Evaluation of early cardiotoxicity in patients with anthracycline chemotherapy by left ventricular torsion function combined with Hs-cTnT
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摘要:
目的 应用三维斑点追踪成像技术获取左室扭转运动相关参数联合血清高敏肌钙蛋白(Hs-cTnT)，评估乳腺癌术后蒽环类化疗药物早期心肌毒性的发生。 方法 82例蒽行环类药物化疗的乳腺癌术后患者，于化疗前(Ⅰ组)、化疗2周期(Ⅱ组)、化疗4周期(Ⅲ组)、化疗6周期(Ⅳ组)获取Hs-cTnT、左室扭转运动参数及常规三维参数，比较各参数对于评价早期心肌毒性的敏感度，分析左室扭转运动与Hs-cTnT的相关性。 结果 4组左室扭转运动参数(左室扭转角度峰值、左室扭矩)依次减低(P < 0.05)。左室扭转角度峰值及左室扭矩的曲线下面积分别为0.954、0.912，且具有高特异性和高敏感度。各组血清Hs-cTnT测值小于正常值，但随药物剂量累计而升高(P < 0.05)；Pearson相关性分析表明，化疗周期中左室扭转运动参数与血清Hs-cTnT浓度呈负相关关系(左室扭转角度峰值：r=-0.467，P < 0.001；左室扭矩：r=-0.419，P < 0.001)。 结论 左室扭转运动能够早期监测左室心肌功能的改变，评估蒽环类化疗药物致乳腺癌术后患者的心肌损伤。 -
关键词:
- 蒽环类 /
- 三维斑点追踪成像技术 /
- 左室扭转 /
- 血清高敏肌钙蛋白
Abstract:Objective To evaluate the changes of left ventricular torsion in patients with breast cancer after anthracycline chemotherapy by three-dimensional speckle tracking imaging, and detect the occurrence of early cardiotoxicity, and explore the correlation between left ventricular torsion and high sensitive cardiac troponin T (Hs-cTnT). Methods A total of 82 patients with breast cancer after anthracycline chemotherapy were selected. The parameters of left ventricular torsion and strain function were measured at four time points: before chemotherapy (Ⅰ), after receiving two cycles (Ⅱ), four cycles (Ⅲ) and six cycles (Ⅳ). The sensitivity of each parameter to evaluate early cardiotoxicity was compared. then correlation analysis was conducted between Hs-cTnT concentration and left ventricular torsion. Results Comparing the four groups, left ventricular torsion parameters (Ptw, Tor) decreased (P < 0.05). The areas under ROC curve of Ptw and Tor were 0.954 and 0.912, they are both with high specificity and sensitivity. After six cycles chemotherapy, the Hs-cTnT was lower than the normal, however, it increased with the dose accumulation of drug during the chemotherapy (P < 0.05). Pearson correlation analysis showed that there was a significant negative correlation between the left ventricular torsion and Hs-cTnT concentration in different chemotherapy stages (Ptw: r=-0.467, P < 0.001; Tor: r=-0.419, P < 0.001). Conclusion Left ventricular torsion can be used as sensitive parameters to evaluate the early cardiotoxicity induced by anthracycline chemotherapy after breast cancer. -
图 1 患者牛眼图及应变曲线
A~B：患者化疗前、2周期左室扭转角度峰值牛眼图及应变曲线；C~D：患者化疗前、2周期左室扭矩牛眼图及应变曲线.
Figure 1. Bull's eye diagram and strain curves of a patient.
表 1 各组常规参数的比较
Table 1. Comparison of routine parameters in each group (Mean±SD)
参数 蒽环类抗肿瘤药物分组 F P Ⅰ组 Ⅱ组 Ⅲ组 Ⅳ组 LVIDd(mm) 43.94±4.22 44.55±3.78 43.66±3.73 43.46±3.09 2.78 0.99 IVSd(mm) 8.22±1.87 8.30±1.24 8.95±1.95 8.63±1.34 0.77 0.92 LVPWd(mm) 8.69±1.87 8.52±1.46 7.65±1.52 7.85±1.89 1.56 0.77 EF(%) 67.70±6.80 67.89±6.78 66.74±6.77 66.39±6.09 1.23 0.56 FS(%) 38.78±3.87 37.98±3.50 38.72±3.36 37.91±3.70 1.81 0.39 EDV(mL) 85.50±8.83 84.80±8.91 84.26±9.82 83.18±8.80 0.43 0.73 ESV(mL) 30.38±6.10 29.73±6.35 29.27±6.89 29.29±5.04 0.68 0.10 LVIDd：左室舒张末期内径；IVSd：室间隔舒张末期厚度；LVPWd：左室后壁舒张末期厚度；EF：左心室射血分数；FS：左室短轴缩短率；EDV：舒张末期容积；ESV：收缩末期容积. Ⅰ组：化疗前；Ⅱ组：化疗2周期；Ⅲ组：化疗4周期；Ⅳ组：化疗6周期. 
