二维斑点追踪技术在早期评估乳腺癌病人蒽环类药物化疗导致右室心肌收缩功能减退中的价值

The value of two-dimensional speckle tracking technique in early assessment of right ventricular myocardial systolic dysfunction in patients with breast cancer caused by anthracycline chemotherapy

目的探讨二维斑点追踪技术在早期评估乳腺癌病人蒽环类药物化疗导致右室心肌收缩功能减退中的价值。方法选取2019年1月至2022年1月于安徽医科大学第一附属医院就诊的乳腺癌病人50例,化疗方案以蒽环类药物为主。于化疗前和化疗第2、4、6个周期后进行超声心动图检查,采集聚焦右心室心尖四腔心切面,测量右心室舒张末期内径(RVEDD)、右心室舒张末期面积(RVEDA)、右心室收缩末期面积(RVESA)、右室舒张期末期容积(RVEDV)、右室收缩期末容积(RVESV)、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、右室射血分数(RVEF)、应用二维斑点追踪技术测量右心室整体纵向收缩期峰值应变值(RVGLS)。结果50例病人各化疗阶段RVEDD、RVEDA、RVESA、RVEDV、RVESV比较,差异均无统计学意义(P>0.05)。随着化疗时间的延长,50例病人TAPSE、RVFAC、RVGLS、RVEF均出现不同程度降低,其中RVGLS在化疗第4个周期(−18.50±2.33)%开始明显下降,差异有统计学意义(P<0.05),TAPSE、RVFAC在化疗第6个周期(17.21±2.15)mm、(38.12±4.92)%开始明显下降,差异有统计学意义(P<0.05),RVEF在四个时间点上差异无统计学意义(P>0.05)。结论二维斑点追踪技术测量RVGLS能反映乳腺癌病人化疗过程中右心室心肌收缩功能的变化,与其他参数相比,RVGLS对右心室心肌收缩功能减退更为敏感,为早期评估右心室心肌收缩功能减退提供可靠的量化指标。

Objective To explore the value of two-dimensional speckle tracking technique in early assessment of right ventricular myocardial systolic dysfunction in patients with breast cancer caused by anthracycline chemotherapy.Methods Fifty breast cancer pa⁃tients were treated in The First Affiliated Hospital of Anhui Medical University from January 2019 to January 2022.The chemotherapy regimen based on anthracyclines was used.Echocardiography was performed before chemotherapy and after the second,fourth and sixth chemotherapy cycles to collect the right ventricular apical four-chamber cardiac view,and measure right ventricular end-diastolic diameter(RVEDD),right ventricular end-diastolic area(RVEDA),right ventricular end-systolic area(RVESA),right ventricular end-di⁃astolic volume(RVEDV),right ventricular end-systolic volume(RVESV),tricuspid annular plane systolic excursion(TAPSE),right ven⁃tricular fractional area change(RVFAC),and right ventricular ejection fraction(RVEF).Two-dimensional speckle tracking technique was used to measure right ventricular global longitudinal strain(RVGLS).Results There were no statistically significant differences in RVEDD,RVEDA,RVESA,RVEDV and RVESV among 50 patients at each chemotherapy stage(P>0.05).With the extension of che⁃motherapy,TAPSE,RVFAC,RVGLS and RVEF of 50 patients decreased to different degrees,and RVGLS decreased significantly from the fourth cycle of chemotherapy[(−18.50±2.33)%](P<0.05).TAPSE and RVFAC decreased significantly from the sixth cycle of che⁃motherapy[(17.21±2.15)mm,(38.12±4.92)%](P<0.05).Although RVEF gradually decreased at four time points,the difference was not statistically significant(P>0.05).Conclusions Measurement of RVGLS by two-dimensional speckle tracking technique can reflect the changes of right ventricular myocardial systolic function in breast cancer patients during chemotherapy.Compared with other param⁃eters,RVGLS is more sensitive to right ventricular systolic dysfunction,which can provide a reliable quantitative index for early assess⁃ment of right ventricular systolic dysfunction.