Kang Yu, Xiao Fei, Chen Haiyan, Wang Wei, Shen Lijing, Zhao Hang, Shen Xuedong, Chen Fangyuan, He Ben
Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Echocardiography, Zhongshan Hospital, Fudan University, China.
Arq Bras Cardiol. 2018 Mar;110(3):219-228. doi: 10.5935/abc.20180042.
Anthracycline generates progressive left ventricular dysfunction associated with a poor prognosis.
The purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline.
Forty-two anthracycline-treated survivors of large B-cell non-Hodgkin lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27 healthy volunteers, aged 51.39 ± 13.40 years (control group) were enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67 ± 71.71mg/m2. The time from last dose of epirubicin to the echocardiographic examination was 52.92 ± 22.32 months. Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO, LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values were analyzed. Transmural strain gradient was calculated as differences in peak systolic strain between the subendocardial and subepicardial layers. A value of p < 0.05 was considered significant.
Conventional parameters of systolic and diastolic function showed no significant difference between two groups. Compared with controls, patients had significantly lower GCS and GLS. Multi-layer speckle tracking analysis showed significant reduction of circumferential strain of subendocardial layer, transmural CS gradient and longitudinal strain of all three layers. In contrast, the two groups did not differ in transmural longitudinal strain gradient and radial strains.
It proved the preferential impairment of subendocardial deformation in long-term survivors after exposure to anthracycline. Multi-layer speckle tracking echocardiography might facilitate the longitudinal follow-up of this at-risk patient cohort.
蒽环类药物会导致进行性左心室功能障碍，预后较差。
本研究旨在评估分层应变分析能否评估蒽环类药物暴露后的亚临床左心室功能障碍。
纳入42例接受蒽环类药物治疗的大B细胞非霍奇金淋巴瘤幸存者，年龄55.83±17.92岁（化疗组），以及27名健康志愿者，年龄51.39±13.40岁（对照组）。化疗组表柔比星的累积剂量为319.67±71.71mg/m²。从最后一剂表柔比星到超声心动图检查的时间为52.92±22.32个月。分析整体纵向（GLS）、圆周（GCS）和径向应变（GRS），以及心内膜下、中层和心外膜下层的纵向（LS-ENDO、LS-MID、LS-EPI）和圆周应变（CS-ENDO、CS-MID、CS-EPI）值。计算跨壁应变梯度，即心内膜下和心外膜下层之间收缩期峰值应变的差异。p<0.05被认为具有统计学意义。
收缩和舒张功能的常规参数在两组之间无显著差异。与对照组相比，患者的GCS和GLS显著降低。多层斑点追踪分析显示，心内膜下层的圆周应变、跨壁CS梯度以及所有三层的纵向应变均显著降低。相比之下，两组在跨壁纵向应变梯度和径向应变方面无差异。
这证明了蒽环类药物暴露后的长期幸存者心内膜下变形存在优先受损情况。多层斑点追踪超声心动图可能有助于对这一高危患者队列进行纵向随访。
