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. -
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. 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. 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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