Evaluation Of Occult Myocardial Toxicity In GP Chemotherapy Regimen Of Lung Cancer Patients By 3D-STI Combined With Cardiac Compostie Index

Objective Left ventricular strain parameters and torsion angles were obtained by three-dimensional speckle tracking imaging（3D-STI）,and myocardial composite index（MCI,MCI=GLS*LVTW）was calculated.To evaluate the diagnostic value of these parameters for occult myocardial toxicity in patients with non-small cell lung cancer using gemcitabine plus cisplatin（GP）chemotherapy.Methods Forty-six patients with non-small cell lung cancer were treated with GP chemotherapy.Thirty healthy volunteers were selected as control group.Three-dimensional parameters and conventional echocardiographic parameters were recorded before the start of chemotherapy（T₁）,after the third chemotherapy（T₂）and after the sixth chemotherapy（T₃）.The changes of global circumferential strain（GCS）,global radial strain（GRS）,global longitudinal strain（GLS）,left ventricular systolic myocardial twist angle（LVtw）,myocardial comprehensive index（MCI）and conventional echocardiographic parameters were compared between the two groups.The ROC curve was made to analyze the most accurate and sensitive indicators for myocardial damage and to evaluate its value in detecting occult myocardial toxicity in patients with non-small cell lung cancer treated with chemotherapy.Results 1.There were no significant differences in age,HR,LVIDd,IVSd,LVPWd,EDV,ESV and LVEF between T₁ group and control group（P>0.05）.2.There was no significant difference in strain parameters GRS,GCS,GLS,LVtw and MCI between T₁group and control group（P>0.05）.The results of GRS and GCS at T₂ group were not significantly different from those at T₁ group and control group（P>0.05）.The results of MCI,LVtw and GLS at T₂ group were lower than those at T₁ group and control group（P<0.05）.The results of GRS,GCS,GLS,LVtw and MCI in the T₃ group were lower than those in the T1 group and the control group,and the difference was statistically significant（P<0.05）.3.The area under the curve of MCI,LVtw and GLS are all larger than 0.7,and the area under the curve of MCI（AUC）is the largest,which is0.836.When the cut-off value was-240.5,the sensitivity of MCI diagnosis of GP chemotherapy regimen to occult toxicity of left ventricular myocardium in patients with non-small cell lung cancer was 91.3%,and the specificity was 72.3%.When-19.5 is the cut-off value of GLS,the test specificity is 82.0%,the sensitivity is 52.2%;when the cut-off value of LVtw is 13.15,the test sensitivity is 69.6%,and the test specificity is68.0%.Conclusion 3D-STI technology combined with MCI has a unique advantage in the early diagnosis of occult cardiotoxicity caused by chemotherapy.ROC curve analysis indicated that MCI was more sensitive than other strain parameters in evaluating occult cardiotoxicity.It could detect the occult toxicity of GP chemotherapy in patients with non-small cell lung cancer at an early stage,and it has high clinical reference value.