Stoodley Paul W, Richards David A B, Hui Rina, Boyd Anita, Harnett Paul R, Meikle Steven R, Clarke Jillian, Thomas Liza
Faculty of Health Science, University of Sydney, Lidcombe Campus, 75 East Street, Lidcombe, NSW 2141, Australia.
Eur J Echocardiogr. 2011 Dec;12(12):945-52. doi: 10.1093/ejechocard/jer187. Epub 2011 Oct 1.
The efficacy of anthracyclines is undermined by potential life-threatening cardiotoxicity. Cardiotoxicity is dependent upon several factors and the timing to its development is variable. Moreover, as adjuvant therapy with trastuzumab often follows, a close monitoring of cardiac function in those treated with anthracyclines is mandatory. Left ventricular ejection fraction (LVEF) by echocardiography is currently used for monitoring cardiotoxicity; however, LVEF has numerous limitations. Two-dimensional strain imaging may provide a more sensitive measure of altered LV systolic function, so the aim of the present study was to compare LVEF and LV systolic strain before and after anthracyclines.
Fifty-two women with histologically confirmed breast cancer were prospectively studied. Echocardiographic LVEF (by Simpson's method), global and regional peak longitudinal, radial, and circumferential 2D systolic strain were measured 1 week before and 1 week after chemotherapy. Global and regional longitudinal LV systolic strain was significantly reduced after treatment; global longitudinal strain decreased from -17.7 to -16.3% (P < 0.01) with 48% of global measurements reduced by >10%. Global and regional radial LV systolic strain after treatment was also significantly reduced; global radial strain dropped from 40.5 to 34.5% (P < 0.01) with 59% of global measurements reduced by >10%. In contrast, no reduction in LVEF >10% after chemotherapy was observed.
Reduced LV systolic strain immediately after anthracycline treatment may indicate early impairment of myocardial function before detectable change in LVEF.
蒽环类药物的疗效因潜在的危及生命的心脏毒性而受到影响。心脏毒性取决于多种因素，其发生时间也各不相同。此外，由于曲妥珠单抗辅助治疗经常随后进行，因此对接受蒽环类药物治疗的患者进行心脏功能密切监测是必要的。目前，通过超声心动图测量左心室射血分数（LVEF）用于监测心脏毒性；然而，LVEF有许多局限性。二维应变成像可能提供一种更敏感的左心室收缩功能改变的测量方法，因此本研究的目的是比较蒽环类药物治疗前后的LVEF和左心室收缩应变。
对52名经组织学确诊的乳腺癌女性进行前瞻性研究。在化疗前1周和化疗后1周测量超声心动图LVEF（采用Simpson法）、整体和局部峰值纵向、径向和圆周二维收缩应变。治疗后整体和局部左心室纵向收缩应变显著降低；整体纵向应变从-17.7%降至-16.3%（P<0.01），48%的整体测量值降低超过10%。治疗后整体和局部左心室径向收缩应变也显著降低；整体径向应变从40.5%降至34.5%（P<0.01），59%的整体测量值降低超过10%。相比之下，化疗后未观察到LVEF降低超过10%的情况。
蒽环类药物治疗后立即出现的左心室收缩应变降低可能表明在LVEF出现可检测变化之前心肌功能已早期受损。
