| 摘要: |
| 目的 应用二维斑点追踪成像（2D-STI）技术评估乳腺癌患者曲妥珠单抗化疗相关的左心室和右心室收缩功能的早期改变，探究其在评价化疗相关早期亚临床心脏毒性中的应用价值。 方法 回顾性分析我院确诊有明显病例分型并接受曲妥珠单抗化疗的乳腺癌患者89例，共3个化疗周期，一个化疗周期为3周。于化疗前基线水平（T0）、3个化疗周期（T1、T2、T3）分别行一次超声心动图检查，测量左心室和右心室常规超声参数，应用2D-STI测量左心室和右心室整体纵向峰值应变（LVGLS和RVGLS）。心脏毒性定义为左心室射血分数下降，且低于基线水平的10%。以化疗过程中出现心脏毒性为临床结局，应用Logistic回归和ROC曲线分析T1期各参数对化疗相关的早期亚临床心脏毒性的预测价值。结果22例（24.7%）患者在化疗周期中出现心脏毒性（心脏毒性组），67例（75.3%）未发生心脏毒性（无心脏毒性组）。发生心脏毒性的患者，其T2期LVEF低于基线水平的18%，而LVGLS和RVGLS于T1期、T2期均显著低于基线水平。ROC曲线和Logistic回归分析表明T1期的RVGLS联合LVGLS是预测乳腺癌化疗相关早期亚临床心脏毒性的最佳指标，其诊断敏感性为98%，特异性为75%。结论 无明显左室射血分数降低的曲妥珠单抗化疗乳腺癌患者，其T1期LVGLS和RVGLS已经发生减低，2D-STI技术有助于早期发现化疗相关的亚临床心脏毒性。 |
| 关键词: 斑点追踪成像 乳腺癌 曲妥珠单抗 心脏毒性 心室功能 |
| DOI： |
| 投稿时间：2019-06-28修订日期：2019-07-08 |
| 基金项目: |
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| Evaluation of early subclinical heart toxicity associated with trastuzumab chemotherapy in breast cancer patients by speckle tracking imaging |
| Jiang Yao,Cheng Jing |
| (Ultrasound Department of Chongqing Traditional Chinese Medicine Hospital) |
| Abstract: |
| 【Abstract】 Objective Two-dimensional ultrasonic speckle tracking imaging (2D-STI) was used to evaluate the early changes of left ventricular and right ventricular systolic function in patients with breast cancer. To explore its clinical value in evaluating early subclinical cardiotoxicity associated with chemotherapy with trastuzumab. Methods A total of 89 patients with breast cancer who were diagnosed in our hospital and received trituximab chemotherapy were analyzed retrospectively. there were 3 chemotherapy cycles and one chemotherapy cycle was 3 weeks. The baseline level before chemotherapy (T0), the first cycle (T1), the second cycle (T2) and the third cycle (T3) were examined by echocardiography, and the routine echocardiography parameters were measured. The global longitudinal peak strains (LVGLS and RVGLS) of left ventricle and right ventricle were measured by 2D-STI. Cardiotoxicity is defined as a decrease in left ventricular ejection fraction, which is less than 10% of the baseline level. With the occurrence of cardiotoxicity in the course of chemotherapy as the clinical outcome, the working characteristic (ROC) curve and Logistic regression analysis were used to analyze the predictive value of the parameters to the early (T1) cardiotoxicity associated with chemotherapy. Results 22 patients (24.7%) had cardiotoxicity during the chemotherapy cycle (cardiotoxicity group) and 67 patients (75.3%) had no cardiotoxicity (non-cardiotoxicity group). In patients with cardiotoxicity, T2 LVEF was lower than 18% of the baseline level, while LVGLS and RVGLS were significantly lower than the baseline level in T1 and T2. ROC curve and Logistic regression analysis showed that T1 RVGLS combined with LVGLS was the best index to predict early subclinical cardiotoxicity associated with chemotherapy in breast cancer. The diagnostic sensitivity and specificity were 98% and 75%, respectively. Conclusion In patients with breast cancer who had no significant decrease in left ventricular ejection fraction (LVEF), LVGLS and RVGLS in stage T1 had been decreased, 2D-STI technique is helpful for the early detection of chemotherapy-related subclinical cardiotoxicity. |
| Key words: Speckle tracking imaging breast cancer tritiazumab cardiotoxicity ventricular function |
