The Synchronous Study On Multi-indicators Of Cadiac Toxicity In Patients After Breast Cancer Chemotherapy

Objective:Echocardiography（ECHO）,electrocardiogram（ECG）,and serum myocardium enzymes were used to assess the toxic effects of cardiac function in patients with breast cancer after anthracycline therapy.The purpose of the study is to compare the sensitivity of the three measures.Methods:70 cases from January 2012 to December 2017 in Breast Surgery Department,were diagnosed with breast cancer by pathological examination.The patients were aged 24-66years and had a median of 53 years.All enrolled patients without uncontrolled hypertension and diabetes during the treatment period never had genetic disease,familial disease,other malignancies,or cardiovascular disease,radiotherapy and was treatmented consisitently by anthracycline chemotherapy in our hospital during follow-up period.Observed indicators after or before chemotherapy are as follows:1、ECHO:left ventrical ejection fraction（LVEF）,left ventrical short-axis fractional shortening（LVFS）,Mitral early diastolic flow velocity（E）,Mitral late diastolic flow velocity（A）,E/A ratio,mitral annular early diastolic velocity（E’）,mitral annular late diastolic velocity（A’）,E’/A’ratio,E/E’ratio and TDI-Tei index.2、ECG:Whether there is an arrhythmia,T wave changes,ST-T segment changes,QT interval changes,PR interval changes,QRS wave abnormalities,electrical axis deflection,conduction block,etc.3、Serum biochemical tests:Determination of serum myocardial enzyme concentrations,including aspartate aminotransferase（AST）,alphahydroxybutyrate dehydrogenase（HBD）,creatine kinase（CK）,creatine kinase isozyme（CK-MB）,Lactate dehy-drogenase（LDH）.The obtained variables were divided into measurement data and count data and were performed with the paired T test,independent sample t test,paired Chi square test,Fisher’s exact probability method for the four table data,and Chi square test of R×C list,Chisquared and nonparametric rank sum tests by SPSS 22.0statistical software.The difference was considered statistically significant at P<0.05.Results:In 34 patients with breast cancer,the TDI-Tei index was 0.525±0.118 before anthracycline chemotherapy,and the TDI-Tei index was 0.648±0.135 after chemotherapy.The TDI-Tei index was significantly increased early,,and the difference compared with before chemotherapy was statistically significant(t=6.567,P=1.836×10^-7).The TDI-Tei index before and after chemotherapy in 19 patients without diabetes or hypertension were 0.509±0.987 and 0.629±0.113,respectively.There was a significant difference between before and after chemotherapy(t=6.485,P=4×10^-6).The TDI-Tei index before and after chemotherapy in 15 patients with diabetes or hypertension was 0.543±0.141 and 0.671±0.159,respectively.There was a significant difference between before and after chemotherapy（t=0.159,P=0.004）.There was no significant difference in TDI-Tei index between patients with basic disease and those without basic disease.There was no significant difference（P>0.05）.Echocardiographic indicators for assessing systolic and diastolic function,including LVEF,FS,E,A,E/A,E/E’,E’,A’,E’/A’,electrocardiogram,and serum myocardial enzymes had less change before and after chemotherapy,and the difference of change was not statistically significant（P>0.05）.In addition,the positive rates of three indicators of chemotherapeutic cardiotoxicity monitoring results were different.The positive rate of TDI-Tei index was 84.2%among 19 patients after chemotherapy,and the positive rate of serum myocardial enzyme was 41.2%in 17 patients after chemotherapy.The difference in positive rate between the two groups was statistically significant（χ²=7.202,P=0.007）.The positive rate of ECG after chemotherapy in 31 patients was 61.3%,which was not statistically different from the positive rate of serum myocardial enzymes（χ²=1.789,P=0.181）.Conclusions:With an increase in the dose of anthracyclines,heart function impairment in patients with chemotherapy will increase.Compared with ECG,ECHO routine monitoring indicators,and serum myocardial enzymes,TDI-Tei index can sensitively reflect cardiac toxicity in patients with breast cancer chemotherapy.Mild hypertension or diabetes in patients did not affect the assessment of the cardiotoxicity of chemotherapeutic drugs by the TDI-Tei index.