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表 2 各组3D-STI参数及Hs-cTnT的比较
Table 2. Comparison of 3D-STI parameters and Hs-cTnT in each group (Mean±SD)
参数 蒽环类抗肿瘤药物分组 F P Ⅰ组 Ⅱ组 Ⅲ组 Ⅳ组 Ptw(°) 13.29±1.89 10.45±1.74* 8.12±1.67# 6.56±1.69 & 125.71 < 0.01 Tor(°/cm) 1.64±0.29 1.31±0.25* 1.09±0.29# 0.84±0.28 & 80.44 < 0.01 GAS -34.24±2.27 -32.45土2.86* -30.69±2.52# -28.47±2.80 & 45.04 < 0.01 GLS -18.23±3.33 -17.45±2.30 -15.67±2.31* -14.56±2.21# 22.35 < 0.01 GRS 47.16±2.67 46.45±3.44 45.56±3.73 44.53土3.47* 3.71 < 0.05 GCS -19.22±2.56 -18.75±2.77 -18.56±2.55 -18.67±2.54 1.46 0.31 Hs-cTnT (pg/mL) 2.05±1.25 5.65±1.94 8.44±2.56 9.56±2.43 141.46 < 0.01 *P < 0.05 vs Ⅰ组；#P < 0.05 vs Ⅱ组； &P < 0.05 vs Ⅲ组. Ptw：左室扭转角度峰值；Tor：左室扭矩；GAS：面积应变；GLS：纵向应变；GRS：径向应变；GCS：圆周应变；Hs-cTnT：血清高敏肌钙蛋白.
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表 3 3D-STI参数ROC分析结果
Table 3. ROC analysis result of 3D-STI parameters
参数 曲线下面积 95%CI 敏感度(%) 特异性(%) 截断值(%) 约登指数 Ptw(°) 0.954 0.915 ~0.962 90.6 86.6 11.25 0.749 Tor(°/cm) 0.912 0.856~0.944 85.3 84.5 1.33 0.675 GAS(%) 0.822 0.764~0.881 88.2 63.4 -31.5 0.516 GLS(%) 0.701 0.690~0.799 51.4 81.6 -18.8 0.343 GRS(%) 0.650 0.554~0.713 67.3 54.3 45.9 0.271 GCS(%) 0.582 0.467~0.677 29.6 78.4 -21.5 0.111 LVEF(%) 0.569 0.491~0.664 68.9 48.4 60.4 0.149
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[1] Nicolazzi MA, Carnicelli A, Fuorlo M, et al. Anthracycline and trastuzumab-induced cardiotoxicity in breast cancer[J]. Eur Rev Med Pharmacol Sci, 2018, 22(7): 2175-85. [2] 彭韵朴, 周珏珉. 蒽环类药物所致心脏毒性的研究进展[J]. 海南医学, 2021, 32(19): 2550-4. doi: 10.3969/j.issn.1003-6350.2021.19.027 [3] 高朗, 林艺霞, 钱明竹, 等. 三维超声斑点追踪成像技术在心力衰竭患者中的应用进展[J]. 中华超声影像学杂志, 2021, 30(10): 912-6. doi: 10.3760/cma.j.cn131148-20210408-00248 [4] 陈天琪, 付淑萍, 阮海东, 等. 三维斑点追踪成像技术联合心肌做功评价蒽环类药物对乳腺癌患者左室功能的影响[J]. 中国超声医学杂志, 2021, 37(5): 539-42. doi: 10.3969/j.issn.1002-0101.2021.05.020 [5] 王宝震, 张越, 郝晓一, 等. 二维与三维超声心动图斑点追踪技术检测乳腺癌蒽环类药物心脏毒性的可行性研究[J]. 现代肿瘤医学, 2022, 30(5): 829-34. doi: 10.3969/j.issn.1672-4992.2022.05.015 [6] Cardinale D, Iacopo F, Cipolla CM. Cardiotoxicity of anthracyclines [J]. Front Cardiovasc Med, 2020, 7: 26. doi: 10.3389/fcvm.2020.00026 [7] Bhagat A, Kleinerman ES. Anthracycline-induced cardiotoxicity: causes, mechanisms, and prevention[J]. Adv Exp Med Biol, 2020, 1257: 181-92. [8] Bernstein D. Response by Bernstein to letter regarding article, anthracycline cardiotoxicity: worrisome enough to have You quaking?[J]. Circ Res, 2018, 122(7): e64-e65. [9] 乔杰, 袁媛, 赵婵. 高敏肌钙蛋白T对心脏病患者妊娠期不良心血管事件的预测效果[J]. 