Zhu Jiabao, Xie Shuhui, Ji Hanzhen, Gu Xingxing, Wu Jing
Department of Ultrasound, Nantong Third People's Hospital, Nantong University, Nantong, China.
Department of Library and Information Science, Nantong Third People's Hospital, Nantong University, Nantong, China.
Front Cardiovasc Med. 2022 Aug 11;9:936212. doi: 10.3389/fcvm.2022.936212. eCollection 2022.
To obtain various myocardial strain parameters by using two-dimension speckle tracking echocardiography (2D-STE) technique, calculate the myocardial composite index (MCI) which combines the global longitudinal strain (GLS) of left ventricle and the left ventricular twist (LVtw), and evaluate their diagnostic efficacies for subclinical left ventricular (LV) dysfunction in patients undergoing anthracycline chemotherapy.
A total of 35 female breast cancer patients, who underwent postoperative chemotherapy in the Department of Thyroid and Breast Surgery of Nantong Third People's Hospital from September 2018 to December 2019 and had successful follow-up, were included into the chemotherapy group, and the patients were evaluated respectively at baseline and in early, interim and later chemotherapy stages according to the course of chemotherapy; in addition, 30 healthy women undergoing physical examination during the same period were included into the control group. In different chemotherapy stages, the data such as left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) were collected by using conventional echocardiography, and various myocardial strain parameters such as GLS, global radial strain (GRS), global circumferential strain(GCS) and LVtw were measured using 2D-STE, and then MCI was calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the application values of various parameters in the diagnosis of early cardiotoxicity.
There was a difference in MCI between patients at baseline and in the early chemotherapy stage; there were differences in GLS, LVtw and MCI between patients at baseline and in the interim chemotherapy stage; there were differences in four parameters such as MCI, GLS, LVtw and GCS between patients at baseline and in the later chemotherapy stage; The AUC of MCI was 0.915, when the cutoff value was -210.89 (%×°), the sensitivity and specificity were 84.37% and 90.41%, respectively.
MCI combines the longitudinal and torsional motions of myocardium, and thus has a better diagnostic value for early detection of subclinical LV dysfunction caused by anthracycline chemotherapy drugs compared with strain parameters in a single direction.
应用二维斑点追踪超声心动图（2D-STE）技术获取多种心肌应变参数，计算结合左心室整体纵向应变（GLS）和左心室扭转（LVtw）的心肌综合指数（MCI），并评估其对接受蒽环类化疗患者亚临床左心室（LV）功能障碍的诊断效能。
选取2018年9月至2019年12月在南通市第三人民医院甲状腺乳腺外科接受术后化疗且随访成功的35例女性乳腺癌患者纳入化疗组，根据化疗疗程在基线期、化疗早期、中期及后期分别对患者进行评估；另外，选取同期30例健康体检女性纳入对照组。在不同化疗阶段，采用常规超声心动图收集左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）及左心室射血分数（LVEF）等数据，应用2D-STE测量GLS、整体径向应变（GRS）、整体圆周应变（GCS）及LVtw等多种心肌应变参数，进而计算MCI。采用受试者工作特征（ROC）曲线分析评估各参数在早期心脏毒性诊断中的应用价值。
基线期与化疗早期患者的MCI存在差异；基线期与化疗中期患者的GLS、LVtw及MCI存在差异；基线期与化疗后期患者的MCI、GLS、LVtw及GCS这4项参数存在差异；MCI的曲线下面积（AUC）为0.915，截断值为-210.89（%×°）时，灵敏度和特异度分别为84.37%和90.41%。
MCI结合了心肌的纵向和扭转运动，因此与单向应变参数相比，对早期检测蒽环类化疗药物引起的亚临床LV功能障碍具有更好的诊断价值。
