Guerra Federico, Marchesini Marco, Contadini Daniele, Menditto Alessio, Morelli Marco, Piccolo Elisa, Battelli Nicola, Pistelli Mirco, Berardi Rossana, Cascinu Stefano, Capucci Alessando
Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
Support Care Cancer. 2016 Jul;24(7):3139-45. doi: 10.1007/s00520-016-3137-y. Epub 2016 Feb 29.
Recent development in anticancer therapies for breast carcinoma allowed an improvement in patients' survival, notwithstanding a parallel increase of cardiovascular morbidity. Cardiotoxicity of anticancer therapies represents a relevant problem due to its insidious onset and potentially irreversible cardiac damage. The aim of the present study was to test whether 2D speckle tracking analysis can help in predicting overt systolic dysfunction.
A "real world" cohort of 69 patients with breast carcinoma undergoing adjuvant and/or neo-adjuvant chemotherapy was tested 2D-speckle tracking analysis before the beginning of chemotherapy and every 3 months for 1 year. Clinical data, 12-lead ECGs, and lab tests were collected according to the same visit protocol.
Over 1-year follow-up, 19 patients (27 %) developed cardiac dysfunction according to the CREC criteria, with an average onset time from enrolment of 6.8 months. A global longitudinal strain (GLS) threshold ≥-16 % at 3 months from chemotherapy was able to predict subsequent systolic dysfunction development with high sensitivity (80 %) and specificity (90 %) and a negative predictive value of 92 %. After the introduction of cardioprotective drugs, left ventricular ejection fraction (LVEF) progressively recovered, while alterations of GLS persisted at 1-year follow-up.
Strain imaging with 2D speckle tracking allows the identification of patients at low-risk for chemotherapy-related systolic dysfunction and can help optimizing resources allocations and improving follow-up quality. GLS can also provide a more accurate prognostic index of resolved systolic dysfunction when compared to standard LVEF.
尽管抗癌疗法导致心血管疾病发病率同时上升，但乳腺癌抗癌疗法的最新进展使患者生存率有所提高。抗癌疗法的心脏毒性因其隐匿性发作和潜在的不可逆心脏损伤而成为一个相关问题。本研究的目的是测试二维斑点追踪分析是否有助于预测明显的收缩功能障碍。
对69例接受辅助和/或新辅助化疗的乳腺癌患者的“真实世界”队列在化疗开始前及化疗后1年每3个月进行一次二维斑点追踪分析测试。按照相同的就诊方案收集临床数据、12导联心电图和实验室检查结果。
在1年的随访中，19例患者（27%）根据CREC标准出现心脏功能障碍，从入组开始的平均发病时间为6.8个月。化疗后3个月时整体纵向应变（GLS）阈值≥ -16%能够以高敏感性（80%）、特异性（90%）和92%的阴性预测值预测随后收缩功能障碍的发生。引入心脏保护药物后，左心室射血分数（LVEF）逐渐恢复，而GLS的改变在1年随访时仍持续存在。
二维斑点追踪应变成像能够识别化疗相关收缩功能障碍低风险患者，有助于优化资源分配并提高随访质量。与标准LVEF相比，GLS还可为已解决的收缩功能障碍提供更准确的预后指标。