中国妇产科临床杂志, 2021, 22(4): 405-8. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202104019.htm [10] Hosseini A, Sahebkar A. Reversal of doxorubicin-induced cardiotoxicity by using phytotherapy: a review[J]. J Pharmacopuncture, 2017, 20 (4): 243-56. [11] Chang WT, Feng YH, Kuo YH, et al. Layer-specific distribution of myocardial deformation from anthracycline-induced cardiotoxicity in patients with breast cancer—from bedside to bench[J]. Int J Cardiol, 2020, 311: 64-70. doi: 10.1016/j.ijcard.2020.01.036 [12] 王飞, 赖玉琼, 庞丹梅, 等. 三维斑点追踪技术可评价乳腺癌患者蒽环类药物治疗前后的心室功能改变[J]. 分子影像学杂志, 2019, 42(4): 434-8. doi: 10.12122/j.issn.1674-4500.2019.04.03 [13] Torrent-Guasp F, Ballester M, Buckberg GD, et al. Spatial orientation of the ventricular muscle band: physiologic contribution and surgical implications[J]. J Thorac Cardiovasc Surg, 2001, 122(2): 389-92. doi: 10.1067/mtc.2001.113745 [14] Magrath P, Maforo N, Renella P, et al. Cardiac MRI biomarkers for Duchenne muscular dystrophy[J]. Biomark Med, 2018, 12(11): 1271-89. doi: 10.2217/bmm-2018-0125 [15] Notomi Y, Shiota T, Popović ZB, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging[J]. J Am Coll Cardiol, 2005, 45(12): 2034-41. doi: 10.1016/j.jacc.2005.02.082 [16] Hjertaas JJ, Matre K. A left ventricular phantom for 3D echocardiographic twist measurements[J]. Biomed Tech (Berl), 2020, 65(2): 209-18. doi: 10.1515/bmt-2019-0096 [17] 熊莉, 邓又斌, 申屠伟慧, 等. 超声斑点追踪技术对心肌梗死患者左心室扭转角度的研究[J]. 中华超声影像学杂志, 2007, 16(12): 1017-20. doi: 10.3760/j.issn:1004-4477.2007.12.002 [18] 中国临床肿瘤学会, 中华医学会血液学分会. 蒽环类药物心脏毒性防治指南(2013年版)[J]. 临床肿瘤学杂志, 2013, 18(10): 925-34. doi: 10.3969/j.issn.1009-0460.2013.10.014 [19] Song FY, Kang Y, Zhang CJ, et al. The early variation of left ventricular twisting function in patients with lymphoma received anthracycline therapy assessed by three-dimensional speckle tracking echocardiography[J]. Cardiol J, 2017, 24(5): 484-94. doi: 10.5603/CJ.a2017.0035 [20] Kinova E, Somleva-Todorova D, Goudev A. Left ventricular strain and rotation in patients with dilated cardiomyopathy and severe systolic dysfunction[J]. Cardiology, 2020, 145(1): 1-12. doi: 10.1159/000503682 [21] Bulut M, Acar RD, Acar Ş, et al. Evaluation of torsion and twist mechanics of the left ventricle in patients with systemic lupus erythematosus[J]. Anatol J Cardiol, 2016, 16(6): 434-9. [22] 刘晓丽, 张文华, 宋昕殊, 等. 应用三维斑点追踪技术评价蒽环类药物对乳腺癌化疗患者心肌损害及转归[J]. 中国超声医学杂志, 2019, 35 (8): 696-9. doi: 10.3969/j.issn.1002-0101.2019.08.009 -
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