Early detection of cardiotoxicity by 3D speckle tracking imaging of area strain in breast cancer patients receiving chemotherapy

Eighty‐three breast cancer patients who underwent six cycles of EC chemotherapy regimen (epirubicin + cyclophosphamide) without symptoms and signs of heart disease were enrolled in the study. Three‐dimensional speckle tracking imaging technique (3D‐STI) was used to measure left ventricular global area strain (GAS), overall annular strain (GCS), overall longitudinal strain (GLS), and overall radial strain (GRS). Meanwhile, serum troponin T (Hs‐cTnT) was measured. The clinical value of each index on cardiotoxicity after chemotherapy was analyzed using the receiver operating characteristic (ROC) curve. Hs‐cTnT increased from the early stage to the end during chemotherapy, but it was still in the normal range. During the mid‐chemotherapy and the end‐chemotherapy, GAS, GLS, GCS, and E/A significantly reduced, while the changes in LVESV, LVEDV, LVEF, and GRS were not significant after chemotherapy. Pearson correlation analysis showed a significant negative correlation between GAS and anthracycline doses (r = ?.772, P < .01); GAS and Hs‐cTnT were significantly negatively correlated (P < .05). The area under the curve (AUC) of GAS, GLS, GCS, and GRS are 0.815, 0.683, 0.645, and 0.585, respectively. A GAS of ?31.5% was used as the cutoff value for diagnosing left ventricular systolic dysfunction after receiving chemotherapy. The sensitivity of the previous parameters was 81.9%, and the specificity was 80.3%. Interobserver consistency analysis showed that 3D‐STI strain parameter measurement has good repeatability. GAS has greater value in predicting early myocardial damage after anthracycline chemotherapy.     

Evaluation of cardiac functions in juvenile systemic lupus erythematosus with two-dimensional speckle tracking echocardiography

The aim of this study was to investigate subclinical systolic and diastolic dysfunction in juvenile-onset systemic lupus erythematosus (j-SLE) patients with speckle tracking echocardiography (STE) and the effects of disease activity on left ventricular (LV) regional functions. Thirty-five patients with j-SLE and 30 healthy children (control group) were evaluated between January and August 2015. STE was performed on all patients and controls. Medical records, including diagnosis criteria, age at diagnosis, and duration of disease, were evaluated. SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI). j-SLE patients had lower ejection fraction than did control subjects but still within normal range. LV end-diastolic and end-systolic dimensions were significantly larger in j-SLE patients (32.43?±?3.2 vs 28.3?±?3.1 and 21.1?±?1.9 vs 18.9.0?±?2.2, respectively; p?=?0.001). There was a significant reduction in longitudinal strain of LV segments in the j-SLE patients compared with controls. J-SLE patients were further divided into subgroups. Group 1 comprised patients having SLEDAI scores >8 at the onset of disease but who improved with therapy during follow-up. Group 2 included j-SLE patients with SLEDAI scores >8 at diagnosis and persistently >4 at the end of follow-up. In the LV mid-inferior and mid-inferolateral segments, STE strain measurements of group 2 were significantly lower than those of group 1 (15.9?±?6.4 vs 20.0?±?4.4, 17.9?±?7.2 vs 23.2?±?3.8; p?=?0.075, p?=?0.055, respectively). Simple and non-invasive STE would be helpful in predicting cardiovascular prognosis with new therapeutic medications/interventions or in objectively comparing the effects of immunosuppressive drugs in comparison with preceding STE evaluation.     

超声二维斑点追踪技术评价右心室功能的研究进展

右心室功能的准确评价在多种心肺疾病的诊断分级和预后判断中起着重要作用。由于右心室形态结构复杂、功能影响因素较多，现有评价右心室功能的传统超声心动图指标，如三尖瓣瓣环平面收缩期位移、右心室面积变化率等，在临床应用和预后价值方面仍存在一定的局限性。近年来，随着斑点追踪技术的发展，已经开始应用于多种临床及亚临床状态下右心室整体及局部功能评估，在心衰、肺动脉高压以及肿瘤化疗心脏损伤等方面展现了其独特的优越性。本文就二维斑点追踪技术在右心室功能评价方面的临床应用作一综述。     

Feasibility of assessing cardiac systolic function using longitudinal fractional shortening calculated by two-dimensional speckle tracking echocardiography

