二维斑点追踪分层应变技术对乳腺癌患者化疗后心脏毒性的评估价值

The Evaluation Value of Two-Dimensional Speckle Tracking Layer-Specific Strain Technique for the Assessment of Cardiotoxicity in Breast Cancer Patients after Chemotherapy

摘要: 目的：应用二维斑点追踪成像(two-dimensional speckle tracking imaging, 2D-STI)评估乳腺癌患者经蒽环类药物化疗后的左心室收缩功能状况，探讨其在监测化疗药物所致心脏毒性方面的应用价值。方法：本研究共纳入我院外科手术后病理诊断为乳腺癌的女性患者30例，每位患者均按治疗方案接受多柔比星化疗。在常规超声心动图的基础上，应用2D-STI分层应变技术监测首次化疗前(C1)、第二化疗周期前1天(C2)、第三化疗周期前1天(C3)以及第四化疗周期前1天(C4)患者左心室心肌内膜、心肌中膜以及心肌外膜的整体纵向应变(GLS-endo、GLS-mid及GLS-epi)及环向应变(GCS-endo、GCS-mid及GCS-epi)。结果：乳腺癌术后，C2、C3、C4与C1相比，患者的超声心动图常规参数和临床基本资料(LVEF, FS, SV, EDV、ESV)、舒张压(BP(d))以及收缩压(BP(s))，均无统计学差异。C2与C1比较，患者的GLS-endo、GLS-mid、GLS-epi、GCS-endo、GCS-mid以及GCS-epi亦无统计学差异。而与C1相比，C3期患者的GLS-endo与GCS-endo显著降低(p < 0.05)，且GLS-mid、GLS-epi、GCS-mid以及GCS-epi有下降趋势，但差异无统计学意义。另外，与C1相比，C4期患者的GLS-endo以及GCS-endo亦显著降低(p < 0.05)，且GLS-mid、GLS-epi、GCS-mid以及GCS-epi亦有下降趋势，但差异无统计学意义。结论：2D-STI分层应变技术可早期定量评价乳腺癌患者经蒽环类药物化疗后所致的左心室毒性状况，为改善预后提供影像学指导。

Abstract: Objective: To evaluate left ventricular (LV) systolic function in patients with anthracycline chem-otherapy by two-dimensional speckle tracking imaging (2D-STI) layer-specific strain, and to in-vestigate the value of 2D-STI in early diagnosis of myocardial toxicity with anthracycline chemo-therapy. Methods: Thirty female patients who were pathologically diagnosed as breast cancer after surgical treatment in our hospital were enrolled and were given doxorubicin chemotherapy according to the plan. On the basis of conventional echocardiography, the application of 2D-STI layer-specific strain technology to monitor before chemotherapy (C1), 1 day before the second cycle (C2), 1 day before the third cycle (C3), and 1 day before the fourth cycle (C4) The global longitudinal strain (GLS-endo, GLS-mid, GLS-epi) and global circular strain (GCS-endo, GCS-mid and GCS-epi) of the patient’s left ventricular endocardium, media and epicardium). Results: Comparing C2, C3, C4 with C1 in patients undergoing chemotherapy after breast cancer surgery, conventional echocardiographic parameters and basic clinical data LVEF, FS, SV, EDV, ESV and diastolic blood pressure (BP(d)) and systolic blood pressure (BP(s))), the difference was not statistically significant; while comparing C2 with C1, GLS-endo, GLS-mid, GLS-epi, GCS-endo, GCS-mid and GCS-epi of patients did not significantly decrease; C3 compared with C1, Patients’ GLS-endo and GCS-endo decreased significantly and the difference was statistically significant (p < 0.05); while GLS-mid, GLS-epi, GCS-mid and GCS-epi had a downward trend, but the difference was not statistically significant; Comparing C3 with C1, patients’ GLS-endo and GCS-endo are significantly reduced and the difference is statistically significant (p < 0.05), while GLS-mid, GLS-epi, GCS-mid and GCS-epi have a downward trend, but The difference was not statistically significant. Conclusion: 2D-STI layer-specific strain technology can be used for early quantitative evaluation of left ventricular cardiotoxicity in patients undergoing anthracycline chemotherapy after radical mastectomy.