The Application Of Gated Equilibration Ventriculography In The Heart Function Assessment Of Cancer Patients

PartⅠThe comparison of the left heart function assessment between Gated equilibration ventriculography and EchocardiogramPurpose:This study is to analyze the parameters of the left ventricular systolic and diastolic function by Gated equilibration ventriculography and echocardiogram and to compare the difference or correlation of the heart function test between the two techniques.Methods:ALL 42 patients(22 tumor patients before treatment as non-therapy group,20 volunters as normal group) were studied, each one underwent Gated equilibration ventriculography and echocardiography test in two days..Independent-sample T test was used to compare the heart function between the two groups.Paired T test and correlation were used to compare the heart function by the two techniques.Results:There was no statistically difference of the heart function parameters between the two techniques,which tested by Gated equilibration ventriculography and echocardiography.When the non-therapy group and normal group analysed seperately,there also no difference of the heart function parameters between the two techniques.There was correlation between Gated equilibration ventriculography and echocardiogram in the assessment of left ventrial ejection fraction(LVEF)(r=0.678,P＜0.01). In the tumor group or normal group,there still were good correlation between Gated equilibration ventriculography and echocardiogram in the assessment of LVEF,r seperately was 0.642 and 0.646.LVEF tested by Gated equilibration ventriculography was lower than that by echocardiogram.The average differences were separately 2.61±4.45%(P＜0.01) in the total comparetion,2.81±4.06%(P＜0.01) in the tumor group,2.40±4.94%(P＜0.05) in the normal group.The ratio of transmitral E and A(E/A) accessed by the color Doppler positively correlated to the ratio of transmitral E and A(Ea/Aa) assessed by the TDI(Tissue Doppler Imaging),(r=0.802,P＜0.01).The peak filling rate(PFR) by Gated equilibration ventriculography was positively correlated with Ea/Aa by TDI,r=0.530, P＜0.01.There still was statistically correlation between PFR and Ea/Aa in the normal group,while there was no correlation between PFR and Ea/Aa in the tumor group.Conclusion:The heart function parameters of tumor patients before treatment are the same as those of the normal persons.The LVEF in the tumor PartⅡThe analyses of the left heart function in breast cancer patients by Gated equilibration ventriculography afer different therapy Purpose:It is very important that we should concern the affection both of the compound therapy to the heart function of the breast cancer patients,which may change the therapy plan or the prospect of the patients.This study is to analyze the affection of age,condition of the disease and different therapy to the heart function in the breast cancer patients and to find out the risk factor.Methods: The Gated equilibration ventriculography results of 106 breast cancer patients were retrospective reviewed.Analyzed the therapy of the patients one year before the heart scan,which included 28 cases received CEF(cyclophosphamide,epirubicin, 5-fluorouracil) chemotherapy,29 cases received taxame-based chemotherapy,27 cases received CEF-T(cyclophosphamide,epirubicin,5-fluorouracil,taxol) chemotheraphy,22 cases received radiation therapy,30 cases received endo,43 cases received targeted therapy.The relationship among the age,TNM stage,different therapy and the parameters of the heart function test was discussed by univariate analyses.The variance analysis was used to analyze the affection of different chemotherapy to the parameters of heart function and two-independent T test was used to compare the rEF(regional ejection fraction) between the left and right chest radiation therapy.Results:Different chemotherapy plan is the independent risk factors affecting the parameters such as LVEF,PER,PFR,1/3EF whose wald are separately 0.466,0.431,0.360,0.280(P＜0.05).The location of the tumor and radiation therapy are the interaction factors affecting LVEF and PFR(P＜0.05).Comparing chemotherapy plan between each other,we found that there were significantly differences of LVEF,PER,PFR,1/3EF between the non-chemotherapy patients and each chemotherapy plan.The LVEF,PER,PFR of the CEF chemotherapy are lower than those of the other two chemotherapy plan(P＜0.01 ). There is no statistically difference of heart function between the CEF-T and the T chemotherapy plan.The lateral rEF of the left chest radiotherapy was lower than that of the right,while the ventricularseptal rEF of the right chest radiotherapy was lower than that of the left,no matter the kind of chemotherapy plan had been before the radiotherapy.In the patients with CEF or CEF-T chemotherapy,the LVEF and PFR after left chest radiotherapy were lower than those after right chest radiotherapy.Conclusion:The chemotherapy is the independent factor which can affect the heart function.The anthracycline chemotherapy can affect the heart systolic and diastolic function.The degree of the effection depended on the cumulative dose.No matter the kind of chemotherapy plan was,the breast cancer radiatiotherapy may affect the regional ejection fraction,The radiation therapy yield is consistent with the changes of the heart regional ejection fraction.Gated equilibration ventriculography can effectively monitor the heart function of breast cancer patients after chemotherapy and radiotherapy.PartⅢThe application of gated equilibration ventriculography in the breast cancer patients with targeted therapyPurpose:The targeted therapies of the breast cancer improve the outcome of the patients,however,the cardiotoxicity with targeted therapy may affect the treatment consistence.So closely monitor of the heart function has got the clinical concerns.This study is to prospect breast cancer patients who received lapatinib monotherapy or lapatinib combining with taxeme-based chemotherapy and to observe the targeted therapy affection to the heart function.Methods:60 patients were divided into two groups by different treatment,group A(25 cases) received lapatinib combining with taxeme-based chemotherapy and group B(35 cases) received lapatinib monotherapy.All the patients were taken gated equilibration ventriculography in three different times when before therapy,6 months and 12 months after therapy.The parameters which including LVEF,PER,PFR,1/3EF,l/3FF,TPER and TPFR were observed.The variance analysis was used to compare parameters of different times in the same group and two-independent T test was used to compare the parameters of two groups.Result:24 patients and 16 patients were followed after 6 months and 12 months in group A,34 patients and 28 patients were followed after 6 months and 12 months in group B.In group A,the PER 12 months after therapy is lower than that before therapy(3.64±0.68 vs 3.10±0.40;P＜0.05) while there is no statistics difference between 6 months after therapy and before therapy;the PFR 6 months after therapy was declined statistically,and declined one more step after 12 months(3.61±1.02,3.11±0.84,2.79±0.64;P＜0.05).In group B,the PFR declined 12monthes after treatment(2.86±0.55 vs 3.23±0.87,P＜0.05).There were no other significant differences among different monitor time in the both group.Conclusion:The lapatinib monotherapy and lapatinib combined with taxeme-based chemotherapy both can affect patients' heart function.The lapatinib combined with taxeme-based chemotherapy may decrease the PER and PFR,which affect the diastolic function earlier than systolic function.The lapatinib monotherapy may affect the diastolic function.The lapatinib combined with taxeme-based chemotherapy can infect diastolic function more and earlier than lapatinib monotherapy.PER and PFR may be more sensitive to assess heart function changes than LVEF.Gated equilibration ventriculography can effectively monitor the heart function of breast cancer patients during targeted therapies.