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安徽医科大学第一附属医院超声科
纸质出版日期:2021,
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[1]朱小凤,刘贝,张金鑫,曹雷,郑慧.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[J].临床超声医学杂志,2021,23(03):191-194.
ZHU Xiaofeng, LIU Bei, ZHANG Jinxin, et al. Influence of right ventricular myocardial function in breast cancer patients with anthracycline chemotherapy by three-dimensional speckle tracking[J]. Journal of Clinical Ultrasound in Medicine, 2021,23(3):191-194.
[1]朱小凤,刘贝,张金鑫,曹雷,郑慧.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[J].临床超声医学杂志,2021,23(03):191-194. DOI: 10.16245/j.cnki.issn1008-6978.2021.03.012.
ZHU Xiaofeng, LIU Bei, ZHANG Jinxin, et al. Influence of right ventricular myocardial function in breast cancer patients with anthracycline chemotherapy by three-dimensional speckle tracking[J]. Journal of Clinical Ultrasound in Medicine, 2021,23(3):191-194. DOI: 10.16245/j.cnki.issn1008-6978.2021.03.012.
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
99m
Tc-MIBI和
18
F-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)、右室面积变化分数(RV-FAC)、左/右室舒张末容积(LV-V/RV-V)、左室射血分数(LVEF)、右室整体纵向应变(RVGLS)、圆周应变(RVGCS)、径向应变(RVGRS)及面积应变(RVGAS)
比较不同时间点上述参数的差异。采用Pearson相关分析法分析RVGLS、RVGAS与常规超声心动图指标及3D-STI指标的相关性;绘制受试者工作特征(ROC)曲线评估RVGLS和RVGAS预测右室心肌受损的诊断效能。结果化疗前及化疗2、4、6周期后
S、TAPSE、RV-FAC、RV-V、LV-V及LVEF比较差异均无统计学意义。3D-STI检查显示
与化疗前比较
化疗2、4、6周期后RVGLS均降低
化疗4、6周期后RVGAS均降低(均P
<
0.05);与化疗2周期比较
化疗4、6周期后RVGLS和RVGAS均降低(均P
<
0.05);化疗6周期后RVGLS和RVGAS均较化疗4周期降低(均P
<
0.05)。相关性分析显示
RVGLS与S、TAPSE、RV-FAC、RV-V、LV-V、LVEF、RVGCS、RVGRS、RVGAS均相关(均P
<
0.05)
RVGAS与S、TAPSE、RV-FAC、RV-V、LV-V、LVEF、RVGLS、RVGCS、RVGRS均相关(均P
<
0.05)。ROC曲线分析显示
以RVGLS
<
16.99%和RVGAS
<
20.57%为截断值
其预测右室心肌受损的敏感性、特异性分别为73.1%、96.2%和90.0%、65.0%
曲线下面积分别为0.879、0.830。结论 3D-STI评估蒽环类药物对乳腺癌患者右室心肌功能影响有较高价值
可作为临床早期监测右心功能改变的重要方法。
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
99m
Tc-MIBI and
18
F-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.
超声心动描记术斑点追踪三维乳腺肿瘤恶性蒽环类药物心室功能右心脏毒性
EchocardiographySpeckle trackingthree-dimensionalBreast tumormalignantAnthracyclineVentricular functionrightCardiotoxicity
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