Evaluation Of Changes In Mechanical Properties Of Right Ventricular Myocardium In Patients With Radical Mastectomy After Receiving Pirarubicin By Three-dimensional Speckle Tracking Imaging

Objective To evaluate the changes of mechanical properties and to probe the clinical value of three-dimensional speckle tracking echocardiography（3D-STI）in evaluating the early myocardial dysfunction of right ventricular myocardial dysfunction in patients undergoing radical mastectomy after the application of pirarubicin.Methods Thirty-six patients were selected,all of whom were treated with pirarubicin according to the plan after radical resection of breast cancer.On the basis of routine echocardiography,3D-STI was used to test the mechanical changes of RVM in patients before chemotherapy（C1）,at the end of the second,fourth,and sixth cycles of chemotherapy（C2,C3,C4）.At the same time,serum hypersensitive troponin（hs-cTnI）and N-terminal B-type pro-natriuretic peptide（NT-proBNP）were measured.And 31 patients underwent ^99mTc-MIBI and ¹⁸F-FDG myocardial perfusion/metabolism imaging at C4.Myocardial perfusion abnormalities and survival were analyzed according to radionuclide imaging results.Conventional ultrasound parameters measured included right ventricular diastolic volume（RV-V）,right ventricular fraction of area change（RVFAC）,tissue Doppler echocardiography of tricuspid annular plane systolic excursion（TAPSE）,tissue doppler tricuspid annulus systolic velocity（S’）,left ventricular diastolic volume（LV-V）and left ventricular ejection fraction（LVEF）.Therightventricularmyocardial deformation parameters based on three-dimensional strain include:right ventricle global longitudinal strain（RVGLS）,right ventricle global circular strain（RVGCS）,right ventricle global radial strain（RVGRS）and right ventricle global area strain（RVGAS）.Results（1）RVGLS was significantly lower in group B than that in C2（-22.68±8.02%VS-28.61±1.81%,P<0.05）,while RVGCS（-18.44±1.75%VS-18.19±1.76%）,RVGRS（73.82±4.82%VS 73.85±5.45%）,RVGAS（-35.32±2.25%VS-36.06±2.38%）had no significant difference between the two groups（P>0.05）;RVGLS（-19.25±1.39%VS-28.61±1.81%）and RVGAS（-29.57±2.81%VS-36.06±2.38%）were significantly lower in C3 than in C2（P<0.05）;RVGLS and RVGAS（-15.18±2.69%VS-28.61±1.81%;-21.39±4.15%VS-36.06±2.38%,P<0.05）were continue to decline in C4 than in C2,which were related to the cumulative dose of drug.RVGCS,RVGRS,hs-cTnI and NT-proBNP had no significant difference among the four groups（P>0.05）.（2）RVFAC,S’,TAPSE,RV-V,LV-V and LV-EF had no statistical differences among the four groups（P<0.05）.RVGLS and RVGAS in patients with TAPSE<18mm were significantly less than those patients with TAPSE≥18mm in 6 cycles after chemotherapy（-12.49±1.55%VS-17.09±1.31%;-17.14±1.71%VS-24.43±2.21%,P<0.05）.RVGLS and RVGAS with blood hs-cTnI>0.1 ng/ml were significantly less than those with hs-cTnI<0.1ng/m（-13.03±2.17%VS-16.71±1.86%;-18.08±3.16%VS-23.75±3.02%,P<0.05）.RVGLS and RVGAS in patients with the decline of RVFAC>5%were significantly less than those patients with the decline of RVFAC≤5%（-13.58±2.61%VS-16.59±1.88%;-18.74±3.49%VS-23.76±3.19%,P<0.05）.（3）Analysis showed that there was significant correlation between RVGLS,RVGAS and TAPSE,RVFAC,S’（r=0.43,0.51;0.37,0.26;0.21,0.38;P<0.01）.The ROC curve analysis showed that when the absolute value of RVGLS was less than18.9%,the area under the curve,the sensitivity and the specificity of the decrease of RVFAC>5%was 0.82,94.1%and 89.5%;when the absolute value of RVGAS was less than 27.4%,the area under the curve,the sensitivity and the specificity of the decrease of RVFAC>5%was 0.85、95.2%和89.4%.