超声心肌做功评价乳腺癌患者化疗后局部心肌功能的改变

Evaluation of regional myocardial function changes in breast cancer patients after chemotherapy by ultrasonic myocardial work

目的探讨超声心肌做功评价乳腺癌患者化疗后局部心肌功能的改变。方法选取2021年9月至2022年10月于我院肿瘤外科就诊的27例女性乳腺浸润性癌患者作为病例组,同期选取我院体检中心行健康查体的30名女性作为对照组。化疗前(T_(0))、化疗2周期后(T_(1))、化疗4周期后(T_(2))病例组和对照组均接受超声心动图检查。比较两组的二维超声参数、四维左室容积定量分析技术(4D-LVQ)参数、左室整体心肌应变(GLS)参数;分析心肌做功“牛眼图”。结果病例组T_(1)、T_(2)的左室射血分数(LVEF)与T_(0)比较,差异无统计学意义(P>0.05)。病例组T_(2)的整体做功指数(GWI)、整体有用功(GCW)、整体做功效率(GWE)及GLS低于T_(0),整体无用功(GWW)大于T_(0)(P<0.05)。病例组T_(2)的基底段、中间段、心尖段心肌做功指数(MWI-B、MWI-M、MWI-AP)和基底段、中间段、心尖段心肌做功效率(MWE-B、MWE-M、MWE-AP)低于T_(0)(P<0.05)。对照组与病例组T_(0)、T_(1)及T_(2)的MWI和MWE表现为自心底向心尖增大。结论无创心肌做功早于容积变化,心肌做功“牛眼图”可以评价早期乳腺癌患者化疗后局部心肌功能。

Objective To evaluate the changes of regional myocardial function in patients with breast cancer after chemotherapy by ultrasonic myocardial work.Methods From September 2021 to October 2022,27 female patients with invasive breast cancer who were treated in the oncological surgery department of our hospital were selected as case group.At the same time,30 females who underwent physical examination in the physical examination center of our hospital were selected as control group.Echocardiography was performed in the case group before chemotherapy(T_(0)),after 2 cycles of chemotherapy(T_(1)),and after 4 cycles of chemotherapy(T_(2))and the control group.The two-dimensional ultrasound parameters,four-dimensional auto quantification of left ventricular volume(4D-LVQ)parameters and left ventricular global longitudinal strain(GLS)parameters were compared between the two groups;the myocardial work"bull's eye diagram"was analyzed.Results There was no significant difference in left ventricular ejection fraction(LVEF)between T_(1),T_(2) and T_(0) in the case group(P>0.05).The global work index(GWI),global constructive work(GCW),global work efficiency(GWE)and GLS at T_(2) in the case group were lower than those at T_(0),while the global wasted work(GWW)was bigger than that at T_(0)(P<0.05).The basal/middle/apical myocardial work index(MWI-B,MWI-M,MWI-AP)and basal/middle/apical myocardial work efficiency(MWE-B,MWE-M,MWE-AP)at T_(2) in the case group were lower than those at T_(0)(P<0.05).The MWI and MWE of the control group and the case group at T_(0),T_(1) and T_(2) showed an increase from the bottom of the heart to the apex of the heart.Conclusion The noninvasive myocardial work is earlier than the volume change.The"bull's eye diagram"of myocardial work can evaluate the local myocardial function of patients with early breast cancer after chemotherapy.