Altern Ther Health Med. 2023 Oct;29(7):388-393.
To explore the use of 3-dimensional speckle-tracking echocardiography (3DSTE) to evaluate changes in left ventricular function in patients with breast cancer after anthracycline chemotherapy.
The clinical data of 30 patients with breast cancer diagnosed by pathology at The Third Affiliated Hospital of Qiqihar Medical University from December 2020 to December 2022 were collected for retrospective analysis. All patients received anthracycline chemotherapy, and serum cardiac troponin T (cTnT) concentrations were measured within 24 to 48 hours before chemotherapy and after 1 cycle and 4 cycles of chemotherapy. Then, conventional ultrasonography, routine echocardiography, and 3DSTE were performed to obtain dynamic images and parameters such as left ventricular global longitudinal strain, global area strain, global circumferential strain, global radial strain, and twist values. The myocardial comprehensive index was calculated to compare changes before and after anthracycline chemotherapy. A receiver operating characteristic curve was created for each parameter, and the areas under the curves were calculated.
Except for left ventricular end-diastolic diameter and end-diastolic interventricular septum thickness, the other conventional ultrasonography parameters differed at the 3 chemotherapy time points tested (all P < .001). The parameters as measured by 3DSTE decreased with an increased cumulative dose of anthracycline drugs, and the values differed at the different time points (all P < .001); the MCI value decreased the most. The serum cTnT concentrations of 9 patients after 4 cycles of chemotherapy were higher than the normal range, and the serum cTnT concentrations differed at the different chemotherapy time points (P < .001). Receiver operating characteristic curve analysis showed that the area under the curve value for MCI was higher than other quantitative parameters of imaging; for MCI, the area under the curve was 0.799, the Youden index was 0.683, the sensitivity was 77.80%, and the specificity was 90.50%.
3DSTE is helpful for early detection of damage to left ventricular function in patients with breast cancer treated with anthracycline drugs, and MCI is the most sensitive observation index among the parameters tested.
应用三维斑点追踪技术（3DSTE）评价蒽环类药物化疗后乳腺癌患者左心室功能的变化。
回顾性分析 2020 年 12 月至 2022 年 12 月齐齐哈尔医学院附属第三医院经病理确诊的 30 例乳腺癌患者的临床资料，所有患者均接受蒽环类药物化疗，化疗前 24~48 h 及 1 个周期、4 个周期化疗后检测血清心肌肌钙蛋白 T（cTnT）浓度，同时进行常规超声心动图、常规二维超声心动图及 3DSTE 检查，获取左心室整体长轴应变、整体面积应变、整体圆周应变、整体径向应变及扭转值等动态图像及参数，计算心肌综合指数，比较化疗前后的变化。对各参数绘制受试者工作特征曲线，计算曲线下面积。
除左心室舒张末期内径及舒张末期室间隔厚度外，其余常规超声心动图参数在 3 个化疗时间点均有差异（均 P<.001）。3DSTE 测量参数随着蒽环类药物累积剂量的增加而逐渐下降，且不同时间点比较差异均有统计学意义（均 P<.001），其中以心肌综合指数下降最明显。9 例患者在化疗 4 个周期后血清 cTnT 浓度高于正常值，不同化疗时间点比较差异有统计学意义（P<.001）。受试者工作特征曲线分析显示，心肌综合指数的曲线下面积值大于其他影像学定量参数；对于心肌综合指数，曲线下面积为 0.799，约登指数为 0.683，灵敏度为 77.80%，特异度为 90.50%。
3DSTE 有助于早期发现接受蒽环类药物化疗的乳腺癌患者左心室功能损伤，其中心肌综合指数是检测参数中最敏感的观察指标。
