Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea.
Cardiovasc Ultrasound. 2020 Jul 21;18(1):28. doi: 10.1186/s12947-020-00210-5.
We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy.
A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared.
CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%).
PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.
我们研究了左心房（LA）应变测量在未发生化疗后曲妥珠单抗治疗相关心脏功能障碍（CTRCD）的乳腺癌患者中预测随后癌症治疗相关心脏功能障碍（CTRCD）的有用性。
共有 72 名未发生化疗后 CTRCD 且接受额外曲妥珠单抗治疗的乳腺癌女性患者被分为 CTRCD（n = 13）和无 CTRCD 组（n = 59）。比较左心室整体纵向应变（LVGLS）和峰值心房纵向应变（PALS）下降等超声心动图测量结果。
在接受额外曲妥珠单抗治疗后，有 13 名患者（18.1%）发生了 CTRCD。基线超声心动图结果无差异。化疗后完成时，常规超声心动图参数无差异，但 PALS 下降（15.0±4.7%比 8.9±3.2%，p<0.001）和 LVGLS 下降（10.5±1.3%比 9.1±1.1%，p=0.002）在 CTRCD 组中明显大于无 CTRCD 组。化疗完成时 PALS 下降可以预测曲妥珠单抗治疗后未来发生 CTRCD，其敏感性和特异性均优于 LVGLS 下降（截断值 11.79%，敏感性 76.9%和特异性 81.4%比截断值 9.9%，敏感性 69.2%和特异性 78.0%）。
在乳腺癌化疗后发生明显 CTRCD 之前，PALS 或 LVGLS 下降已经出现，且 PALS 下降在预测未来 CTRCD 方面的敏感性和特异性优于 LVGLS 下降。PALS 的连续测量可作为预测未来 CTRCD 的有用参数。
