The Study Of Using Tissue Doppler Imaging To Appreciate Cardiotoxicity Of Anthracycline Intervened By Dexrazoxane

Objective: Anthracycline, which is considered as the first-linechemotherapy agent in breast cancer, can significantly increase the mortalityand curative ratio. However, the most serious side effect-cardiotoxicity limitsthe dose. The cardiotoxicity of anthracycline was first reported by Lefrak in1973, and some other scholars argue that the cardiotoxicity of anthracyclinewas more serious than the recurrent risk. The cardiotoxicity of anthracyclinewas regarded as the considerable side effect and the noninvasive monitoringfor cardiac function is also very important. Left ventricular ejection fraction(LVEF), as one of the cardiac function index, is widely used in clinicalexamination. However, the changes of LVEF just appeared when sufferingserious damage or at the late stage of cardiotoxicity. So LVEF cannot showobvious changes during the early damaged period yet. Thus it is expected tofind a new method to monitor the cardiotoxicity of anthracycline earlier,noninsively and sensitively. Tissue doppler image, a new technology ofdetecting the myocardial motion, was widely used in cardiovascular specialty,and little research about the cardiotoxicity of anthracycline was reported.Kapusta et al. found that TDI can detect the abnormality which theechocardiography cannot find through the research about children who weresuffered from anthracycline. The result indicated that TDI can detect thedamage of myocardial without the effect of cardiac load during and afterchemotherapy. This thesis is going to explore the clinical value ofechocardiography and tissue doppler imaging (TDI) in assessing cardiacfunction damage and the early using of dexrazoxane (DEX) in breast cancerpatients receiving anthracycline (ATC) chemotherapy.Methods: There were40breast cancer patients without cardiovasculardiseases before chemotherapy. And4courses of chemotherapy were treated by EC.40patients were divided into two groups: I group (20patients weretreated by anthracycline); and II group (20patients were treated byanthracycline and dexrazoxane). These patients were examined byechocardiography，tissue doppler imaging before chemotherapy and4coursesof chemotherapy later by using PHILIPS iE33colour doppler ultrasonicsystem and were saved by ultrasonic imaging information system. Besides theroutine echocardiography parameters, we pay more attention on the ratiobetween early mitral inflow velocity and mitral annular early diastolic velocity(E/Ea) and Tei index. Isovolumetric contraction index (ICT／ET) andisovolumetric relaxation index (IRT／ET)were included in Tei index.Results： In I group, compared with the baseline(beforechemotherapy),the value of E, Ea, and E/Ea decreased(P＜0.001), IRT/ET andTei index increased（P＜0.05）.There was no remarkable difference of thevalue of ICT/ET between prechemothrapy and postchemotherapy. In II group,compared with the baseline, there were no significant differences of the valueof E、E/Ea, ICT/ET, IRT/ET and Tei index except Ea(P＜0.05).No matter in Igroup or in II group, the value of LVEF was no significant difference(P＞0.05).Conclusions：E/Ea value measured by TDI, which reflects the leftventricular diastolic function, and Tei index, which reflects myocardialperformance, can appreciate cardiotoxicity induced by anthracycline earlier. Itis more sensitive than the value of LVEF measured by echocardiography.Given DEX can decrease the cardiotoxicity induced by anthracycline.