Evaluation Of Myocardial Damage And Prognosis In Patients With Breast Cancer Chemotherapy By Anthracyclines Using Two-Dimensional Ultrasound And Three-dimensional Speckle Tracking

Objective : To evaluate the left ventricular function of breast cancer patients with different ages before and after chemotherapy by two-dimensional ultrasound and three-dimensional speckle tracking technology,and to further evaluate the outcome of myocardial damage after one year of chemotherapy.Methods:From January 2016 to September 2018,60 female patients with breast cancer diagnosed in the second tumor department in our hospital,and who were undergoing chemotherapy after surgery.The patients were treated with epirubicin(EPI).The treatment plan was included in the criteria: 1.There was no obvious abnormality in ECG and liver and kidney function indicators.2.There was no abnormality in left ventricular structure and function indexes in conventional echocardiography,and left ventricular ejection fraction was greater than 50%.3.Expected lifetime is greater than 24 months.4.without distant multiple metastases.5.before the chemotherapy to exclude congenital heart disease,hypertension,coronary heart disease,arrhythmia and other cardiovascular diseases.According to the age of illness,they were divided into two groups: 30 patients aged <45 years(group I)and 30 patients aged >45 years(group II).Each group was divided into 5 groups according to chemotherapy time: before chemotherapy(group A);chemotherapy 2 cycle(group B),4 cycles(group C),6 cycles(group D),and more than 1 year after the end of 6 cycles(group E);cumulative doses of EPI were 0,120mg/m2?240 mg/m2?360 mg/m2,60 healthy subjects were selected as normal controls.Conventional echocardiography and three-dimensional echocardiography were performed before and after chemotherapy to determine the relevant parameters.1.conventional echocardiographic parameters: left ventricular end-diastolic diameter(LVDd),end-diastolic interventricular septal thickness(IVSTd),end-diastolic left ventricular posterior wall thickness(PWTd),left ventricular ejection fraction(LVEF);Early diastolic mitral peak blood flow velocity(E)to late diastolic mitral peak blood flow velocity(A)E/A;tissue Doppler parameter measurement: Early diastolic mitral annulus velocity E',late diastolic mitral annulus velocity A',calculated ratio E'/A'.2.3D-STI measurement parameters:left ventricular global longitudinal strain(LVGLS)?left ventricular global radial strain(LV-GRS)? left ventricular global area strain(LV-GAS)?left ventricular global circumferential strain(LV-GCS).Results:1.Conventional echocardiographic measurement parameter resultsThere were no significant differences between the control group and the two groups before and after chemotherapy in LVDd,LVSd,IVST,LVPWT and LVEF(P>0.05).There was no significant difference in E/A,E',E'/A' between the IA and IIA groups compared with the control group(P>0.05);IB,IC,ID group compared with IA group,IIB,IIC,IID group compared with IIA group,E/A,E',E'/A' were decreased,the difference was statistically significant(P<0.05);IE group compared with the ID group,E/A,E',E'/A' were increased,the difference was statistically significant(P<0.05);IIE group compared with IID group,E/A,E',E'/A' were no significant change,and the difference was not statistically significant(P>0.05).2.Comparison of 3D-STI measurement resultsThere was no significant difference in GLS,GAS,GRS and GCS between the IA ? IIA groups compared with the control group(P>0.05);GAS and GLS weredecreased in group IIB compared with the IIA group(P<0.05),but there was no significant difference in GAS and GLS between group IB and group IA(P>0.05);IC,ID group compared with IA group,IIC,IID group compared with IIA group,the GLS and GAS were both decreased.(P<0.05);Compared with ID group,GLS and GAS were increased in IE group(P<0.05).There was no significant difference in GLS and GAS between IIE group and IID group(P>0.05);There was no significant difference in GAS and GLS between the IIA group and the IA group(P>0.05).The GAS and GLS were decreased in the IIB group compared with the IB group,and the difference was statistically significant.(P<0.05).Conclusion:1.EPI chemotherapy has a toxic effect on the heart in the early stage.The left ventricular diastolic function is reduced earlier than the systolic function.The left ventricular systolic dysfunction in older patients is earlier than that in young patients.At the end of chemotherapy for more than 1 year,the systolic function and diastolic function of female with breast cancer <45 years old were higher than those during chemotherapy,suggesting that the cardiotoxic damage of EPI in young patients is reversible.2.The application of TDI and 3D-STI technology can evaluate left ventricular myocardial function early,sensitively and accurately.