3D-STI对乳腺癌术后TRA治疗患者早期心肌毒性的效能评价

Assessment of efficiency of 3D-STI technology on early myocardial toxicity in patients with TRA treatment after breast cancer surgery

目的探讨三维斑点追踪成像(3D-STI)技术对乳腺癌术后曲妥珠单抗(TRA)治疗相关早期心肌毒性的效能。方法回顾性研究选择2020年1月至2022年12月该院接受TRA治疗并维持治疗的120例乳腺癌术后患者,分别在化疗前及化疗2、4、6个周期后进行常规超声和3D-STI技术检测。随访至2023年10月,以是否出现心肌毒性为临床结局分为心肌毒性组和无心肌毒性组。结合基线资料,使用单因素和多因素logistic回归分析确定心肌毒性的影响因素,应用受试者工作特征(ROC)曲线评估不同时间的3D-STI参数对心肌毒性的预测价值。结果化疗前和化疗2个周期后心肌毒性组和无心肌毒性组整体纵向应变(GLS)、整体面积应变(GAS)、整体径向应变(GRS)、整体圆周应变(GCS)等3D-STI技术参数差异无统计学意义(P>0.05);化疗4个周期后和化疗6个周期后心肌毒性组GLS、GAS和GCS低于无心肌毒性组(P<0.05)。logistic回归分析结果显示,化疗4个周期后GLS(OR=0.542,95%CI:0.424~0.694)、GAS(OR=0.580,95%CI:0.360~0.936)和GCS(OR=1.699,95%CI:1.035~2.790)与化疗6个周期后GLS(OR=0.534,95%CI:0.440~0.648)、GAS(OR=0.559,95%CI:0.347~0.901)和GCS(OR=1.613,95%CI:1.131~2.300)是乳腺癌术后TRA治疗心肌毒性的影响因素(P<0.05)。ROC曲线结果显示,化疗4个周期后GLS诊断临界值为-17.23%,AUC为0.645(95%CI:0.541~0.749);GCS诊断临界值为-19.22%,AUC为0.556(95%CI:0.444~0.668)。化疗6个周期后GLS诊断临界值为-17.82%,AUC为0.856(95%CI:0.786~0.927);GAS诊断临界值为-27.17%,AUC为0.994(95%CI:0.983~<1.000);GCS诊断临界值为-18.38%,AUC为0.842(95%CI:0.771~0.913)。结论化疗4、6个周期后3D-STI参数可预测乳腺癌术后TRA治疗后的心肌毒性。

Objective To study the efficiency of 3D-STI technology on trastuzumab(TRA)treatment related early myocardial toxicity.Methods In a retrospective study,120 breast cancer postoperative patients receiving TRA treatment and maintenance therapy in this hospital from January 2020 to December 2022 were selected and conducted the routine ultrasound and 3D-STI technological examinations before chemotherapy,in 2,4,6 cycles of chemotherapy.Follow-up continued until October 2023.The patients were divided into the myocardial toxicity group and non-myocardial toxicity group according to whether or not developing myocardial toxicity.By combining with the baseline data,the univariate and multivariate logistic regression were employed to analyze and determine the influencing factors of myocardial toxicity.The predictive value of 3D-STI parameters at different time points for myocardial toxicity was evaluated by using the receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in 3D-STI technical parameters such as GLS,GAS,GCS and GRS before chemotherapy and in 2 cycles of chemotherapy between the myocardial toxicity group and the non-myocardial toxicity group(P>0.05);GLS,GAS and GRS after 4,6 cycles of chemotherapy in the myocardial toxicity group were lower than those in the non-myocardial toxicity group(P<0.05).The logistic regression analysis results showed that GLS(OR=0.542,95%CI:0.424-0.694),GAS(OR=0.580,95%CI:0.360-0.936)and GCS(OR=1.699,95%CI:1.035-2.790)after 4 cycles of chemotherapy,and GLS(OR=0.534,95%CI:0.440-0.648),GAS(OR=0.559,95%CI:0.347-0.901)and GCS(OR=1.613,95%CI:1.131-2.300)after 6 cycles of chemotherapy were the influencing factors of myocardial toxicity in TRA treatment after breast cancer surgery(P<0.05).The results of the ROC curve showed that after 4 cycles of chemotherapy,the diagnostic critical value of GLS was-17.23%and the area under the curve(AUC)was 0.645(95%CI:0.541-0.749);the diagnostic critical value of GCS was-19.22%and AUC was 0.556(95%CI:0.444-0.668).The GLS diagnostic critical value after 6 cycles of chemotherapy was-17.82%,and AUC was 0.856(95%CI:0.786-0.927);the GAS diagnostic critical value was-27.17%,and AUC was 0.994(95%CI:0.983-<1.000);the diagnostic critical value of GCS was-18.38%,and AUC was 0.842(95%CI:0.771-0.913).Conclusion The 3D-STI parameters in 4,6 cycles of chemotherapy could predict the myocardial toxicity after TRA treatment after breast cancer surgery.