Liu Jennifer E, Barac Ana, Thavendiranathan Paaladinesh, Scherrer-Crosbie Marielle
Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
JACC CardioOncol. 2020 Dec 15;2(5):677-689. doi: 10.1016/j.jaccao.2020.10.011. eCollection 2020 Dec.
Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.
超声心动图成像对于心脏毒性癌症治疗期间的患者管理至关重要。左心室射血分数是识别左心室功能障碍最常用的参数。然而，它在检测心脏毒性治疗导致的心脏功能亚临床变化方面缺乏敏感性。整体纵向应变（GLS）是研究最多的应变参数，具有既定的诊断和预后价值。多项研究已证明GLS的变化是心脏毒性的早期标志物。本文作为一份入门指南，帮助临床医生在心脏肿瘤学中获取和解读应变。包含嵌入式视频的病例说明了获取GLS测量值的逐步方法以及应避免的常见陷阱。本文还简要总结了GLS在心脏肿瘤学中的应用指征及其在指导肿瘤治疗中的作用。此外，还讨论了如何在超声心动图实验室中实施应变的实用方法，以及培训和质量保证方面的指导。
