Evaluation Of Cardiotoxicity In Lung Cancer PatientsReceiving Chemotherapy By Three-dimensional SpeckleTracking Imaging And Global Left Ventricular MyocardialStrain

Objective The incidence of lung cancer has been rising in the recent 50 years,and it has been staying at a high level in the recent 10 years.A large number of the patients have been in the terminal stages when treated,so the main treatment of lung cancer is still chemotherapy in the clinic.This research evaluates the influence of the left ventricular myocardial systolic function who used chemotherapeutic agents in patients with non-small cell lung cancer using 3D-STI technology,and make clear the dynamic change process of the early myocardial damage.Also,the research explores the diagnostic value of global left ventricular myocardial strain parameters in predicting myocardial cardiotoxicity,aiming at early detecting the cardiotoxicity of chemotherapeutic agents in patients and direct the clinical medication.Methods This study selected patients with non-small cell lung cancer who prepared to receive chemotherapy.A total of 54 patients were eligible and succeeded to follow-up.The chemotherapy regimen was Pemetrexed(500 mg/m2)combined with cisplatin(75mg/m2);time interval was 21 days;one course of treatment had 6 cycles.Cardiovascular disease was excluded.Biochemical indexes of liver and renal function was not obviously abnormal.Electrocardiogram was not obviously abnormal before,after and during chemotherapy.Ultrasound images were basically clear.Expected lifetime was more than 24 months.Conventional echocardiography and three-dimensional strain parameters obtained by 3D-STI were measured to each patient before chemotherapy,at 3 chemotherapeutic cycles and at 6 chemotherapeutic cycles.GAS,GLS,GCS and GRS,which were obtained by 3D-STI technology,were compared and analyzed by the receiver operating characteristics(ROC)curve to evaluate the optimal sensitivity and specificity in detecting the future cardiotoxicity in clinic.Results1.LVIDd?IVSd?LVPWd?LVEF?CO?HR?SV?SPI?EDV?ESV?EDmass?ESmass,which were non-strain parameters,had no statistical significance as chemotherapy cycles prolonged.(P>0.05)2.GAS,GLS and GCS deteriorated significantly as chemotherapy cycles prolonged(P<0.05).GRS also reduced as chemotherapy cycles prolonged,but this was not statistically significant(P>0.05).3.GAS,GLS and GCS were significantly lower in the group at 6 chemotherapeutic cycles than before chemotherapy and at 3 chemotherapeutic cycles(P<0.05),and GAS,GLS were lower in the group at 3 chemotherapeutic cycles than before chemotherapy with statistical significance(P<0.05).4.The ROC curve showed that the areas under the curve(AUC)of GAS,GLS,GCS,and GRS were 0.947,0.786,0.671,0.613 respectively,and the AUC of GAS,GLS were more than 0.7.The optimal cut-off value of GAS was-30.2%,and its specificity and sensitivity were 91.2% and 85.0% respectively in estimating the damage of chemotherapeutic agents on left ventricular myocardial function,and the optimal cut-off value of GLS was-30.2%,and its specificity and sensitivity were 91.2% and 91.2%respectively in estimating the damage of chemotherapeutic agents on left ventricular myocardial function.Conclusion 3D-STI technology can early detect the cardiotoxicity of chemotherapeutic agents in lung cancer patients.GAS has a high specificity and sensitivity in detection of left ventricular myocardial dysfunction.Applications of3D-STI technology and global left ventricular myocardial strain can early detect the subclinical cardiotoxicity of chemotherapeutic agents in lung cancer patients,and guide the clinician to adjust the chemotherapy regimens timely,which has a high clinical reference value.