Assessment Of Chronic Right Ventricular Function Changes In Asymptomatic Patients With Breast Cancer After Anthracycline-based Chemotherapy By Echocardiography

Objective:To evaluate the changes of chronic right ventricular function in asymptomatic patients with breast cancer after anthracycline-based chemotherapy by echocardiography,and to investigate the diagnostic value of ultrasonic parameters.Methods:A total of 52 patients who received anthracycline(ATC)treatment were selected from the breast surgery department of the Affiliated Hospital of North Sichuan Medical College,and divided into two groups according to the time of the completion of chemotherapy:group A:25 patients after anthracycline treatment for 1-3 years,group B:27 patients after anthracycline treatment for more than 3 years.Another 30 healthy female volunteers served as control subjects.Dynamic two-dimensional images were collected at standard left ventricular long axis view and apical four-chamber view to obtain parameters,such as left ventricular end-diastolic anteroposterior diameter(LVEDD),two dimensional left ventricular ejection fraction(LVEF),right ventricular end-diastolic basal diameter(RVEDD),tricuspid annular plane systolic excursion(TAPSE)and tricuspid valve diastolic peak flow velocity(E).By measuring the right ventricular end diastolic and end systolic area,the right ventricular fractional area change(RV-FAC)was calculated.Tissue Doppler imaging(TDI)was used to obtain the systolic,early and late diastolic tricuspid annular velocity s,e,a,E/e,e/a,and tei-index of right ventricle.Echo-Pac software was used to acquire the right ventricular free wall global longitudinal peak systolic strain(GLS),global longitudinal peak systolic,peak early and late diastolic strain rate(GLSRs,GLSRe,GLSRa).The changes of each parameters among the three groups were compared.The receiver operating characteristic(ROC)curve was plotted to predict the diagnostic efficacy of echocardiographic parameters for evaluation value of right ventricular function impairment.Results:(1)Compared with the control group,TAPSE and RV-FAC were decreased in both groups A and B,and the difference was statistically significant(P<0.05)[control group vs.A vs.B:TAPSE:(23.93±2.68)mm vs.(21.64±2.23)mm vs.(21.67±2.34)mm;RV-FAC:(58.53±10.30)%VS.(50.95±8.00)%vs.(47.98±9.07)%].(2)There were no significant changes among group A,B and control group in e,a,S,E/e and e/a,However,compared with the control group,RV-tei increased in the chemotherapy group(P<0.05)[control group vs.A vs.B:(0.40±0.10)vs.(0.47±0.09)vs.(0.49±0.08)].(3)The RV-GLS、GLSRs and GLSRe in groups A,B were significantly lower than that in control group(P<0.05),but there were no significant difference among group A,B and control group in GLSRa(P>0.05).Compared with group A,RV-GLS decreased in group B(P<0.05)[control group vs.A vs.B:RV-GLS:(-24.86±1.98)%vs.(-22.32±1.45)%vs.(-20.94±2.23)%;GLSRs:(-1.57±0.16)/s vs.(-1.37±0.18)/s vs.(-1.37±0.17)/s;GLSRe:(1.61±0.19)/s vs.(1.43±0.15)/s vs.(1.42±0.18)/s].(4)The area under ROC curves of RV-GLS predicted the right ventricular function impairment was the highest,which was 0.886.When the cutoff value was-23.2%,the sensitivity was 84.6%and the specificity was 80%.Conclusions:(1)Subclinical impairment of chronic right ventricular systolic function exists in asymptomatic breast cancer patients after anthracycline chemotherapy,and diastolic function tends to decrease.The right ventricular systolic function shows mild and persistent decline with the prolongation of time.(2)TAPSE,RV-FAC,RV-Tei and 2D-STI can be used to detect right ventricular function damages caused by ATC,among which GLS in 2D-STI is a sensitive indicator.