Xu Haiyan, Mao Ling, Liu Hailang, Zhang Yuanyuan, Yang Jing
Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China.
Department of Thyroid and Breast Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and the Second People's Hospital of Huai'an, Huai'an, Jiangsu, People's Republic of China.
Int J Gen Med. 2021 Mar 16;14:885-893. doi: 10.2147/IJGM.S300257. eCollection 2021.
This study was aimed at assessing the longitudinal strain changes of RV function using three-dimensional speckle tracking echocardiography (3D STE) in breast cancer patients receiving anthracycline chemotherapy.
A total of 95 women with breast cancer receiving epirubicin (360 mg/m) underwent 3D STE at baseline, the end of chemotherapy and 12 months after chemotherapy. 3D STE assessment included RV ejection fraction (EF), LV global longitudinal strain (GLS), RV GLS, and RV free wall longitudinal strain (RV FWLS). Meanwhile, serum hs-cTnI and NT-proBNP were measured. Chemotherapy-related cardiac dysfunction (CTRCD) was defined as an absolute decrease in 3D LVEF > 10% to a value <50%, while a percent reduction of 3D LV GLS > 15% indicated subclinical CTRCD.
Subclinical CTRCD occurred in 10 (10.5%) patients during follow-up. Compared to baseline, the 3D GLS of LV and GLS and FWLS of RV decreased significantly at 12months after chemotherapy (all p<0.01). Variations of 3D RV GLS and RV FWLS had a good discrimination for predicting subclinical CTRCD. The variation of 3D RV FWLS was the only independent predictor of subclinical CTRCD (OR, 1.37; 95% CI, 1.12-2.87; p = 0.028) in multivariate analysis. The cutoff value with -17.5% of 3D RV FWLS variation had a high predictive accuracy for subclinical CTRCD, with an AUC of 0.74, 80.5% sensitivity and 65.8% specificity. The association between 3D RV FWLS and the cumulative dose of anthracyclines was calculated by Spearman's test (r = -0.71, p < 0.001).
Longitudinal strain analysis by 3D STE allows the identification of subclinical RV dysfunction when conventional indices of RV function are unaffected. 3D RV FWLS was superior to other parameters in early detection of the development of CTRCD in breast cancer patients receiving epirubicin therapy.
本研究旨在利用三维斑点追踪超声心动图（3D STE）评估接受蒽环类化疗的乳腺癌患者右心室（RV）功能的纵向应变变化。
共有95例接受表柔比星（360 mg/m²）治疗的乳腺癌女性患者在基线、化疗结束时及化疗后12个月接受了3D STE检查。3D STE评估包括右心室射血分数（EF）、左心室整体纵向应变（GLS）、右心室GLS和右心室游离壁纵向应变（RV FWLS）。同时，检测血清高敏心肌肌钙蛋白I（hs-cTnI）和N末端B型利钠肽原（NT-proBNP）。化疗相关心脏功能障碍（CTRCD）定义为三维左心室射血分数（3D LVEF）绝对下降>10%至<50%，而三维左心室GLS下降>15%表示亚临床CTRCD。
随访期间10例（10.5%）患者出现亚临床CTRCD。与基线相比，化疗后12个月时左心室的三维GLS以及右心室的GLS和FWLS均显著下降（均p<0.01）。三维右心室GLS和右心室FWLS的变化对预测亚临床CTRCD具有良好的鉴别能力。在多因素分析中，三维右心室FWLS的变化是亚临床CTRCD的唯一独立预测因素（比值比[OR]，1.37；95%置信区间[CI]，1.12 - 2.87；p = 0.028）。三维右心室FWLS变化为-17.5%的截断值对亚临床CTRCD具有较高的预测准确性，曲线下面积（AUC）为0.74，敏感性为80.5%，特异性为65.8%。通过Spearman检验计算三维右心室FWLS与蒽环类药物累积剂量之间的相关性（r = -0.71，p < 0.001）。
当右心室功能的传统指标未受影响时，3D STE进行的纵向应变分析可识别亚临床右心室功能障碍。在接受表柔比星治疗的乳腺癌患者中，三维右心室FWLS在早期检测CTRCD发展方面优于其他参数。