Background: The left ventricular longitudinal fractional shortening (LVLFS) evaluated by the speckle tracking method reflects the longitudinal contraction of left ventricle (LV). We aimed to evaluate the accuracy of LVLFS as an index of LV systolic function. Methods: Two hundred thirty‐three patients with or without heart failure (HF) were divided into four groups according to the progress of HF. Conventional echocardiography and two‐dimensional speckle tracking echocardiography (2DSTE) were performed in all subjects. Besides, cardiac magnetic resonance (CMR) images were acquired in a subgroup of 30 patients with poor echo image quality. LVEF was measured using the biplane Simpson's method by two‐dimensional echocardiography and CMR, respectively. LVLFS was calculated using QLAB 7.0, which performed speckle tracking analysis automatically. Results: Generally, LVLFS declined accordingly with the progression of HF (P < 0.05). In a liner regression model, LVLFS correlated well with conventional LVEF (r = 0.856, P < 0.001). In the subgroup study performed in patients with poor acoustic windows, LVLFS correlated better with LVEF measured by CMR than conventional LVEF measured using biplane Simpson's method (r = 0.899 vs. 0.848). As for the reproducibility, better intra‐ and interobserver variability was observed in LVLFS than in conventional LVEF (6.2 ± 3.5% vs. 8.5 ± 4.7% and 7.8 ± 5.6% vs. 11.3 ± 6.2%, P < 0.05), especially for patients with poor image quality. Besides, measurement of LVLFS is much less time‐consuming than conventional LVEF. Conclusions: The results of this study suggest a linear relationship between LVLFS and LVEF. LVLFS may provide sensitive and accurate assessment of LV systolic function, and its measurement reproducibility is better than that of LVEF. (Echocardiography 2011;28:402‐407)     

二维斑点追踪成像在缺血性心肌病伴糖尿病患者心室功能评估中的临床应用价值

目的探讨二维斑点追踪成像在缺血性心肌病(ICM)伴糖尿病患者心室功能评估中的临床应用价值。方法入选2016年6月至2018年7月在上海交通大学医学院附属瑞金医院住院或门诊就诊的ICM患者,根据有无糖尿病分为糖尿病组和非糖尿病组,各128例。应用斑点追踪成像测量各个切面的圆周应变(SC)及圆周应变率(SrC)、径向应变(SR)及径向应变率(SrR)、纵向应变(SL)及纵向应变率(SrL),分析两组间的差异以及各参数与N末端脑钠肽前体(NT-proBNP)、纽约心脏协会(NYHA)心功能分级间的相关性。结果 (1)ICM伴糖尿病患者斑点追踪成像显示的室壁运动功能较不伴糖尿病的患者更差。(2)3个切面观的SL、SrL在两组中差异均有统计学意义(t=-2.320～-2.052,均P <0.05)。(3)在ICM伴糖尿病患者中,SL、SrL与NT-proBNP、NYHA心功能分级间的相关性较非糖尿病患者更明显。(4)ICM伴糖尿病患者较非糖尿病患者的室壁运动减弱程度在各个节段有所不同。结论二维超声斑点追踪成像可更灵敏地发现ICM伴糖尿病患者的室壁运动减弱并评估其最严重受损节段,其中SL及SrL是评估这部分患者心室功能的最佳参数。     

Erratum to: Evaluation of cardiac functions in juvenile systemic lupus erythematosus with two-dimensional speckle tracking echocardiography

Clinical Rheumatology -     

Evaluation of left and right ventricle by two-dimensional speckle tracking echocardiography in systemic sclerosis patients without overt cardiac disease

Clinical Rheumatology - The aim was to evaluate the left and right ventricular functions concurrently by two-dimensional speckle tracking echocardiography (STE) in systemic sclerosis (SSc) patients...     

Differentiating cardiac amyloidosis and hypertrophic cardiomyopathy by use of three-dimensional speckle tracking echocardiography

Introduction: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three‐dimensional (3D) speckle tracking‐derived functional parameters enabled differentiation of CA and HCM by a disease‐specific pattern. Methods: Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast‐enhanced cardiovascular magnetic resonance (CMR). Three‐dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (?%)], and circumferential [CS (?%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers. Results: Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the “physiological” gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear “inverse pattern” in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =–0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR‐derived diagnosis “CA” and “HCM.” Conclusions: Three‐dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a “function‐pattern‐based” differentiation of amyloidosis and HCM. (Echocardiography 2012;29:668‐677)     

二维斑点追踪技术评价白大衣高血压患者左心房功能

目的采用二维斑点追踪技术评价白大衣高血压(white-coat hypertension,WCH)患者左心房功能。方法选取辽宁中医药大学附属第二医院诊断为WCH的患者59例作为WCH组,健康体检者48例作为对照组。所有受试者均进行诊室血压和动态血压测量。运用常规超声心动图评价左心室舒张和收缩功能。运用二维斑点追踪技术测量左心房储备期纵向应变及应变率(LASr,LASRr),通道期纵向应变及应变率(LAScd,LASRcd)和收缩期纵向应变及应变率(LASct,LASRct),分别评价左心房储备功能、通道功能和泵功能。结果 WCH组诊室收缩压和诊室舒张压均高于对照组(t=12.34、15.36,P <0.05);而两组之间动态血压平均值差异无统计学意义(P> 0.05)。WCH组Mitral e'小于对照组,而Mitral E/e'大于对照组(t=6.52、6.76、8.35、8.61,P <0.05);两组之间左心室射血分数(LVEF)差异无统计学意义(P> 0.05)。WCH组LAScd和LASRct小于对照组(t=4.08、2.84,P<0.05),LASct和LASRcd大于对照组(t=4.14、6.10,P<0.05);两组之间LASr和LASRr差异无统计学意义(P> 0.05)。WCH患者诊室收缩压和舒张压与LAScd和LASRct呈负相关(r=-0.21～-0.36,P <0.05),与LASRcd和LASct呈正相关(r=0.27～0.34,P <0.05)。结论 WCH患者左心房通道功能减低,而左心房泵功能增强,左心房功能与诊室血压密切相关。     

