RVGLS、RVFWLSbas、RVFWLSmid、RVFWLSap各参数均有减低,其中化疗周期结束后LVEF、3D-LVEF、3D-RVEF、LVGLS、RVFWLSmid、RVFWLSap的差异性具有统计学意义(P<0.05),3D-LVEF出现显著性差异早于LVEF,RVFWLS各节段比RVGLS较早出现显著性差异性。结论乳腺癌患者接受蒽环类化疗后可造成心肌功能损害,3DE及STI可早期为临床提供关于蒽环类化疗药致乳腺癌患者心功能损害的有利证据。

Objective To explore the value of three-dimensional echocardiography(3DE)and speckle tracking imaging(STI)in evaluating the effects of anthracyclines on the cardiac function of breast cancer patients.Methods 38 breast cancer patients who were first diagnosed in Dongguan Hospital and received anthracycline chemotherapy before surgery from July 2020 to November 2021 were prospectively studied.Preoperative breast cancer patients were examined by echocardiography before chemotherapy,within 24 hours after the second chemotherapy,within 24 hours after the fourth chemotherapy,and after the end of the chemotherapy cycle.And all parameters of cardiac function obtained by routine echocardiography,3DE and STI were compared.Pearson correlation analysis was used to analyze the correlation between various parameters of cardiac function and drug dosage.Results Left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS)and RVFWLSap were negatively correlated with the cumulative dose of anthracyclines.Compared with before chemotherapy,left ventricular ejection fraction(LVEF),3D-LVEF,3D right ventricualr ejection fraction(3D-RVEF),LVGLS,RVGLS,RVFWLSbas,RVFWLSmid and RVFWLSap of each cycle after anthracycline chemotherapy were decreased;there were statistically significant differences in LVEF,3D-LVEF,3D-RVEF,LVGLS,RVFWLSmid and RVFWLSap after the end of the chemotherapy cycle(P<0.05);the significant differences observed in 3D-LVEF were earlier than those observed in LVEF;the significant differences in each segment of RVFWLS appeared earlier than those in RVGLS.Conclusion The myocardial function of breast cancer patients after receiving anthracycline chemotherapy can be damaged.3DE and STI can provide early clinical evidence of impairment of cardiac function of breast cancer patients induced by anthracycline chemotherapy.