Two-dimensional Speckle Tracking Imaging Detects Changes In Left Ventricular Global Systolic Function And Torsion After Epirubicin Chemotherapy In Patients With Breast Cancer

Part1. Two-dimensional speckle tracking imaging detects changes in left ventricular global systolic function after epirubicin chemotherapy in patients with breast cancerObjective To assess left ventricular global systolic function in breast cancer patients after epirubicin chemotherapy by two-dimensional speckle tracking imaging (2D-STI).Methods Thirty women with histologically confirmed breast cancer were prospectively studied.Two-dimensional images were recorded from the apical four-, two-chamber, long-axis views, and from basal, the papillary muscles and apical LV short-axis. Then the images were stored for off-line analysis of2D speckle-tracking myocardial strain. Global peak longitudinal (GLS), radial (GRS) and circumferential (GCS)2D systolic strain and strain rate were measured within1week before and within3days after the fourth cycle of chemotherapy (every21days for1cycle,4cycles spend3months) and the cumulative dose of the drug was231.21-402.68mg/m2.Results Compare with before, GLS and GRS were significantly reduced after4cycles of treatment. At baseline, GLS and GRS values were-19.70±1.93%and33.37±7.89%, respectively, and they significantly decreased to-18.71±2.14%and30.00±7.48%(both P<0.05) after4cycles of treatment. In contrast, conventional echocardiographic parameters, left ventricular global peak systolic strain rate and GCS did not show significant changes throughout follow-up (P>0.05). Neither age nor cumulative dose was found significant association with the changes of left ventricular strain parameters before and after chemotherapy (all P>0.05).Conclusion Myocardial systolic function was impaired in the early stages of epirubicin chemotherapy, especially longitudinal and radial systolic function.2D-STI has its value for early detecting subclinical damage of left ventricular global systolic function after epirubicin chemotherapy, which has the application value of guiding the early clinical intervention and estimating prognosis. Objective To evaluate the changes of left ventricular (LV) bulk rotation and untwisting in breast cancer patients after epirubicin chemotherapy by two-dimensional speckle tracking imaging (2D-STI).Methods Thirty-nine women aged47.9±7.7years with histologically confirmed breast cancer were prospectively studied. Conventional and Doppler echocardiography images were obtained from the patients within1week before and within3days after the fourth cycle of chemotherapy (every21days for1cycle,4cycles spend3months). The cumulative dose of epirubicin was231.21～428.57mg/m2at the fourth cycle. After standard echocardiography, LV torsion and twisting degree, velocity and time profiles from apical and basal short-axis images were analysed using2D-STI, whereas LV ejection fraction (LVEF) were determined by Simpson’s method.Results①Doppler and two-dimensional echocardiographic parameters did not show significant changes during chemotherapy (P<0.05).②There were no significant differences in the direction and shape of left ventricular torsion-and velocity-time curves. The systolic rotation reached its peak value near the end-systole in both the basal and apical planes in patients both before and after treatment. Systolic rotation reached its peak value at end-systole in both groups (before group94.89±24.06%vs after group101.35±10.73%).All the times to peak untwisting velocity during early diastole did not show significant changes before and after chemotherapy (P<0.05).③Peak LV torsion degree (P=0.008), peak untwisting velocity during early diastole (P=0.025), peak apical rotation degree (P=0.013) and peak apical untwisting velocity during early diastole (P=0.039) were significantly higher in patients after treatment than before.④Compared with before,peak LV systolic torsion/twisting velocity, peak basal rotation degree and peak basal untwisting velocity during early diastole did not show significant changes (P<0.05).⑤Peak apical twisting degree correlated significantly with the LV peak systolic torsion degree (P<0.05). Peak apical untwisting velocity and LV peak untwisting velocity during early diastole correlated significantly with their Corresponding torsion/twisting degrees, respectively (P<0.05).⑥Neither age nor cumulative dose was found significant association with the changes of left ventricular torsion/twisting parameters before and after chemotherapy (all P>0.05).Conclusion Myocardial systolic function was impaired in the early stages of epirubicin chemotherapy. Peak apical rotation might be the main compensatory mechanism to maintain normal LVEF in patients with subclinical epirubicin cardiotoxicity. Torsion analysis was useful for the evaluation of subclinical myocardial damage mediated by epirubicin.2D-STI has its value for early monitoring left ventricular bulk rotation and untwisting after epirubicin chemotherapy.