| 摘要: |
| 目的 探讨2D-STI技术对蒽环类药物化疗期间心电图表现不同且常规超声心动图无阳性发现的乳腺癌患者左室心肌受损的应用价值。方法 选取乳腺癌术后化疗患者38例及对照组30例，乳腺癌化疗患者于化疗前1天（T0）、每周期化疗后第21天（T1、T2、T3、T4）行超声心动图检查。根据任一化疗周期内心电图（ECG）情况将乳腺癌化疗患者分为两组：ECG正常组（12例）和ECG异常组（26例）。2D-STI技术获取以下参数：左室心内膜下、中层、心外膜下三层心肌收缩期纵向峰值应变（GLSendo、GLSmid、GLSepi）、左室18节段纵向应变达峰时间标准差（Tls-SD）及最大差值（Tls-dif）、左室舒张早期纵向峰值应变率（LSRe），并计算E/LSRe比值。结果：与T0、T1、T2、T3期比较，ECG正常组与异常组患者T4期E/e’显著增高（P＜0.05），且同一化疗周期内两组患者间E/e’无统计学差异（P＞0.05）；与T0、T1、T2、T3期比较，ECG正常组与异常组患者T4期GLSendo、GLSmid、GLSepi、LSRe均显著减低（P＜0.05），Tls-SD、Tls-dif、E/LSRe均显著增大（P＜0.05）；与ECG正常组患者比较，ECG异常组患者T4期E/LSRe显著增大（P＜0.05），同一化疗周期内两组患者间余上述参数无统计学差异（P＞0.05）。结论 2D-STI技术获取的应变及应变率参数较常规超声参数更敏感识别蒽环类药物化疗进程中乳腺癌患者左室功能变化；无论化疗期间是否出现心电图异常，乳腺癌化疗患者左室心肌收缩、舒张功能都已有受损，且化疗期间出现心电图异常患者左室舒张功能受损更甚；E/e’、LSRe、E/LSRe可能将更敏感地反映蒽环类化疗药物对乳腺癌患者左室舒张功能的影响。 |
| 关键词: 应变 应变率 心电图 乳腺癌 化疗 左室功能 |
| DOI： |
| 投稿时间：2021-12-03修订日期：2022-01-28 |
| 基金项目: |
|
| Evaluation of left ventricular function in breast cancer patients with different electrocardiogram manifestations during anthracycline chemotherapy cycles by two-dimensional speckle tracking imaging technology |
| Wan Mengting,Chen jinling,zhao zhiyu,Mei dan e,Feng chuangli,Yu caigui,Zhou qing,Chen chuang |
| (Renmin Hospital of Wuhan University) |
| Abstract: |
| Objective To evaluate left ventricular systolic and diastolic function of breast cancer patients undergoing anthracycline chemotherapy by strain and stain rate parameters and to explore the application value of recognition of myocardial damage in those patients with different ECG performance and negative 2DE results during anthracycline chemotherapy by 2D-STI technology. Methods 38 breast cancer patients treated by anthracycline chemotherapy and 30 controls were recruited. Echocardiography were performed before and after1, 2, 3, 4 chemotherapeutic cycle (T0, T1, T2, T3, T4). 38 breast cancer patients were divided into normal ECG group (12 cases) and abnormal ECG group (26 cases) according to ECG results.2D-STI strain and strain rate parameters included the longitudinal peak systolic strain of three-layers myocardium (GLSendo, GLSmid, GLSepi), standard deviations and maximal differences of time to peak regional LS（Tls-SD，Tls-dif） in all 18 segments, longitudinal peak strain rate in early diastolic (LSRe) and E/LSRe. Results Compared with E/e’ of T0, T1 T2 or T3, E/e’ of T4 increased significantly in both the normal ECG group and abnormal ECG group (p<0.05), but there was no significant difference between the two groups at the same chemotherapy cycle (p>0.05). Compared with GLSendo、GLSmid、GLSepi、Tls-SD、Tls-dif、LSRe and E/LSRe of T0, T1, T2, and T3, GLSendo、GLSmid、GLSepi、LSRe of T4 decreased significantly and Tls-SD、Tls-dif、E/LSRe of T4 increased significantly both in the two groups(p<0.05). There was no significant difference between the two groups in GLSendo、GLSmid、GLSepi、LSRe of the same chemotherapy cycle (p>0.05). But E/LSRe of T4 in patients of normal ECG group was significantly higher than that of abnormal ECG group. Conclusion Strain and strain rate parameters by 2D-STI may be more sensitive than conventional ultrasound parameters in identification of chemotherapeutic-related cardiac dysfunction. The left ventricular systolic and diastolic function of breast cancer patients were impaired after anthracycline chemotherapy, regardless of with or without abnormal ECG. For patients with abnormal ECG results, left ventricular diastolic function may impair more severely. In addition, E/e"", LSRe and E/LSRe may be more suitable to assess left ventricular diastolic function in breast cancer patients undergoing anthracycline chemotherapy. |
| Key words: strain, strain rate, electrocardiography, breast cancer, chemotherapy, left ventricular function |
