The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Medicine (Baltimore). 2022 Oct 21;101(42):e31084. doi: 10.1097/MD.0000000000031084.
Anthracyclines have been one of the most important therapeutic methods in breast cancer therapy for decades. However, serious long-term toxicities, especially cardiotoxicity limits the continuous usage of anthracyclines, hence affects long term prognosis. Early detection of myocardial dysfunction during treatment is critical but challenging. Two-dimensional speckle tracking echocardiography (2D-STE) is a non-Doppler technique that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. This study aims to compare the sensitivity and precision between 2D-STE and traditional echocardiography on monitoring the left ventricular function in patients with breast cancer after anthracyclines therapy, which is the key indicator for evaluating myocardial changes. Thirty-three patients with breast cancer were recruited from February 2019 to December 2019. All patients were treated with 4 cycles anthracycline. 2D-STE and conventional echocardiography were performed on each patient. Two-dimensional echocardiographic examination was used to collect data interventricular septum diameter (IVSD), end-diastolic left ventricular posterior wall diameter (LVPWD), left ventricular end-diastolic diameter (LVEDD) and left ventricular systole on the parasternal left ventricular long axis view. The final diameter (left ventricular end-systolic diameter [LVESD]) and the left ventricular short axis shortening rate (LVFS) was measured by M-type. The two-plane Simpson's method was used to measure left ventricular end-diastolic volume (LVEDV) and end-systolic volume (left ventricular end-systolic volume [LVESV]) to obtain left ventricular ejection fraction (LVEF). Two-dimensional speckle tracking imaging technical indicator includes left ventricular global longitudinal strain (LVGLS), subendocardial myocardial longitudinal strain (LVGLS-Endo) and epicardial myocardial longitudinal strain (LVGLS-Epi). The correlation between 2-dimensional speckle tracking imaging and conventional ultrasound parameters were analyzed. Compared with baseline (T0), the systolic function parameter LVEF was significantly changed after four cycle chemotherapy (T4) (P < .05). However, the conventional echocardiographic parameters including IVSD, LVPWD, LVEDD, LVESD, LVEDV, and LVESV were not statistically significant (P > .05). Meanwhile, the two-dimensional strain parameters LVGLS, LVGLS-Endo, and LVGLS-Epi were statistically significant after T2 and T4 cycle chemotherapy (P < .01).The two-dimensional strain parameter GLS has higher accuracy and sensitivity for monitoring left ventricular insufficiency caused by anthracycline therapy when compared with traditional echocardiography.
蒽环类药物是几十年来乳腺癌治疗中最重要的治疗方法之一。然而，严重的长期毒性，尤其是心脏毒性，限制了蒽环类药物的连续使用，从而影响了长期预后。在治疗过程中早期发现心肌功能障碍至关重要，但具有挑战性。二维斑点追踪超声心动图（2D-STE）是一种非多普勒技术，可通过跟踪心肌中的声标记物的位移来评估变形和应变。本研究旨在比较 2D-STE 与传统超声心动图监测蒽环类药物治疗后乳腺癌患者左心室功能的敏感性和精确性，这是评估心肌变化的关键指标。
2019 年 2 月至 2019 年 12 月期间，共招募了 33 名乳腺癌患者。所有患者均接受了 4 个周期的蒽环类药物治疗。对每位患者进行 2D-STE 和常规超声心动图检查。二维超声心动图检查采集室间隔直径（IVSD）、舒张末期左心室后壁直径（LVPWD）、左心室舒张末期直径（LVEDD）和胸骨旁左心室长轴切面的左心室收缩末期直径（LVESD）数据。左心室短轴缩短率（LVFS）采用 M 型测量。双平面 Simpson 法测量左心室舒张末期容积（LVEDV）和收缩末期容积（左心室收缩末期容积[LVESV]），以获得左心室射血分数（LVEF）。二维斑点追踪成像技术指标包括左心室整体纵向应变（LVGLS）、心内膜下心肌纵向应变（LVGLS-Endo）和心外膜心肌纵向应变（LVGLS-Epi）。分析二维斑点追踪成像与常规超声参数之间的相关性。与基线（T0）相比，四周期化疗后收缩功能参数 LVEF 明显改变（T4）（P<0.05）。然而，IVSD、LVPWD、LVEDD、LVESD、LVEDV 和 LVESV 等常规超声心动图参数无统计学意义（P>0.05）。同时，T2 和 T4 周期化疗后二维应变参数 LVGLS、LVGLS-Endo 和 LVGLS-Epi 有统计学意义（P<0.01）。与传统超声心动图相比，二维应变参数 GLS 对监测蒽环类药物治疗引起的左心室功能不全具有更高的准确性和敏感性。
