Evaluation Of Left Ventricular Systolic And Diastolic Function In Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy Using Two-dimensional Speckle Tracking And Tissue Doppler

Objective:At present,the commonly used method of detecting cancer therapy related cardiac dysfunction?CTRCD?is to measure left ventricular ejection fraction?LVEF?,but the decrease in LVEF is often the late performance of the systolic dysfunction of the heart.It is difficult to restore the pre-chemotherapy level after the decrease of LVEF even if the intervention is applied.Two-dimensional speckle tracking echocardiography?2D-STE?technique can be used to detect the decrease of the systolic function of the heart accurately in the early stage of CTRCD.In this study,the changes of cardiac systolic function of new-onset breast cancer patients before and after NACT were evaluated by 2D-STE.And tissue Doppler imaging?TDI?was used to evaluate the diastolic function of the heart.It is helpful for clinicians to acquaintance the changes of the patient's condition and apply the intervention measures in time,which is of great significance for the treatment and prognosis of the patients.Methods:A total of 42 patients with new-onset breast cancer which were going to receive NACT and LVEF?53%were included in this study as case group.And 30healthy people were included as control group.Conventional two-dimensional echocardiography,tissue Doppler and 2D-STE were performed for following parameters:1.Conventional two-dimensional echocardiography:Left ventricular end-diastolic dimension?LVEDD?,Left ventricular end-systolic dimension?LVESD?,interventricular septal dimension?IVSD?,Left ventricular end-diastolic volume?LVEDV?,Left ventricular end-systolic volume?LVESV?and LVEF.2.Left ventricle systolic function:Left ventricular systolic global peak longitudinal strain?LV-GLS?.3.Mitral early diastolic inflow velocity?Mitral E?,Mitral late diastolic inflow velocity?Mitral A?,Mitral annulus early diastolic velocity at lateral wall of left ventricle?Mitral Lat e'?,Mitral annulus early diastolic velocity at septal wall of left ventricle?Mitral Sept e'?,Mitral E/A,mean value of Mitral Lat e'and Mitral Sept e'?mean Mitral e'?,Mitral E/mean Mitral e',Left atrial dimension?LAD?,Left atrial end-systolic volume?LAESV?,Left atrium volume index?LAVI?,tricuspid regurgitation peak velocity?TRPV?.Results:1.Left ventricle systolic function:?1?Left ventricular ejection fraction?LVEF?:There were no statistical differences in LVEF among the groups.?2?Left ventricular systolic global peak longitudinal strain?LV-GLS?.There was no statistical difference in LV-GLS between T₀ and control group.There was no statistical difference in LV-GLS among the T₁,T₂,T₃ and control group.LV-GLS decreased at T₄?P<0.05?which was compared with T₀ and control group.2.Left ventricle diastolic function:?1?Mitral early diastolic inflow velocity?Mitral E?Mitral late diastolic inflow velocity?Mitral A?:There was no statistical difference in Mitral E,Mitral A or Mitral E/A between T₀ and control group.There was no statistical difference in Mitral E,Mitral A or Mitral E/A among T₁,T₂ and control group.Mitral E and Mitral E/A decreased at T₃?P<0.05?,which was compared with T₀ and control group,however,there was no statistical difference in Mitral A of T₃.Mitral E and Mitral E/A decreased at T₄?P<0.05?,and Mitral A increased?P<0.05?,which was compared with T₀ and control group.?2?Mitral early diastolic inflow velocity?Mitral Lat e'?,Mitral late diastolic inflow velocity?Mitral Sept e'?:There was no statistical difference in Mitral Lat e'or Mitral Sept e'between T₀ and control group.There was no statistical difference in Mitral Lat e'or Mitral Sept e'among T₁,T₂ and control group.Mitral Lat e'or Mitral Sept e'decreased at T₃ and T₄?P<0.05?.3.Mitral E/mean Mitral e':There was no statistical difference in Mitral E/mean Mitral e'between T₀ and control group.There was no statistical difference in Mitral E/mean Mitral e'between T₁,T₂,T₃ and control group.Mitral E/mean Mitral e'increased at T₄?P<0.05?,which was compared with T₀ and control group.?4?Left atrial dimension?LAD?,left atrium volume index?LAVI?,tricuspid regurgitation peak velocity?TRPV?:There were no statistical differences in LAD,LAVI or TRPV among the groups.None of the tricuspid regurgitation was over mild degree,and all TRPV was below 2.8m/s.Conclusion:1.The decrease in the absolute value of the left ventricular systolic function parameter LV-GLS of breast cancer patients who received NACT treatment without significant reduction in LVEF indicates that the use of chemotherapeutic drugs has led to abnormal systolic function of parts of left ventricular myocardium.2.In breast cancer patients treated with NACT,left ventricular diastolic function parameters Mitral E and Mitral E/mean Mitral e?changed with statistical difference,which shows that the use of chemotherapeutic drugs has resulted in abnormal diastolic function of the myocardium.In breast cancer patients treated with NACT,there was no statistical difference in left ventricular diastolic function parameters LAD,LAVI and TRPV,which indicates that the toxic effect of chemotherapeutic drugs on diastolic function of left ventricular myocardium is limited in short term,the related parameters of left atrium and right heart were not significantly impacted.