二维斑点追踪技术评估右室心梗患者右心房功能的价值

目的 探讨二维斑点追踪技术（2DSTE）评估右房功能用于早期监测右室心肌梗死的价值。方法 随机入组左室下壁心肌梗死（INFMI）患者56例,其中单纯左室下壁心肌梗死（INFMI）34例、左室下壁心肌梗死合并右室心肌梗死（INFMI RVMI）22例,分别作为对照组及病例组。二维超声心尖四腔观测量右房上下径、左右径及面积;彩色多普勒测量三尖瓣血流图E峰值、A峰值及减速时间（DT）;组织多普勒测量三尖瓣瓣环右心室游离壁侧收缩期s′、舒张早期e′及舒张晚期a′;运用2DSTE评价右心房功能,测量右房收缩期应变（SS）、舒张早期应变（EDS）、舒张晚期应变（LDS）。结果 病例组（INFMI RVMI）的右房SS、LDS比对照组（INFMI）明显减低（P<0.05）。右心房LDS截值<6.88％时,鉴别INFMI RVMI与INFMI的AUC为0.834（灵敏度64.71％,特异度94.12％）;SS截值<8.44％时,鉴别INFMI RVMI与INFMI的AUC为0.713（灵敏度41.18％,特异度88.24％）。结论 与INFMI的患者相比,INFMI RVMI患者的右心房储器和收缩功能受损更为显著。二维斑点追踪技术可评价右室心梗患者的右房功能,右房LDS、SS可以提示左室心梗合并右室心梗可能。     

Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes

BackgroundThe aim of the study was to explore the relation between regional myocardial dysfunction and fragmented QRS (fQRS) complexes in systemic sclerosis (SSc).MethodsFifty-three SSc patients and 26 controls were included. All subjects underwent speckle tracking echocardiography for evaluation of left ventricular (LV) function and ECG to check for fQRS complexes.ResultsSSc patients had significantly lower LV global longitudinal, radial and circumferential strain and twist compared to controls. Thirteen SSc patients had fQRS (DII, DIII, aVF leads in eleven patients and V1 to V5 leads in two patients) and they had significantly lower global longitudinal and circumferencial strain compared to SSc patients with normal QRS. The SSc patients with fQRS in DII, DIII, and aVF leads had impaired longitudinal strain and delay in time to peak longitudinal strain in inferior LV segments compared to those with normal QRS.ConclusionfQRS is associated with lower strain measures in SSc patients indicating impairment in LV function.     

二维斑点追踪成像评价肝硬化失代偿期患者心室功能的价值

目的 探讨应用超声心动图结合斑点追踪成像技术评估肝硬化患者心室功能的价值.方法 纳入2017年1月至2019年12月暨南大学附属顺德医院收治的45例肝硬化患者,并从同期体检对象中选择年龄、性别相匹配的45名健康对照者.应用二维超声心动图和斑点追踪成像技术评估两组研究对象的左、右心室功能,观察并比较两组左、右心室结构和功...     

Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction (AMI) is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging (2D-STI) in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention (PCI) in 30 patients with AMI, who had a left anterior descending coronary artery (LAD) culprit lesion. In addition, 20 patients who had minimal stenotic lesions (< 30% stenosis) on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability (hazard ratio: 31.22, P < 0.01). Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.     

二维斑点追踪超声心动图评价非缺血性心肌病和缺血性心肌病的左心室功能

目的 应用二维斑点追踪超声心动图(2D-STE)评价非缺血性心肌病(NICM)和缺血性心肌病(ICM)的左心室功能变化.方法 选择2014年9月-2017年2月华中科技大学同济医学院附属同济医院心血管内科收治的心脏扩大且合并左心室收缩功能降低的84例患者,根据冠状动脉造影结果分为NICM组43例和ICM组41例.行常规...     

Left atrial function by two-dimensional speckle tracking echocardiography in patients with severe rheumatic mitral stenosis and pulmonary hypertension

We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE). Eighty patients with isolated severe MS in sinus rhythm and 40 controls underwent comprehensive echocardiography including STE derived LA strain [reservoir strain (LAS_r), conduit strain (LAS_cd) and contractile strain (LAS_ct)]. The mean MVA was 0.93 ± 0.21 cm². The mean values of LAS_r (14.73 ± 8.59%), LAS_cd (?7.61 ± 4.47%) and LAS_ct (?7.16 ± 5.15%) in patients were significantly lower (p < 0.001) vs. controls 44.11 ± 10.44%, ?32.45 ± 7.63%, ?11.85 ± 6.77% respectively and showed decreasing trend with increasing MS severity and higher NYHA class. In conclusion, LA dysfunction is prevalent in severe MS irrespective of NYHA functional class.