Alam Shamshad, Chandra Sharad, Saran Mahim, Chaudhary Gaurav, Sharma Akhil, Bhandhari Monika, Vishwakarma Pravesh, Pradhan Akshaya, Sethi Rishi, Dwivedi Sudhanshu K, Narain Varun S
Department of Cardiology, King George's Medical University, Lucknow, 226003, India.
Department of Cardiology, King George's Medical University, Lucknow, 226003, India.
Indian Heart J. 2019 Nov-Dec;71(6):468-475. doi: 10.1016/j.ihj.2019.11.253. Epub 2019 Nov 19.
Chemotherapy-induced cardiotoxicity constitutes subclinical myocardial dysfunction, arrhythmias, pericarditis, coronary vasospasm, and significant symptomatic heart failure. Anthracyclines pose higher risk for long-term cardiac dysfunction, with increased incidences of morbidity and mortality. Hence, early detection of chemotherapy-induced cardiac dysfunction may prompt an earlier treatment modification.
To evaluate global, longitudinal, radial, and circumferential strain changes in adult patients undergoing anthracycline chemotherapy along with the usefulness of three-dimensional (3D) echocardiography as the new modality over two-dimensional (2D) echocardiography.
This was a single centre, prospective, observational study that included asymptomatic patients free from any cardiac signs and symptoms attributable to heart failure, who underwent potentially cardiotoxic chemotherapy for malignancy from December 2017 to November 2018 at a tertiary care centre in India. Baseline demographics were recorded, and 2D and 3D echocardiography was performed at baseline and after completion of four cycles of chemotherapy.
All the 55 patients received a cumulative dose of doxorubicin of less than 550 mg/m. Follow-up period from the beginning of doxorubicin therapy was 108 ± 14 days. 9 patients were excluded from the study due to poor 3D images, so data analysis was done only for 46 patients. In 2D echocardiography, only global longitudinal strain (GLS) was observed to be significantly reduced (Δ18.33%; P < 0.001). 2D ejection fraction (EF) did not show significant change (Δ0.67%; P = 0.176), while by 3D echo, EF reduced significantly (Δ3.55%; P < 0.001). 3D global longitudinal (Δ29.19%; P < 0.001), circumferential (Δ30.65%; P < 0.001), area (Δ21.61%; P < 0.001), and radial (Δ29.66%; P < 0.001) strains were observed to be significantly reduced at follow-up.
Myocardial dysfunction induced by cardiotoxic chemotherapy can be detected earlier by using 2D GLS, 3D volumetric analysis, and 3D strain analysis by calculating global, longitudinal, radial, and circumferential strain changes. 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography. These newer techniques could potentially improve the ability for early detection of subclinical abnormalities of LV function in patients undergoing cardiotoxic chemotherapy and thus early initiation of treatment could be possible.
化疗引起的心脏毒性包括亚临床心肌功能障碍、心律失常、心包炎、冠状动脉痉挛以及严重的有症状心力衰竭。蒽环类药物导致长期心脏功能障碍的风险更高，发病率和死亡率增加。因此，早期发现化疗引起的心脏功能障碍可能促使更早地调整治疗方案。
评估接受蒽环类化疗的成年患者的整体、纵向、径向和圆周应变变化，以及三维（3D）超声心动图作为一种新方法相对于二维（2D）超声心动图的实用性。
这是一项单中心、前瞻性、观察性研究，纳入了无症状且无任何可归因于心力衰竭的心脏体征和症状的患者，这些患者于2017年12月至2018年11月在印度一家三级医疗中心接受了可能具有心脏毒性的恶性肿瘤化疗。记录基线人口统计学数据，并在基线时和完成四个化疗周期后进行2D和3D超声心动图检查。
所有55例患者接受的阿霉素累积剂量均小于550mg/m²。从阿霉素治疗开始的随访期为108±14天。9例患者因3D图像质量差被排除在研究之外，因此仅对46例患者进行了数据分析。在2D超声心动图中，仅观察到整体纵向应变（GLS）显著降低（变化18.33%；P<0.001）。2D射血分数（EF）未显示显著变化（变化0.67%；P=0.176），而通过3D超声心动图，EF显著降低（变化3.55%；P<0.001）。随访时观察到3D整体纵向应变（变化29.19%；P<0.001）、圆周应变（变化30.65%；P<0.001）、面积应变（变化21.61%；P<0.001）和径向应变（变化29.66%；P<0.001）均显著降低。
通过计算整体纵向、径向和圆周应变变化，利用2D GLS、3D容积分析和3D应变分析，可以更早地检测出心脏毒性化疗引起的心肌功能障碍。3D超声心动图评估在检测左心室功能的微小变化方面似乎更准确，但与2D超声心动图相比，图像质量略差。这些新技术可能会提高对接受心脏毒性化疗患者左心室功能亚临床异常的早期检测能力，从而有可能更早开始治疗。
