超声心动图三维斑点追踪技术对乳腺癌曲妥珠单抗治疗中心脏毒性评估的应用

  目的  探讨超声心动图三维斑点追踪技术对乳腺癌曲妥珠单抗治疗中心脏毒性评估的应用。  方法  选取昆明医科大学第一附属医院2020年11月至2022年7月收治的应用曲妥珠单抗治疗乳腺癌患者65例，分别在治疗后3个月、6个月、9个月、12个月后给予常规超声心动图及三维斑点追踪技术（three-dimensional speckle tracking technique，3D-STI），观察不同时间点的心脏指标参数的差异，包括左室射血分数（LVEF）、左房容积指数（LAVI）、二尖瓣舒张早期血流速度/二尖瓣环舒张早期移动速度（E/Em）、二尖瓣环舒张早期移动速度/二尖瓣环舒张晚期移动速度（Em/Am）、二尖瓣环收缩期移动速度（Sm）、二尖瓣舒张早期血流速度（E峰）、二尖瓣舒张晚期血流速度（A峰）、二尖瓣舒张早期环移动速度（Em）、二尖瓣舒张晚期环移动速度（Am）、左室扭转（LVtw）、左室整体纵向应变（GLS）、整体环周应变（GCS）、整体径向应变（ GRS）、整体面积应变GAS ）指标。  结果  治疗后3个月、6个月、9个月、12个月相关参数和治疗前相比，LAVI、E/Em、Am有所升高，Em/Am和Em有所下降，LAVI和E/Em之间呈正相关性；与治疗前相比，治疗后3个月、6个月、9个月、12个月的LVEF、GLS、GRS、LVtw、GCS、GAS均有所下降（P < 0.05）。  结论  乳腺癌患者应用曲妥珠单抗治疗时应用超声心动图三维斑点追踪技术效果理想，可以早期、准确对心脏毒性情况进行判断，可以为早期治疗提供参考依据，改善预后、临床结局方面价值显著。

Evaluation of Cardiotoxicity in Trastuzumab Treatment of Breast Cancer Using Three-dimensional Speckle Tracking Echocardiography

  Objective  To investigate the application of three-dimensional speck tracking echocardiography in the evaluation of cardiotoxicity in trastuzumab treatment of breast cancer.   Methods  A total of 65 breast cancer patients treated with trastuzumab in the First Affiliated Hospital of Kunming Medical University from November 2020 to July 2022 were selected. Conventional echocardiography and three-dimensional speckle tracking technique （3D-STI） were performed 3, 6, 9, and 12 months after treatment. The differences in cardiac parameters at different time points were observed. The parameters included left ventricular ejection fraction （LVEF）, left atrial volume index （LAVI）, early diastolic mitral flow velocity/early diastolic mitral annular flow velocity （E/Em）, early diastolic mitral annular flow velocity/late diastolic mitral annular flow velocity （Em/Am）, early diastolic mitral annular flow velocity （Sm）, and early diastolic mitral annular flow velocity （E/Em）. Peak E）, peak late diastolic mitral flow velocity （peak A）, early diastolic mitral annular velocity （Em）, late diastolic mitral annular velocity （Am）, left ventricular torsion （LVtw）, global longitudinal strain （GLS）, global circumferential strain （GCS）, global radial strain （GRS）, global area strain （GAS）.   Results  Compared with those before treatment, LAVI, E/Em and Am increased 3 months, 6 months, 9 months, and 12 months after treatment, while Em/Am and Em decreased. LAVI and E/Em were positively correlated. Compared with before and after treatment, LVEF, GLS, GRS, LVtw, GCS and GAS decreased 3, 6, 9 and 12 months after treatment （P < 0.05）.   Conclusions  The application of three-dimensional echocardiographic speck tracking technology in the treatment of breast cancer patients with trastuzumab has an ideal effect, which can judge the cardiotoxicity more early and accurately, provide a reference for early treatment, and has value in improving prognosis and clinical outcome.