超声心动图斑点追踪技术在蒽环类化疗药物所致心脏毒性反应早期监测中的应用分析

Application analysis of echocardiographic spot tracking technology in early monitoring of cardiotoxic reactions induced by anthracycline chemotherapy drugs

目的研究超声心动图斑点追踪技术在早期监测蒽环类化疗药物所致心脏毒性反应中的应用效果。方法回顾性选取2022年1月至2023年1月沧州市人民医院收治的100例乳腺癌患者,所有患者于蒽环类化疗药物治疗4个周期之后均接受12导联心电图检查,参考检查结果分为A组(心电图异常,n=50)与B组(心电图正常,n=50);同时,选取同一时期入院体检的50名健康女性为C组。三组均接受超声心动图检查,生物力学参数予以二维斑点追踪成像测定。比较三组常规超声心动图相关参数[左心房内径(LAD)、左心室内径(LVD)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)、A峰值流速、二尖瓣口舒张期E、E/A比值,左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)]与二维斑点追踪成像技术相关参数[基底段平面纵向心肌应变(bLS)、中间段平面纵向心肌应变(mLS)、心尖段平面纵向心肌应变(aLS)、整体全层纵向应变(GLS)、达峰时间离散度(PSD)、整体全层径向应变(GRS)、整体全层圆周应变(GCS)、心尖部旋转角度峰值(AP-Prot)、心底部旋转角度峰值(MV-Prot)、左心室整体扭转角度峰值(LV-Ptw)]。结果三组LAD、LVD、IVS、LVPW、LVEF比较,差异均无统计学意义(P>0.05);A组E/A比值为0.91±0.21,明显低于B组(1.31±0.22)、C组(1.33±0.24),LVEDV为(104.25±12.86)mL,明显高于B组[(88.87±11.46)mL]、C组[(88.59±11.13)mL],差异均有统计学意义(P<0.05)。A组bLS、mLS、aLS、GLS、GRS、GCS、AP-Prot、LV-Ptw分别为-8.59±2.12、-10.36±2.33、-9.28±2.20、-9.52±2.09、15.58±4.61、-13.29±3.32、(4.28±0.99)°、(9.19±1.62)°,均明显低于B组[-16.23±2.38、-15.22±2.49、-16.41±2.22、-15.92±2.57、21.63±6.78、-18.39±3.12、(7.58±2.31)°、(13.71±2.14)°]、C组[-21.79±3.45、-18.37±2.41、-19.98±4.11、-20.01±4.12、25.17±6.59、-19.17±5.96、(9.19±2.43)°、(16.12±2.31)°],PSD为(66.89±15.67)ms,明显高于B组[(46.63±13.09)ms]、C组[(29.82±6.86)ms],B组bLS、mLS、aLS、GLS、GRS、AP-Prot、LV-Ptw均明显低于C组,PSD明显高于C组,差异均有统计学意义(P<0.05)。结论超声心动图斑点追踪技术于早期监测蒽环类化疗药物所致心脏毒性反应中具有显著效果,观察左心室纵向心肌活动可对早期心脏收缩功能异常予以评估。

Objective To study the effect of spot tracking echocardiography in early detection of cardiotoxicity caused by anthracyclines.Methods A total of 100 breast cancer patients admitted to Cangzhou People's Hospital from January 2022 to January 2023 were retrospectively selected.All patients received 12-lead electrocardiogram(ECG)after 4 cycles of anthracycline chemotherapy treatment.According to the examination results,they were divided into group A(abnormal ECG,n=50)and group B(normal ECG,n=50).At the same time,50 healthy women admitted to hospital for physical examination during the same period were selected as group C.The three groups were examined by echocardiography,and the biomechanical parameters were determined by two-dimensional spot tracking imaging.The conventional echocardiography related parameters[left atrial diameter(LAD),left ventricular diameter(LVD),interventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),A-peak flow velocity,mitral diastolic E,E/A ratio,left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV)]and two-dimensional speckle tracking imaging technology related parameters[basal segment longitudinal strain(bLS),middle segment longitudinal strain(mLS),apical segmentlongitudinal strain(aLS),global longitudinal strain(GLS),peak strain dispersion(PSD),and global radial strain(GRS),global circumferential strain(GCS),peak rotation of apex(AP-Prot),peak rotation of MV-plane(MV-Prot),and left ventricular peak twist(LV-Ptw)]were compared in the three groups.Results There were no statistically significant difference in LAD,LVD,IVS,LVPW,and LVEF among the three groups(P>0.05);the E/A ratio of group A was 0.91±0.21,which was significantly lower than that of group B(1.31±0.22)and group C(1.33±0.24),and the LVEDV of group A was(104.25±12.86)mL,which was significantly higher than that of group B[(88.87±11.46)mL]and group C[(88.59±11.13)mL],the differences were statistically significant(P<0.05).The AP-Prot,LV-Ptw,GCS,GRS,bLS,mLS,aLS,and GLS of group A were-8.59±2.12,-10.36±2.33,-9.28±2.20,-9.52±2.09,15.58±4.61,-13.29±3.32,(4.28±0.99)°,(9.19±1.62)°,which were significantly lower than those of group B[-16.23±2.38,-15.22±2.49,-16.41±2.22,-15.92±2.57,21.63±6.78,-18.39±3.12,(7.58±2.31)°,(13.71±2.14)°]and group C[-21.79±3.45、-18.37±2.41,-19.98±4.11,-20.01±4.12,25.17±6.59,-19.17±5.96,(9.19±2.43)°,(16.12±2.31)°],while PSD of group A was(66.89±15.67)ms,which was significantly higher than that of group B[(46.63±13.09)ms]and group C[(29.82±6.86)ms],the bLS,mLS,aLS,GLS,GRS,AP-Prot and LV-Ptw of group B were significantly lower than those of group C,while PSD of group B was significantly higher than that of group C,the differences were statistically significant(P<0.05).Conclusion Echocardiographic spot tracking technology is effective in the early detection of cardiotoxicity induced by anthracyclines,and the longitudinal myocardial activity of the left ventricle can be used to evaluate the early cardiac systolic dysfunction.