| Objective:Noninvasive myocardial work(MW)parameters were used to evaluate the changes of left ventricular function in breast cancer patients undergoing chemotherapy with pegylated liposomal doxorubicin(PLD),and to explore the value of MW in evaluating the early cardiac function injury caused by chemotherapy.MW parameters of patients treated with PLD chemotherapy and patients treated with epirubicin(Epi)chemotherapy were compared,so as to compare the effects of the two drugs on myocardium,providing an important clinical basis for optimal drug selection.Methods:60 female breast cancer patients who were admitted to the Department of General surgery of our hospital from May 2020 to December 2021 were selected and divided into PLD group(30 cases)and Epi group(30 cases)according to their choice of anthracyclines(ACs).Echocardiography was performed and images were stored before chemotherapy and after every two courses of chemotherapy(T0,T2,T4 and T6)in the PLD group,and echocardiography was performed and images were stored in the Epi group before chemotherapy and after the fourth course of chemotherapy(T0 and T4).Another 30 healthy female volunteers with matched general conditions were recruited as normal controls for the same examination.The stored images were imported into the Echo PAC clinical workstation for off-line analysis.Left ventricular pressure-strain loops(PSL)technique was used to obtain MW parameters including global work index(GWI),global work efficiency(GWE),global constructive work(GCW)and global wasted work(GWW),and the differences of parameters within and between groups were compared.Results:1.Comparison of general clinical data: there were no significant differences in age,heart rate,blood pressure systolic pressure,blood pressure diastolic pressure,body weight,body surface area and body mass index between PLD group and Epi group before chemotherapy and control group(all P > 0.05).2.Comparison of parameters before and after chemotherapy in PLD group:(1)early diastolic peak velocity/late diastolic peak velocity(E/A)of mitral valve at T6 were lower than T0 and T2,the difference was statistically significant(P < 0.05).Global longitudinal strain(GLS)at T6 was lower than T0 and T2,the difference was statistically significant(P < 0.05).There were no significant differences in other conventional ultrasound parameters at different chemotherapy stages(all P > 0.05).(2)Myocardial work parameters GWI,GCW and GWE decreased gradually with the progress of chemotherapy,GWI and GCW in T4 and T6 were significantly lower than those in T0(P < 0.05),GWE in T2 was statistically different from T0(P < 0.05),GWE in T4 was lower than that in T2(P < 0.05).GWW increased gradually,and T4 and T6 were significantly higher than T0(P < 0.05).3.Comparison of parameters in PLD group and in Epi group:(1)Before chemotherapy,there were no significant differences in conventional ultrasound parameters and MW parameters between PLD group,Epi group and control group(all P > 0.05).(2)After 4cycles of chemotherapy,GWI,GWE and GCW of PLD group were lower than the control group(all P<0.05),while GWW of PLD group was higher than the control group(P<0.05).GWI,GWE and GCW of Epi group were lower than the control group(all P<0.05),while GWW was higher than the control group(P<0.05).GWI,GWE and GCW of PLD group were higher than the EPI group(all P<0.05).Conclusion:1.MW parameters can be used to detect subclinical cardiac function damage in breast cancer patients undergoing chemotherapy with PLD,providing a new imaging method for clinical real-time monitoring of cardiac function changes in patients undergoing chemotherapy.2.In breast cancer patients who choose PLD for chemotherapy,the changes of MW parameters before and after chemotherapy are smaller than those who choose Epi for chemotherapy,indicating the cardiotoxicity of PLD based chemotherapy regimens was lower than that of Epi based chemotherapy regimens. |
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