Evaluation Of The Effects Of Anthracycline-based Chemotherapy Drugs On Left Ventricular Function In Patients With Breast Cancer By Real-time Three-dimensional Speckle Tracking

Objective:To evaluate the value of real-time three-dimensional speckle tracking(RT3D-STI)in evaluating the effects of anthracycline-based chemotherapy drugs on left ventricular function in patients with breast cancer.Materials and Methods:A total of 59 breast cancer patients who underwent 6 cycles of anthracycline chemotherapy were enrolled in our hospital.The patients were se lected without hypertension,cardiovascular and cerebrovascular diseases,diabetes and other underlying diseases.After physical examination and blood biochemistry,myocardial enzymes,No abnormal findings were found in conventional echocardiography.Routine two-dimensional echocardiography and RT3D-STI were performed on the selected patients before chemotherapy,2 cycles of chemotherapy,4 cycles of chemotherapy,and 6 cycles of chemotherapy.The conventional two-dimensional parameters: Left ventricular end-diastolic internal dimension(LVEDd),Left ventricular end-systolic internal dimension(LVEDs),Early diastolic transmitral velocity(E),Late diastolic transmitral velocity(A),Early diastolic tissue velocity(Em),Late diastolic tissue velocity(Am),Si ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),Left ventricular ejection fraction(LVEF);RT3D-STI for left ventricular myocardial strain and torsion parameters: Three-dimensional strain(3DS),Global longitudinal strain(GLS),Global radial strain(GRS),Global circumferential strain(GCS),Left ventricular twist(LVtw),three-dimensional left ventricular ejection fraction(3DLVEF),calculated MCI(myocardial composite index)= GLS × LVtw.Thirty healthy volunteers were selected as the control group during the same period.The differences between the groups were compared,and the ROC curve of the cardiotoxicity of anthracycline-type chemotherapy drugs was determined by RT3D-STI related parameters.The correlation between the three-dimensional parameters of RT3D-STI and the cumulative dose of the drug was analyzed and the Bland-Altman diagram was used to evaluate the observer.And consistency between observers.Results:(1)Two-dimensional conventional parameters: Compared with the control group and before chemotherapy,E/A,Em,Em/Am decreased after 6 cycles of chemotherapy(P<0.05).(2)Three-dimensional parameters: Compared with the control group and before chemotherapy,LVtw and MCI decreased after 2 cycles of chemotherapy,4 cycles of chemotherapy,and 6 cycles of chemotherapy(P<0.05);after 4 cycles of chemotherapy and after 6 cycles of chemotherapy 3DS and GLS decreased(P<0.05);while GCS decreased slightly during the whole chemotherapy cycle(P>0.05);there was no significant change in GRS;3DLVEF decreased after 6 cycles of chemotherapy(P<0.05).(3)According to the working characteristics of the subjects,the ROC curve was measured.The areas under the ROC curve of LVtw,MCI,3DS and GLS for detecting cardiotoxicity of anthracyclines were 0.891,0.873,0.837,0.754,respectively.The cutoff values were 12.35°,-191.34%×°,-32.3%,and-16.45%,respectively,and the sensitivity was 88.1%,98.3%,96.6%,and 86.4%,respectively,and the specificities were 75.7%,63.8%,and 60.5%,respectively.,54.2%.(4)LVtw,MCI,3DS were negatively correlated with drug dose(r=-0.803,-0.776,-0.768,P<0.01).(5)The Bland-Altman plot shows a good agreement between the observer and the observer for MCI values: the mean difference in the observer is 2.0(% × °),and the 95% CI is-17.3 to 21.3(% ×°);The average difference between observers is 4.0(% × °),and 95% CI is-5.2 to 13.2(% × °).Conclusion:Real-time three-dimensional speckle tracking technology can detect the effect of anthracycline chemotherapy on left ventricular function in patients with breast cancer.The sensitivity of MCI is the highest among all parameters.