摘要
目的应用二维斑点：瞧踪成像（2D-STI）技术评价乳腺癌蒽环类药物化疗前后左室跨壁力学的变化，早期预测蒽环类药物化疗导致的心脏毒性。方法乳腺癌术后蒽环类药物化疗患者46例，分别于化疗前及化疗1、3、6周期后行超声心动图检查，应用2D-STI获取左室收缩期整体纵向峰值应变（GLS）、径向峰值应变（GRS）、环向峰值应变（GCS），心内膜下纵向峰值应变（LS-endo）、径向峰值应变（RS-endo）、环向峰值应变（CS-endo；，心外膜下纵向峰值应变（LS-epi）、径向峰值应变（RS-epi）、环向峰值应变（CS-epi），计算跨壁应变梯度（TMSG）。比较化疗前后常规超声心动图参数及应变相关参数，并应用ROC曲线比较应变参数对蒽环类药物心脏毒性的检验效能。结果①蒽环类药物化疗6周期后，9例（19．6％）发生心脏毒性，37例（80．4％）未达到心脏毒性的诊断标准；②与化疗前基础状态比较，葸环类药物化疗各周期后心脏结构参数差异无统计学意义（P〉0．05）；6周期后左室射血分数、短轴缩短率、E／A减低，E／e升高，差异有统计学意义（P〈0．05）；③化疗3、6周期GLS、LS-endo、LS-epi、TMSG-LS、TMSG-RS减低，差异有统计学意义（P〈0．05’；化疗6周期后GRS、RS-endo、RS-epi减低，差异有统计学意义（P〈0．05）。④ROC曲线结果表明，化疗3周期左室TMSG-LS、LS-endo、GLS、LS-epi检测蒽环类药物心脏毒性的准确性，曲线下面积TMSG-LS〉LS-endo〉GLS〉LS-epi。结论化疗3周期TMSG-LS、LS-endo、GLS、LS-epi减低，早于LVEF及其他应变参数，化疗3周期TMSG-LS、LS-endo检测心脏毒性具有较高的准确性，能早期监测乳腺癌蒽环类药物化疗导致的心脏损害。
Objective To evaluate the left ventricular transmural mechanics changes of breast cancer patients between before and after anthracycline chemotherapy by two-dimensional speckle tracking imaging （2D-STI） ,and to predict early cardiotoxicity caused by anthracycline. Methods Forty-six breast cancer patients with postoperative anthracycline-based chemotherapy were recruited. Echocardiography were performed on all subjects before and at 1,3 and 6 anthracycline-based chemotherapeutic cycle. Global longitudinal strain（GLS）, endocardial longitudinal strain（LS-endo） ,epicardial longitudinal strain（LS-epi）, global radial strain （ GRS）, endocar：lial radial strain （ RS-endo）, epicardial radial strain （ RS-epi）, global circumferential strain （GCS）, endoeardial eircumferential strain （CS-endo） and epicardial circumferential strain（CS-epi） were assessed by 2D-STI and transmural myocardial strain gradient-longitudinal strain （TMSG-LS） ,transmural myocardial strain gradient-radial strain（TMSG-RS）, transmural myocardial strain gradient-circumferential strain（TMSG-CS） were calculated. Conventional echocardiographic parameters and strain-related parameters before and after chemotherapy were compared. The receiver operating characteristics（ROC） curve was performed to determine sensitivity and specifity of strain parameters for prediction value of cardiotoxicity induced by anthracycline chemotherapy. Results （1）After the sixth cycle of anthracycline chemotherapy, 9 patients （ 16.4% ） had developed anthracycline-induced cardiotoxicity, and 37 patients （80.4%） did not meet the criteria for cardiotoxicity. （2）There were no significant differences inconventional echocardiography parameters between before and after chemotherapy （P 〉 0.05 ）. Left ventricular ejection fraction （LVEF）, fractional shortening （FS） and E/A significantly decreased, but E/e significantly increased after six cycles of chemotherapy （ P 〈 0.05）. （3）When comparison with baseline cases,GLS, LS-endo, LS-epi, TMSG- LS, TMSG-RS decreased after 3,6 cycles of chemotherapy, GRS, RS-endo and RS-epi decreased after six cycles of chemotherapy, the difference was statistically significant （ P 〈0.05）. （4）ROC curve results showed the value of TMSG-LS, LS-endo, GLS and LS-epi after three cycles of chemotherapy to detect of anthracycline-induced cardiotoxicity, the areas under the curve were TMSG LS〉 LS-endo〉 GLS〉 LS-epi. Conclusions After three cycles of chemotherapy,the decreases of TMSG-LS,LS-endo,GLS and LS-epi preceded the change of LVEF and other strain parameters,TMSG-LS and LS-endo can accurately and early detect anthracycline chemotherapy-induced cardiotoxicity.
出处
《中华超声影像学杂志》
CSCD
北大核心
2015年第12期1033-1038,共6页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
乳腺肿瘤
蒽环类
跨壁应变梯度
二维斑点追踪成像
Echocardiography
Breast neoplasms
Anthracyclines
Transmural myocardial strain gradient
Two-dimensional speckle tracking imaging
