de Almeida André Luiz Cerqueira, Silva Viviane Almeida, de Souza Filho Alberto Teófilo, Rios Vinicius Guedes, Lopes João Ricardo Pinto, de Afonseca Samuel Oliveira, Cunha Daniel de Castro Araújo, Mendes Murilo Oliveira da Cunha, Miranda Danilo Leal, dos Santos Júnior Edval Gomes
Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.
Hospital Dom Pedro de Alcântara, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, BA, Brasil.
Arq Bras Cardiol. 2015 Apr;104(4):274-83. doi: 10.5935/abc.20140209. Epub 2015 Jan 27.
Heart failure is a severe complication associated with doxorubicin (DOX) use. Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown to be useful in identifying subclinical ventricular dysfunction.
a) To investigate the role of strain in the identification of subclinical ventricular dysfunction in patients who used DOX; b) to investigate determinants of strain response in these patients.
Cross-sectional study with 81 participants: 40 patients who used DOX ± 2 years before the study and 41 controls. All participants had left ventricular ejection fraction (LVEF) ≥ 55%. Total dose of DOX was 396 mg (242 mg/ms2). The systolic function of the LV was evaluated by LVEF (Simpson), as well as by longitudinal (εLL), circumferential (εCC), and radial (εRR) strains. Multivariate linear regression (MLR) analysis was performed using εLL (model 1) and εCC (model 2) as dependent variables.
Systolic and diastolic blood pressure values were higher in the control group (p < 0.05). εLL was lower in the DOX group (-12.4 ± 2.6%) versus controls (-13.4 ± 1.7%; p = 0.044). The same occurred with εCC: -12.1 ± 2.7% (DOX) versus -16.7 ± 3.6% (controls; p < 0.001). The S' wave was shorter in the DOX group (p = 0.035). On MLR, DOX was an independent predictor of reduced εCC (B = -4.429, p < 0.001). DOX (B = -1.289, p = 0.012) and age (B = -0.057, p = 0.029) were independent markers of reduced εLL.
a) εLL, εCC and the S' wave are reduced in patients who used DOX ± 2 years prior to the study despite normal LVEF, suggesting the presence of subclinical ventricular dysfunction; b) DOX was an independent predictor of reduced εCC; c) prior use of DOX and age were independent markers of reduced εLL.
心力衰竭是使用阿霉素（DOX）相关的一种严重并发症。通过二维斑点追踪（2D - STE）评估的应变已被证明有助于识别亚临床心室功能障碍。
a）研究应变在使用DOX的患者亚临床心室功能障碍识别中的作用；b）研究这些患者应变反应的决定因素。
对81名参与者进行横断面研究：40名在研究前±2年使用DOX的患者和41名对照者。所有参与者的左心室射血分数（LVEF）≥55%。DOX的总剂量为396mg（242mg/ms2）。通过LVEF（辛普森法）以及纵向应变（εLL）、圆周应变（εCC）和径向应变（εRR）评估左心室的收缩功能。以εLL（模型1）和εCC（模型2）作为因变量进行多元线性回归（MLR）分析。
对照组的收缩压和舒张压值更高（p < 0.05）。DOX组的εLL低于对照组（-12.4±2.6%对-13.4±1.7%；p = 0.044）。εCC也有同样情况：-12.1±2.7%（DOX组）对-16.7±3.6%（对照组；p < 0.001）。DOX组的S'波更短（p = 0.035）。在MLR分析中，DOX是εCC降低的独立预测因素（B = -4.429，p < 0.001）。DOX（B = -1.289，p = 0.012）和年龄（B = -0.057，p = 0.029）是εLL降低的独立标志物。
a）在研究前±2年使用DOX的患者中，尽管LVEF正常，但εLL、εCC和S'波降低，提示存在亚临床心室功能障碍；b）DOX是εCC降低的独立预测因素；c）既往使用DOX和年龄是εLL降低的独立标志物。
