三维斑点追踪技术评估蒽环类药物对乳腺癌患者右室心肌功能的影响

目的 探讨三维斑点追踪(3D-STI)技术评估蒽环类药物对乳腺癌患者右室心肌功能影响的临床应用价值.方法 选取行蒽环类药物化疗的乳腺癌患者46例,均于化疗前1 d及化疗2、4、6周期后1 d行3D-STI检查及99mTc-MIBI和18F-FDG双核素显像检查,测量其三尖瓣环收缩期血流速度(S)和位移(TAPSE)、右...

Influence of right ventricular myocardial function in breast cancer patients with anthracycline chemotherapy by three-dimensional speckle tracking

Objective To explore the clinical application value of three-dimensional speckle tracking(3D-STI)technique in evaluating the right ventricular myocardial function in breast cancer patients with anthracycline chemotherapeutic.Methods A total of 46 patients with breast cancer treated with anthracycline were enrolled,they were examined by 3D-STI and 99mTc-MIBI and 18F-FDG of binuclein imaging 1 d before chemotherapy,and 1 d after 2,4 and 6 cycles of chemotherapy.The systolic blood flow velocity and displacement of tricuspid annulus(S,TAPSE),right ventricular area change fraction(RV-FAC),left/right ventricular end-diastolic volume(LV-V/RV-V),left ventricular ejection fraction(LVEF),right ventricular global longitudinal strain(RVGLS),circumferential strain(RVGCS),radial strain(RVGRS)and area strain(RVGAS)were measured.The differences of the above parameters at different time points were compared,and Pearson correlation analysis was used to analyze the correlation among RVGLS,RVGAS and conventional echocardiographic indexes and 3D-STI parameters.ROC curves was drawn to evaluate the diagnostic efficiency of RVGLS and RVGAS in predicting right ventricular dysfunction.Results Before and after 2,4,6 cycles of chemotherapy,the comparison of S,TAPSE,RV-FAC,RV-V,LV-V,LVEF had no significant difference.3D-STI examination showed the RVGLS was decreased after 2,4,6 cycles of chemotherapy compared with that before chemotherapy,and the RVGAS was decreased after 4,6 cycles of chemotherapy compared with that before chemotherapy(all P<0.05).Compared with 2 cycles of chemotherapy,the RVGLS and RVGAS were decreased after 4 and 6 cycles of chemotherapy(all P<0.05).The RVGLS and RVGAS after 6 cycles of chemotherapy were lower than those of 4 cycles of chemotherapy(both P<0.05).Correlation analysis showed that RVGLS was correlated with S,TAPSE,RV-FAC,RV-V,LV-V,LVEF,RVGCS,RVGRS and RVGAS(r=0.260,0.267,0.202,0.210,0.165,0.188,0.286,0.199,0.848,all P<0.05),RVGAS was also associated with S,TAPSE,RV-FAC,RV-V,LV-V,LVEF,RVGLS,RVGCS,RVGRS(all P<0.05).ROC curve analysis showed that taking RVGLS<16.99%and RVGAS<20.57%as cutoff values,the sensitivity and specificity of predicting right ventricular dysfunction were 73.1%,96.2%and 90.0%,65.0%,respectively,the area under the curve were 0.879 and 0.830,respectively.Conclusion 3D-STI has high value in the evaluation of right ventricular myocardial function in breast cancer patients with anthracycline chemotherapy,it can be used as an important monitoring method for early right cardiac function changes.