Evaluation Of The Left Ventricular Myocardial Dysfunction By Three-dimensional Speckle Tracking Imaging In Breast Cancer Survivors Treated With Anthracycline

0bjective Breast cancer is one of common malignant tumor diseases, the incidence of this disease of women is in the first place among the malignant tumor.As the female lifestyle, eating habits, social status, employment pressure change,the morbidity and mortality of breast cancer show ascendant trend year by year,which has brought great threat to the healthy life of human society.Anthracycline is a kind of broad-spectrum antitumor cytotoxic drugs,whith in joint application with other chemotherapy drugs is the first choice for breast cancer survivors.Anthracycline can improve survival condition of breast cancer survivors, and reduce the chance of recurrence.However,The clinical application value of anthracycline-based drugs is limited by its cardiac toxicity, causing irreversible damage to heart muscle cells.Clinical must pay enough attention to its cardiac toxicity,thus can early detect and make effective treatment for it.3D-STI is a kind of new ultrasound technique developed based on three dimensional image,can reconstruct the 3 dimensional data in real time. 3D-STI can track the myocardial movement in stereo space, accurately evaluate myocardial global and local systolic function.This study is to explore the value of 3D-STI in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving Anthracycline chemotherapy drugs,with the purpose of helping clinical detect the subclinical damage of myocardial function and providing important information for timely adjustment of chemotherapy regimens.Methods21 healthy volunteers served as control subjects.A group of 63 breast cancer postoperative patients were recruited and received a six-cycle epirubicin and cyclophosphamide as adjuvant chemotherapy regimen.By physical examination,electrocardiogram,two-dimensional chocardiography and myocardial enzymes,all of the subjects have normal electrocardiogram and left ventricular ejection fraction,without high cholesterol, diabetes, kidney disease and related cardioascular diseases.Electrocardiogram,Conventional echocardiography and 3D-STl parameters of breast cancer postoperative patients were measured 24-48 hours after the cumulative dose of 0mg/ m2,120mg/ m2,240mg/ m2,360mg/ m2.The receiver operating characteristics(ROC)curves of 3D-STl parameters(GAS,GLS,GCS,GRS)were drawn to determine optimal sensitivity and specificity.Pearson correlation analysis show the relationship of GAS and chemotherapy drugs dose.Results1. Compared to the data of control and before chemotherapy subjects,E/A at the end of the chemotherapy decreased significantly(P < 0.05). Comparison of control and chemotherapy subjects in age,ESV,EDV,LVEF,LVFS,LVIDd,IVS and LVPWd,all data had no significantly difference(P>0.05).2. Compared to the data of control and before chemotherapy subjects, GAS and GLS after the cumulative dose of 240mg/ m2,360mg/ m2 decreased significantly(P <0.05),GCS after the cumulative dose of 360mg/ m2 decreased significantly(P<0.05).GRS had no significantly difference in the whole process of chemotherapy(P>0.05).3. Only the area under ROC of GAS and GLS were greater than 0.7,The area under ROC of GAS was 0.974,and its optimal cut-off value was-31.5%,with a specificity of 87.1% and a sensitivity of 92.9%. The area under ROC of GLS was 0.778,and its optimal cut-off value was-17.5 %, with a specificity of 66.0% and a sensitivity of78.6%.4. Pearson correlation analysis showed GAS was significantly associated with cumulative anthracycline dose(r=-0.834,P<0.01).Conclusions During chemotherapy,GAS can detect minor LV myocardial dysfunction associated with cardiotoxic of anthracycline.Therefore,3D-STI is useful in early dectection of left ventricular myocardial subclinical function in patients with breast cancer after receiving anthracycline.