（4）Among the 36 patients,31 of them were successfully detected by ^99mTc-MIBI and ¹⁸F-FDG radionuclide myocardial perfusion/metabolism imaging,and 17 of them showed no abnormal myocardial perfusion in each segment of the right ventricle（the radionuclide myocardial perfusion/metabolism imaging score was 0¹）.Abnormal myocardial perfusion was found in 2 or more segments of the right ventricle of the 14patients(the radionuclide myocardial perfusion/metabolism imaging score was 2points,but the ¹⁸F-FDG imaging showed obvious blood perfusion/metabolism mismatch,that is,the damaged myocardium was still alive.No radionuclide showed myocardial perfusion defect and the radionuclide myocardial perfusion/metabolism imaging score was 3.).RVGLS（-16.42±1.89%VS 13.05±2.26%）and RVGAS（-23.48±3.21%VS 18.29±3.17%）were significantly increased in 17 patients with normal myocardial perfusion in the right ventricle compared with 14 patients with abnormal myocardial perfusion.Hs-cTnI（0.068±0.018 ng/ml VS 0.123±0.006 ng/ml）was significantly decreased（P<0.05）,while RVGCS（-17.91±1.78%VS-17.25±1.45%）、RVGRS（71.71±5.42%VS 71.57±5.11%）and NT-proBNP（43.31±4.05pg/ml VS45.79±5.42 pg/ml）（P>0.05）had no statistical differences between the two groups.ROC curve showed that,when the absolute value of RVGLS is less than18.2%,the area under the curve,sensitivity and specificity of judging RV damage are0.87,92.9%and 88.2%,when the absolute value of RVGAS was less than 26.8%,the area under the curve,sensitivity and specificity to judge RV damage were 0.86,94.8%and 86.6%,respectively.Conclusion In patients with radical mastectomy,there was no significant change in ventricular global function during the course of chemotherapy with pirarubicin.However,at the end of the second chemotherapy cycle,the longitudinal strain of the right ventricular myocardium began to decline,and at the end of the fourth chemotherapy cycle,both the longitudinal strain and the area strain of the right ventricular myocardium decreased.After that,GLS and GAS were further reduced with the drug dose accumulation.This not only proved that the mechanical damage to the right ventricle of the patient appeared earlier,but also showed that the damage was further aggravated with the accumulation of drug dose.3D-STI could provide an early and reliable new method for evaluation of the change of mechanical properties ofRVM caused by anthracycline.Objective Three-dimensional speck-tracking ultrasound imaging was used to evaluate the effect of dexrazoxane on the changes of myocardial mechanical properties in the right ventricle of breast cancer patients undergoing chemotherapy with pirarubicin and its clinical value was discussed.Methods Sixty-four breast cancer patients who underwent radical surgery and anthracyclines chemotherapy between January 2016 and December 2018 were randomly selected.They were randomly divided into the research group（with dexrazoxane）and the control group（without dexrazoxane）.On the basis of conventional ultrasound examination,3D-STI was used to test the mechanical properties of RVM in patients before chemotherapy,at the end of the sixth cycles of chemotherapy.At the same time,serum hypersensitive troponin（hs-c Tn I）and N-terminal B-type pro-natriuretic peptide（NT-pro BNP）were measured.The parameters of echocardiography include right ventricular fraction of area change（RVFAC）,tissue Doppler echocardiography of tricuspid annular plane systolic excursion（TAPSE）,tissue doppler tricuspid annulus systolic velocity（S’）.The right ventricular myocardial deformation parameters based on three-dimensional strain include the right ventricle global longitudinal strain（RVGLS）,right ventricle global circular strain（RVGCS）,right ventricle global radial strain（RVGRS）,right ventricle global area strain（RVGAS）.Results 1、 Comparison between research groups:（1）Compared with the patients before chemotherapy,the RVGLS（-26.10±2.33% VS-28.60±2.57%）,RVGAS（-35.78±5.60% VS-38.66±5.73%）of the patients after chemotherapy were significantly reduced（P<0.05）.while RVGCS（-17.79±2.26% VS-17.85±2.25%）、RVGRS（74.72±13.46% VS 74.83±13.49%）、hs-c Tn I（0.153±0.061ng/ml VS 0.151 ± 0.062 ng/ml）and NT-pro BNP（68.10±15.21 pg/ml VS 67.66±15.10 pg/ml）had no significant difference（P>0.05）.