Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China.
Department of Breast Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China.
Clin Cardiol. 2022 May;45(5):540-548. doi: 10.1002/clc.23813. Epub 2022 Mar 16.
Left atrial (LA) function and mechanical dispersion changes in breast cancer patients treated with chemotherapy remain unclear.
LA function and LA mechanical dispersion in breast cancer patients would be impaired after chemotherapy.
This single-center retrospective study included 91 consecutive breast cancer patients treated with chemotherapy and 30 controls. Patients were examined by echocardiography three times at intervals. Conventional parameters, left ventricular strain, LA strain, and LA mechanical dispersion were evaluated and compared.
LA strain during reservoir phase (LASr), conduit phase (LAScd), and contraction phase (LASct) all decreased markedly after chemotherapy and were lower than those of the controls (all p < .01). The standard deviation of time to peak positive strain during LA reservoir phase corrected by R-R interval (LA SD-TPSr) was significantly increased after chemotherapy and was higher than that of the controls (p < .001). The change of LA function was expressed as Δ. Multivariate linear regression analyses showed that LAVIp (0.399, 95% confidence interval [CI]: 0.610, 1.756, p = .000) was independently associated with ΔLASr, LAPEF (-0.325, 95% CI: -45.123, -10.676, p = .002) and age (0.227, 95% CI: 0.021, 0.350, p = .027) were independently associated with ΔLAScd, and LAVImax (0.341, 95% CI: 0.192, 0.723, p = .001) was independently associated with ΔLASct. LAVImax (0.505, 95% CI: 0.000, 0.001, p = .039) and mitral E (-0.256, 95% CI: 0.000, 0.000, p = .024）were independently associated with ΔLA SD-TPSr.
Mechanical function of LA declined after chemotherapy in breast cancer patients. With the decrease of LA mechanical function, LA mechanical dispersion assessed by two-dimensional speckle-tracking echocardiography increased significantly, and its clinical value needs to be further studied.
化疗治疗的乳腺癌患者左心房（LA）功能和机械弥散变化仍不清楚。
化疗后乳腺癌患者的 LA 功能和 LA 机械弥散会受损。
这项单中心回顾性研究纳入了 91 例连续接受化疗的乳腺癌患者和 30 例对照。患者每隔一段时间接受 3 次超声心动图检查。评估并比较了常规参数、左心室应变、LA 应变和 LA 机械弥散。
化疗后 LA 储备期（LASr）、LA 射血分数（LAPEF）、LA 最大容量（LAVImax）和 LA 主动排空分数（LAEF）均明显降低，且低于对照组（均 p<0.01）。校正 R-R 间期后的 LA 储备期达峰正向应变的标准差（LA SD-TPSr）明显升高，高于对照组（p<0.001）。LA 功能的变化表示为Δ。多变量线性回归分析显示，LAVIp（0.399，95%置信区间 [CI]：0.610，1.756，p=0.000）与ΔLASr 独立相关，LAPEF（-0.325，95%CI：-45.123，-10.676，p=0.002）和年龄（0.227，95%CI：0.021，0.350，p=0.027）与ΔLAScd 独立相关，而 LAVImax（0.341，95%CI：0.192，0.723，p=0.001）与ΔLASct 独立相关。LAVImax（0.505，95%CI：0.000，0.001，p=0.039）和二尖瓣 E 波（-0.256，95%CI：0.000，0.000，p=0.024）与ΔLA SD-TPSr 独立相关。
乳腺癌患者化疗后 LA 机械功能下降。随着 LA 机械功能的降低，二维斑点追踪超声心动图评估的 LA 机械弥散显著增加，其临床价值有待进一步研究。
