2D-STI和TDI对左侧乳腺癌患者放化疗相关心脏毒性事件的诊断价值

目的探讨二维斑点追踪成像(2D-STI)、组织多普勒成像(TDI)对左侧乳腺癌患者放化疗后的相关心脏毒性的诊断价值。方法选取2017年9月至2018年9月唐山市中医医院收治的女性左侧乳腺癌患者36例进行前瞻性研究,采用随机数字表法将患者分为单纯化疗组(n=20)和放化疗组(n=16)。单纯化疗组患者未接受胸壁放疗,放化疗组患者接受胸壁放疗。采用数字表法随机选取同期经常规体检、心电、超声心动图检查均未发现异常的健康女性20例作为对照组。2D-STI检测三组研究对象的左室整体纵向应变(GLS);TDI检测三组研究对象的二尖瓣环侧壁早期舒张速度(lateral e')及室间隔侧早期舒张速度(septal e')。根据《中国成年人超声心动图检查测量指南》定义左室功能障碍,分析与左室功能障碍相关的影响因素。结果与对照组(GLS 17.59%,lateral e'13.53%,septal e'10.02%)相比,单纯化疗组(GLS 15.27%,lateral e'10.55%,septal e'8.25%)和放化疗组患者(GLS 14.34%,lateral e'9.41%,septal e'6.46%)均显著降低,差异具有统计学意义(P<0.05);此外,与单纯化疗组(GLS 15.27%和septal e'8.25%)相比,放化疗组患者(GLS 14.34%和septal e'6.46%)显著降低,差异具有统计学意义(P<0.05)。GLS异常发生概率<15.10%定义为左室收缩功能障碍,单纯化疗组和放化疗组患者中GLS异常发生概率分别为50.0%和37.5%,两组组间比较差异无统计学意义(P>0.05);两组分别与对照组比较,差异均具有统计学意义(P<0.05)。三组患者均没有发生左室舒张功能障碍。患者服用蒽环类药物剂量与GLS的关系为负相关(r=-0.51,P<0.05),并且GLS异常的独立危险因素是高剂量蒽环类药物(>300 mg/m^2)(OR=6.86,95%CI:1.48~40.35,P=0.03)。结论2D-STI以及TDI能够有效检测左侧乳腺癌患者放化疗相关的心脏毒性事件,左室收缩功能障碍的独立危险因素是高剂量蒽环类药物。

Diagnostic significance of 2D-STI and TDI techniques for cardiac toxicity of patients with left breast cancer after radiotherapy and chemotherapy

Objective To investigate the diagnostic value of tissue doppler imaging(TDI)and 2-D specular tracing imaging(2D-STI)in the cardiac toxicity of patients with left breast cancer after radiotherapy and chemotherapy.Methods A prospective study was conducted in 36 female with left breast cancer patients admitted to Tangshan Traditional Chinese Medicine Hospital from September 2017 to September 2018.Patients were divided into chemotherapy group(n=20)and radiotherapy and chemotherapy group(n=16)according to different treatment methods.Twenty healthy women who had no abnormalities detected by routine physical examination,ECG and echocardiography were randomly selected as the control group by digital table method.2D-STI was used to detect left ventricular global longitudinal strain(GLS)in these groups.TDI was used to detect the early diastolic velocity(lateral e')of the mitral annulus and the early diastolic velocity(septal e').2D-STI measures left ventricular global longitudinal strain(GLS);TDI measures mitral annulus wall,ventricular septal side diastolic early tissue velocity(lateral e',septal e').Left ventricular dysfunction was defined according to the Guidelines for Measurement of Echocardiography in Chinese Adults,and the influencing factors associated with left ventricular dysfunction were analyzed.Results Compared with the control group(GLS 17.59%,lateral e'13.53%,septal e'10.02%),the chemotherapy alone group(GLS 15.27%,lateral e'10.55%,septal e'8.25%)and patients in the radiotherapy group(GLS14.34%,lateral e'9.41%,septal e'6.46%)were significantly lower,the difference was statistically significant(P<0.05);in addition,compared with the chemotherapy alone group(GLS 15.27%and septal e'8.25%'),the patients in the radiotherapy group(GLS 14.34%and septal e'6.46%)were significantly lower,the difference was statistically significant(P<0.05).The probability of GLS abnormality<15.10%was defined as left ventricular systolic dysfunction.The probability of abnormal GLS in the chemotherapy group and the radiotherapy group was 50.0%and 37.5%,respectively.There was no significant difference between the two groups(P>0.05).The difference between chemotherapy group and control group was statistically significant,and the difference between radiotherapy and chemotherapy group and control group was also significant(P<0.05).There were no left ventricular diastolic dysfunction in each group.GLS was negatively correlated with onion ring dose(r=-0.51,P<0.05),and high-dose anthracyclines(>300 mg/m^ 2)were independent risk factors for GLS abnormalities(OR:6.86,95%CI:1.48~40.35,P=0.03).Conclusion 2D-STI and TDI can effectively detect cardiotoxic events associated with chemoradiotherapy in breast cancer patients.High-dose anthracyclines are independent risk factors for left ventricular systolic dysfunction.