Evaluation Of Left Ventricular Systolic Function In Breast Carcinoma Patients Undergoing Chemotherapy By Two-dimensional Speckle Tracking Imaging And Left Ventricular Pressure-strain Loops

Objective: To evaluate the influence of anthracycline-induced cardiotoxity on left ventricular myocardial function by two-dimensional speckle tracking imaging(2D-STI)and left ventricular pressure-strain loop(LV-PSL)in breast carcinoma patients.Methods:Forty patients who were newly diagnosed of breast carcinoma and planed to undergo anthracycline-based chemotherapy were prospectively included from March 2019 to December 2019 in the Fourth Clinical Medical College of Xinjiang Medical University.All patients received the levels of creatine kinase(CK),creatine kinase isoenzymes(CKMB)and conventional two-dimensional speckle tracking echocardiographs at baseline(T0),as well as after the chemotherapy of 2 cycles(T2),4 cycles(T4)and 6 cycles(T6)of the regimen.The brachial artery cuff blood pressure was also obtained.Each myocardial layer of global longitudinal strain(Endo GLS,Mid GLS and Epi GLS)were measured by 2D-STI.Myocardial work were measured in global myocardial work index(GWI),global constructive work(GCW),global wasted work(GWW)and global MW efficiency(GWE)by LV-PSL.Results: Compared with T0,CK and CKMB were significantly different in T2,T4 and T6.Conventional echcardiographic parameters including left ventricular end-diastolic dimension(LVDD),interventricular septal thickness(IVSTD),early diastolic transmitral velocity(E),late diastolic transmitral velocity(A),E/A and left ventricular ejection fraction(LVEF)had no significant difference during the 4 phases.T4 and T6 showed lower level of GWI(1927.68±207.58 mm Hg% and 1853.30±208.32 mm Hg%)and GCW(2191.68±212.14 mm Hg% and 2127.32±217.13 mm Hg%)than T0,with statistical difference(P<0.05).T6 showed lower absolute value of Endo GLS(-22.97±1.81%),Mid GLS(-20.32±1.62%)and Epi GLS(-18.06±1.53%)than T0,with statistical difference(P<0.05).Endo GLS has a higher correlation with GWI and GCW(r=-0.57 and r=-0.56,all P<0.001).Conclusion: Cardiac cells were damaged in early stage of anthracyclines chemotherapy.Compared with 2D-STI,LV-PSL is more sensitive to detect the influence of left ventricular myocardial function in breast carcinoma patients after anthracyclines chemotherapy.GWI and GCW are sensitive indicators for the early detection of myocardial damage.