| Objective Malignant tumor is a common clinical disease.Chemotherapy is one of the important methods for the treatment of malignant tumors.However,the myocardial damage caused by it has been widely recognized in the clinic.The strategy to reduce the cardiotoxicity of chemotherapy drugs including anthracyclines is knowing fully the risks of cardiotoxicity,strengthening cardiac function monitoring and guiding the adjustment of dosage before and after treatment.Therefore,searching the effective monitoring methods for cardiotoxicity of chemotherapeutic drugs has increasingly become a focus of clinical research.Echocardiography is widely used in clinical and research for the detection of cardiac function and early assessment of myocardial damage because of its non-invasive,simple,moderate price,and good reproducibility.Speckle tracking imaging technology is a new echocardiography technology that can quantitatively evaluate the local and overall systolic and diastolic function of the patients by tracking the echogenic spots of myocardial tissue.The purpose of this study was to investigate the clinical value of two-dimensional and three-dimensional speckle tracking imaging techniques in evaluating the effects of chemotherapy drugs on early left ventricular dysfunction in patients with cancer,and to find the most effective strain parameters for early left ventricular dysfunction.Methods Two-dimensional and three-dimensional speckle tracking imaging techniques were used to monitor 79 postoperative patients with breast cancer treated with anthracyclines and 94 different tumors with three chemotherapy protocols before chemotherapy,early chemotherapy,mid-chemotherapy,and end-chemotherapy.Patient's echocardiographic parameters,2D and 3D speckle tracking strain parameters(2D and 3D left ventricular global longitudinal strain,3D radial strain,circumferential strain,area strain,2D left ventricular global early diastolic and late diastolic strain rate and overall systolic longitudinal strain rate)were examined,at same time monitoring ECG and serum troponin content.Then the correlation between strain parameters and troponin as well as the correlation between strain parameters and chemotherapeutic drug concentrations were analyzed.For exploring the application value of speckle tracking technology,especially three-dimensional speckle tracking technology in the monitoring cardiotoxicity derived from chemotherapy drug,the sensitivity and specificity of each strain parameter to determine early left ventricular dysfunction were analyzed.Results 1.The total abnormal rate of electrocardiogram in the whole chemotherapy cycles of 79 breast cancer patients was 8.86%,the total detection rate of abnormal electrocardiogram of 94 different tumor groups was 10.64%.2.There were no significant changes in the routine parameters of LVESV,LVEDV,LVEF,LVFS,LVIDd,IVS and LVPWd from pro-chemotherapy to endchemotherapy.The difference was not statistically significant(P>0.05).However,the mitral valve E / A radio at end-chemotherapy decreased,it compared with before-chemotherapy,the difference was statistically significant(P <0.05),reflecting the decline in left ventricular diastolic function at the end of chemotherapy.3.The parameters of GAS and GLS of 3D-STI in the fourth cycle of chemotherapy and the sixth cycle of chemotherapy were significantly lower than those before chemotherapy,and the difference was statistically significant.The GCS measurement in the sixth cycle of chemotherapy was also lower than that before chemotherapy.The difference was statistically significant.The change of GRS in the chemotherapy cycle was small.There was a slight decrease in the GRS value at the end of chemotherapy.The change was not statistically significant.2D-STI GSRe,GSRa decreased significantly at mid-chemotherapy and end-chemotherapy,but GLS,GSRs only decreased at the end of chemotherapy.4.ROC curve derived from 3D-STI strain parameters showed the largest area under the GAS curve,the sensitivity and specificity of judging left ventricular systolic dysfunction after chemotherapy were 81.9% and 80.3%,respectively,when the GAS cutoff value was-31.5%.The diagnostic sensitivity and specificity of GLS are second.The area under the overall longitudinal axis strain ROC curve of 3D-STI and 2D-STI is 0.749 and 0.683,respectively.By-20.1% and-16.5% for the GLS cutoff values of 3D-STI and 2D-STI to determine the sensitivity of left ventricular dysfunction due to anthracyclines were 74.7% and 59.5%,respectively,specificity was 53.4% and 50.4%.The sensitivity and specificity determining the left ventricular function changes by 3D-STI overall longitudinal strain are higher than 2D-STI.The sensitivity and specificity of GRS in judging the impairment of left ventricular systolic function after chemotherapy are lower.5.The concentration of Hs-cTnT in each cycle of chemotherapy increased gradually,while compared with that before chemotherapy.The difference was statistically significant(F=109.065,P<0.0001),but the measured value was still within the normal range.By comparing the changes of serum high-sensitivity troponin T concentration in three different chemotherapy potocols,experiment 2 can be seen that all three chemotherapy potocols caused different degrees of troponin elevation.Among them,patients with TAC had the largest increase in troponin,followed by paclitaxel plus cisplatin,and FOLFOX4 had the lowest.Pearson correlation analysis showed that the GAS of 3D-STI was negatively correlated with the concentration of Hs-cTnT in each chemotherapy cycle(r=-0.250,P=0.023,the second cycle of chemotherapy,r=-0.274,P=0.012,The sixth cycle of chemotherapy was r=-0.338,P=0.002);the strain parameters before chemotherapy to the end-chemotherapy were negatively correlated with the cumulative dose of the drug(r=-0.772,p<0.05).6.Repeatability test shows that the three-dimensional speckle tracking technology has better repeatability of strain parameter measurement.Conclusions Chemotherapy drugs can produce different degrees of cardiac toxic and side effects.The troponin,a marker of myocardial injury,is gradually increasing in all stages of chemotherapy.By comparing the changes of serum high-sensitivity troponin T concentration in three chemotherapy potocols,we found anthracyclines may cause subclinical damage to heart damage,no matter which chemotherapy protocol,even FOLFOX4 protocol will have a certain impact on the heart.Therefore,it is important to find indicators that effectively monitor the toxicity of chemotherapy drugs.Both ECG and LVEF examinations are not ideal monitoring methods.Speckle tracking imaging technology can quantitatively evaluate left ventricular function changes before and after chemotherapy.Strain parameters,especially left ventricular global area strain and left ventricular total longitudinal strain can be used for monitoring the cardiotoxicity of chemotherapy drugs.The repeatability is good.Three-dimensional speckle tracking imaging technology can be used to judge the left ventricular function changes after chemotherapy.Its sensitivity and specificity are superior to two-dimensional speckle tracking techniques. |
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