Evaluation of ventricular function changes before and after anthracycline treatment in patients with breast cancer by three-dimensional speckle tracking echocardiography
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摘要:
目的探讨三维斑点追踪技术（3D-STE）评价乳腺癌患者蒽环类药物治疗前后心室功能改变。 方法应用常规超声心动图、二维斑点追踪技术（2D-STE）、3D-STE分别在蒽环类药物化疗前24 h、化疗第2周期及化疗第4周期结束24 h内进行左心室功能检测，对各参数在这3个时间点进行纵向对比，分析其与蒽环类药物累积剂量的相关性，以及对检测蒽环类药物心脏毒性所致心脏功能早期损害的敏感性。 结果3D-STE的左室整体面积应变（3D-GAS）、整体长轴应变（3D-GLS）在化疗第2周期与化疗第4周期结束24 h内均低于化疗前24 h（P<0.05）；左室整体圆周应变（3D-GCS）在化疗第4周期结束24 h内低于化疗前24 h（P<0.05）；而左室整体径向应变（3D-GRS）于整个化疗过程中无明显改变（P>0.05）；在检测左心室功能早期损害方面，3D-GAS的敏感性为81.23%，特异性为81.98%；3D-GLS的敏感性为62.15%，特异性为65.02%；3D-GCS的敏感性为66.09%，特异性为55.08%；3D-GAS、3D-GLS、3D-GCS与蒽环类药物累积剂量成负相关（P<0.05）。 结论3D-STE评价乳腺癌患者蒽环类药物治疗前后心室功能改变值得在临床影像学诊断中推广使用，是监测蒽环类药物所致心脏功能损害的一种敏感、可靠的影像学手段。 Abstract:ObjectiveTo explore three-dimensional speckle tracking echocardiography (3D-STE) in evaluating the ventricular function changes in breast cancer patients before and after the administration of anthracyclines. MethodsRoutine echocardiography, two-dimensional speckle tracking echocardiography (2D-STE) and 3D-STE were separately applied to test the left ventricular function 24 h before, within 24 h of the end of the 2nd and the 4th cycle of anthracycline chemotherapy. The parameters obtained at these 3 time points were compared longitudinally. The correlation with the cumulative dose of anthracyclines was analyzed. Their sensitivity to the detection of early heart impairment caused by cardiotoxicity of anthracycline was analyzed. ResultsThe left ventricular global area strain (3D-GAS) and the global longitudinal strain (3D-GLS) within 24 h after the end of the 2nd and 4th cycle of chemotherapy were lower than those before chemotherapy (P<0.05). The left ventricular global circumferential strain (3D-GCS) within 24 h after the end of the 4th cycle of chemotherapy was lower than that before 24 h of chemotherapy (P<0.05). The change in global radial strain (3D-GRS) during the whole chemotherapy process was not significant (P>0.05). The sensitivity and specificity for 3D-GAS were 81.23% and 81.98%, respectively; 62.15% and 65.02% for 3D-GLS, respectively; 66.09% and 55.08% for 3D-GCS, respectively. 3D-GAS, 3D-GLS, 3D-GCS were negatively correlated with the cumulative dose of anthracyclines(P<0.05). Conclusion3D-STE for evaluating ventricular function changes in breast cancer patients before and after using anthracyclines is worth popularizing in clinical imaging diagnosis. It is a sensitive and reliable imaging method for monitoring the heart impairment caused by anthracyclines. -
Key words:
- three-dimensional spot tracking /
- breast cancer /
- anthracyclines /
- ventricular function
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表 1 化疗前24 h、化疗第2周期及化疗第4周期结束24 h内常规超声心动图参数变化比较（Mean±SD）
化疗时期 IVSd（mm） LVDd（mm） LVPWd（mm） LVEF（%） E/A 化疗前24 h 8.83±0.69 46.04±1.97 8.39±0.72 64.09±3.98 1.22±0.19 化疗第2周期结束24 h内 8.38±0.67 45.32±1.55 8.32±0.89 62.24±2.89 1.16±0.23 化疗第4周期结束24 h内 8.98±0.91 46.23±1.93 8.46±0.63 61.74±2.26 1.19±0.28 IVSd：室间隔舒张末期厚度；LVDd：左室舒张末期内径；LVPWd：左室后壁舒张末期厚度；LVEF：左室射血分数 
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表 2 化疗前24 h、化疗第2周期及化疗第4周期结束24 h内3D-STE与2D-STE各应变参数比较（Mean±SD）
化疗时期 3D-GAS 3D-GLS 3D-GCS 3D-GRS 2D-GLS 化疗前24 h −34.19±2.47 −18.43±2.48 −18.45±2.67 −34.18±4.54 −20.34±2.07 化疗第2周期结束24 h内 −29.13±2.09* −16.39±1.90* −17.29±3.79 −33.21±4.93 −20.19±1.67 化疗第4周期结束24 h内 −24.89±2.41* −15.29±1.91* −15.79±3.65* −32.06±5.09 −18.88±1.25* *P<0.05 vs化疗前24 h
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