Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
J Am Soc Echocardiogr. 2017 May;30(5):454-460. doi: 10.1016/j.echo.2016.12.013. Epub 2017 Mar 2.
During the development of heart failure (HF), the changes of contraction timing pattern and temporal heterogeneity of segmental contraction happen early and may precede both symptomatic HF and the decrease in left ventricular ejection fraction (LVEF). In patients treated with anthracyclines, both symptomatic HF and the decrease of LVEF are detected once significant myocardial injury has occurred. The aim of the current study was to investigate whether changes in the timing of contraction can be detected early after anthracyclines therapy.
Forty-one women (50 ± 11 years old) with newly diagnosed breast cancer were prospectively enrolled in two centers and underwent an echocardiogram before and after anthracyclines. Peak longitudinal myocardial systolic strain was measured on the apical four- and two-chamber views. The time to peak systolic longitudinal strain (TP), ejection time (ET), isovolumic contraction time (IVCT), systolic time, and diastolic time were measured using strain curves and Doppler tracings and compared before and after anthracyclines. The heterogeneity of contraction (dyssynchrony) was measured by the SD of the TP of all segments.
Anthracyclines treatment was associated with an increase in heart rate (HR) and a decrease in TP. TP was correlated with HR. TP/ET was independent of HR and inversely correlated to peak strain both at baseline and after anthracyclines. TP/ET increased after anthracyclines (1.26 ± 0.19 to 1.31 ± 0.22; P < .001), and this increase was correlated with the decrease in strain. The increase in TP/ET was due to an increase in IVCT/ET. A similar degree of dyssynchrony was found at baseline and after anthracyclines.
Anthracyclines treatment induces an increase in the duration of contraction, mainly by increasing the IVCT. This increase is correlated to the decrease in strain and may therefore have additional prognostic value.
在心力衰竭（HF）发展过程中，收缩时相变化和节段收缩的时间异质性很早就会发生，并且可能早于有症状的 HF 和左心室射血分数（LVEF）降低。在接受蒽环类药物治疗的患者中，一旦发生明显的心肌损伤，就会检测到有症状的 HF 和 LVEF 的降低。本研究的目的是探讨在蒽环类药物治疗后是否能早期检测到收缩时相的变化。
41 名（50 ± 11 岁）新诊断为乳腺癌的女性前瞻性地在两个中心入组，并在蒽环类药物治疗前后接受超声心动图检查。在心尖四腔和两腔视图上测量纵向心肌收缩峰值应变。使用应变曲线和多普勒轨迹测量收缩时间的峰值纵向应变（TP）、射血时间（ET）、等容收缩时间（IVCT）、收缩时间和舒张时间，并与蒽环类药物治疗前后进行比较。收缩时相的异质性（不同步）通过所有节段 TP 的标准差来测量。
蒽环类药物治疗后心率（HR）增加，TP 降低。TP 与 HR 相关。TP/ET 不受 HR 影响，与基线和蒽环类药物治疗后峰值应变呈负相关。蒽环类药物治疗后 TP/ET 增加（1.26 ± 0.19 至 1.31 ± 0.22；P <.001），这种增加与应变的降低有关。TP/ET 的增加是由于 IVCT/ET 的增加。在基线和蒽环类药物治疗后都发现了相似程度的不同步。
蒽环类药物治疗后收缩时间延长，主要是通过增加 IVCT。这种增加与应变的降低相关，因此可能具有额外的预后价值。