（2）There were no statistically significant differences between the tricuspid ring systolic displacement（TAPSE 24.51±2.13 mm VS 24.36±1.91mm）,tissue doppler tricuspid ring systolic velocity（S’ 25.58±1.92cm/s VS 25.53±1.89 cm/s）and right ventricular area change fraction（RVFAC 52.69±5.14% VS 52.55±5.10%）in patients of research groups before and after chemotherapy（P>0.05）.2、Comparison between control groups（1）Compared with the patients before chemotherapy,the RVGLS（-24.59±2.36 % VS-28.22±2.15%）、RVGAS（-32.77±6.23% VS-36.40±6.38%）of the patients after chemotherapy were significantly reduced（P<0.05）.while RVGCS（-18.17±2.20% VS-18.22±2.21%）、RVGRS（74.64±13.44% VS 74.73±13.54%）、hs-c Tn I（0.171±0.073ng/ml VS 0.166 ± 0.065ng/ml）、 NT-pro BNP（68.79±15.68 pg/ml VS 67.84±15.11）had no significant difference（P>0.05）.（2）There were no statistically significant differences between the tricuspid ring systolic displacement（TAPSE 24.65±2.11 mm VS 24.49±1.85mm）,tissue doppler tricuspid ring systolic velocity（S 25.88±1.98cm/s VS 25.78±1.87 cm/s）and right ventricular area change fraction（RVFAC 53.02±5.49% VS 52.91±5.04%）in patients of research groups before and after chemotherapy（P>0.05）.3.Comparison between research group and control group（1）There was no significant difference in RVGLS（-28.60±2.57% VS-28.22±2.15%）、RVGCS（-17.85±2.25% VS-18.22±2.21%）、RVGRS（74.83±13.49%VS 74.73±13.54%）、RVGAS（-38.66±5.73% VS-36.40±6.38%）、hs-c Tn I（0.151± 0.062ng/ml VS 0.166 ± 0.065ng/ml）、 NT-pro BNP（67.66±15.10pg/ml VS 67.84±15.11pg/ml）、 TAPSE（24.51±2.13 mm VS 24.65±2.11mm）、S’（25.58±1.92cm/s VS 25.88±1.98cm/s）、RVFAC（52.69±5.14% VS 53.02±5.49%）between research group and control group before chemotherapy（P > 0.05）.（2）There was significant difference in RVGLS（-26.10±2.33% VS-24.59±2.36%）、RVGAS（-35.78±5.60% VS-32.77±6.23%）between research group and control group after chemotherapy（P<0.05）.There was no significant difference in RVGCS（-17.79±2.26% VS-18.17±2.20%）、RVGRS（74.72±13.46% VS 74.64±13.44%）、 hs-c Tn I（0.153 ± 0.061ng/ml VS 0.171 ± 0.073ng/ml）、NT-pro BNP（68.10±15.21pg/ml VS 68.79±15.68pg/ml）、TAPSE（24.36±1.91 mm VS 24.49±1.85mm）、 S’（25.53±1.89cm/s VS 25.78±1.87cm/s）and RVFAC（52.55±5.10% VS 52.91±5.04%）between research group and control group after chemotherapy（P>0.05）.Conclusion 1、At the end of chemotherapy with piriloxacin in breast cancer patients after surgery,although there was no significant change in the overall systolic function of the right ventricle,the longitudinal strain and area strain of myocardial systole decreased based on three-dimensional spot tracking technology.It indicates that the mechanical properties of the right ventricle have been damaged.2、Although there was no significant difference in the ultrasound parameters and blood test indexes between the patients with and without dexrazoxane before chemotherapy.However,at the end of chemotherapy,the longitudinal strain and area strain of myocardial systole in the control group were significantly lower than those in the research group,suggesting that dexrazoxane could alleviate the right ventricular myocardial toxicity of pirarubicin.3、3D-STI may provide a new method for the early clinical and accurate evaluation of the right ventricular myocardial mechanical properties and functional changes in patients receiving pirarubicin chemotherapy after breast cancer surgery.