Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
BMC Cancer. 2018 Oct 25;18(1):1037. doi: 10.1186/s12885-018-4935-z.
Combined anthracycline-trastuzumab chemotherapy has been associated with LV dysfunction. We aimed to assess early changes in left ventricular (LV) and right ventricular (RV) mechanics associated with combined anthracycline-trastuzumab treatment for breast cancer. As well as explore whether early changes in 2-dimensional (2D)-speckle tracking echocardiography (STE) could predict later chemotherapy-induced cardiotoxicity.
Sixty-six patients with breast cancer who received anthracycline-trastuzumab treatment were included (mean [±SD] age, 52 [9] years). Echocardiograms were available for analysis with 2D-STE at the following time points: pretreatment (T0), first cycle (T1), and second cycle (T2) of combined chemotherapy. All patients had a normal pretreatment LV ejection fraction (LVEF). Cardiotoxicity was defined as a decrease in LVEF of at least 10 percentage points from baseline on follow-up echocardiography.
Cardiotoxicity developed in 13 of the 66 patients (20%). The mean (±SD) LVEF at T0 was 66% (±6); at T1 60% (±7); and at T2, 54% (±6). For the 53 patients without cardiotoxicity, the LVEF was 65% (±4%) at T0, 63% (±5%) at T1, and 62% (±4) at T2. Global longitudinal strain (GLS) at T1 was the strongest indicator of subsequent cardiotoxicity (area under the curve, 0.85; cutoff value, - 14.06; sensitivity, 91%; specificity, 83%; P = .003). Compared with baseline (T0), left ventricular longitudinal strain, LV circumferential strain, circumferential peak systolic strain rate (SR), circumferential peak early diastolic SR, right ventricular longitudinal strain, and longitudinal peak systolic SR at T1 and T2 were reduced significantly in patients with cardiotoxicity (P < .05).
Anthracycline-trastuzumab treatment leads to early deterioration of LV GLS, circumferential strain, and systolic SR. Right ventricular GLS and SR were also affected. Early changes in GLS are good predictors of subsequent development of anthracycline-trastuzumab-induced cardiotoxicity.
联合蒽环类药物曲妥珠单抗化疗与左心室（LV）功能障碍有关。我们旨在评估与乳腺癌联合蒽环类药物曲妥珠单抗治疗相关的左心室（LV）和右心室（RV）力学的早期变化。并探讨二维（2D）斑点追踪超声心动图（STE）的早期变化是否可以预测随后的化疗引起的心脏毒性。
66 例接受蒽环类药物曲妥珠单抗治疗的乳腺癌患者入组（平均[±SD]年龄 52[9]岁）。在以下时间点进行二维 STE 分析：预处理（T0）、第一个周期（T1）和第二个周期（T2）联合化疗。所有患者均有正常的预处理左心室射血分数（LVEF）。心脏毒性定义为随访超声心动图上 LVEF较基线至少下降 10 个百分点。
66 例患者中有 13 例（20%）发生心脏毒性。T0 时的平均（±SD）LVEF 为 66%（±6）；T1 时为 60%（±7）；T2 时为 54%（±6）。对于 53 例无心脏毒性的患者，T0 时 LVEF 为 65%（±4%），T1 时为 63%（±5%），T2 时为 62%（±4%）。T1 时的整体纵向应变（GLS）是随后发生心脏毒性的最强指标（曲线下面积，0.85；截断值，-14.06；敏感性，91%；特异性，83%；P=0.003）。与基线（T0）相比，心脏毒性患者 T1 和 T2 时的左心室纵向应变、LV 周向应变、周向收缩早期应变率（SR）、周向收缩早期 SR、右心室纵向应变和纵向收缩早期 SR 均显著降低（P<0.05）。
蒽环类药物曲妥珠单抗治疗导致 LV GLS、周向应变和收缩早期 SR 的早期恶化。右心室 GLS 和 SR 也受到影响。GLS 的早期变化是预测蒽环类药物曲妥珠单抗诱导的心脏毒性随后发展的良好指标。
