Application Of Multimodal Echocardiography In Monitoring Left Ventricular Function Changes Of Breast Cancer Before And After Chemotherapy

Purpose:To explore the application value of 3-dimensional echocardiography HeartModel?3D-HM?and Auto-Cardiac Moving Quantification?aCMQ?in monitoring the changes of left ventricular function in breast cancer patients with different chemotherapy cycles.Methods:Fifty patients with breast cancer receiving doxorubicin-based chemotherapy in our hospital were collected,aged 29-60 years,with an average of?48.22±6.11?years.Before chemotherapy?T₀?and after chemotherapy cycles 1,2,3,4,5 and 6?T₁,T₂,T₃,T₄,T₅ and T₆?,aCMQ was used to measure left atrial global longitudinal peak strain?LAGLS?,left ventricular global circumferential peak strain?LVGCS?,and left ventricular global longitudinal peak strain?LVGLS?in the long axis and short axis of the heart;left ventricular ejection fraction?3D-LVEF?,left ventricular end systolic volume?LVESV?,Left ventricular end diastolic volume?LVEDV?,and left atrial end systolic volume?LAESV?were measured by 3D-HM.LAESV was compared with the patient's body surface area to calculate the left atrial end systolic volume index?LAESVI?.Conventional echocardiographic parameters were measured:Left ventricular end diastolic diameter?LVEDd??Left ventricular end systolic diameter?LVESd??left atrial end systolic maximum anteroposterior diameter?LAD?and left ventricular ejection fraction?2D-LVEF?;Pulsed Doppler ultrasound parameters:Peak velocity in atrial contraction of mitral valve?A??Peak velocity in early diastole of mitral valve?E??ratio of peak velocity in early diastole of mitral valve to peak velocity in atrial contraction?E/A?,tricuspid systolic regurgitation velocity?TRv?;Tissue Doppler ultrasound parameters:septal early diastolic mirtral annuiar velocity?septal e??,lateral early diastolic mirtral annuiar velocity?lateral e??,ratio of mitral orifice early diastolic peak velocity to tissue Doppler mitral annulus early diastolic mirtral annuiar velocity?E/e???The series of ultrasonic parameters of all patients before and after chemotherapy were compared.Correlation analysis was made between the changes of 3D-LVEF??3D-LVEF?and the changes of left ventricle global longitudinal peak strain??LVGLS?before and after chemotherapy.Correlation analysis was made between the changes of left atrial global longitudinal peak strain??LAGLS?and left ventricular global longitudinal peak strain??LVGLS?before and after chemotherapy.Results:?1?Comparison of conventional two-dimensional echocardiography indexes before and after chemotherapy:2D-LVEF decreased at T₆?63.08±4.63?compared with T₀?67.20±4.22?,the difference was statistically significant?P<0.01?;There was no significant difference in LVEDd?LVESd and LAD after each chemotherapy stage?P>0.05?.Comparison ofPulsed Doppler and tissue Doppler ultrasound indexes before and after chemotherapy:E,A,E/A,lateral cardiac wall e',ventricular septal side e',E/e'and TRv indexes showed no significant difference after the end of each chemotherapy stage?P>0.05?.?2?Comparison of 3D-HM technical parameters before and after chemotherapy:3D-LVEF decreased at T₃?59.44±3.62?compared with T₀?62.18±4.17?,the difference was statistically significant?P<0.01?.There was no significant difference among LAESVI,LVEDV and LVESV at the end of each chemotherapy stage?P>0.05?.?3?Comparison of aCMQ technical parameters before and after chemotherapy:the difference between LVGLS and LAGLS in different times of chemotherapy was statistically significant?P<0.01?.LVGLS:there was no significant difference between T₁,T₂ and T₀?P>0.05?,T₃?-22.49±2.20?,T₄?-22.33±1.95?,T₅?22.06±1.46?,T₆?-21.17±2.53?were all lower than T₀?-24.02±2.10?,with significant difference?P<0.01?.LAGLS:T₁?28.88±4.60?,T₂?30.30±5.57?,T₃?29.79±3.72?werehigherthan T₀?27.89±4.48?,the differences were statistically significant?P<0.01?.T₄?25.40±3.85?,T₅?24.79±5.66?,T₆?22.12±5.24?were lower than T₀?27.89±4.48?,the differences were statistically significant?P<0.01?.LVGCS:there was no significant difference between before and after chemotherapy?P>0.05?.?4?Correlation analysis of?3D-LVEF and?LVGLS before and after chemotherapy:there was a positive correlation between?3D-LVEF and?LVGLS before and after chemotherapy,the correlation coefficient r=0.51,with statistical significance?P<0.01?.?5?Correlation analysis of?LAGLS and?LVGLS before and after chemotherapy:the correlation analysis results of?LAGLS and?LVGLS before and after chemotherapy showed a positive correlation with correlation coefficient r=0.48,which was statistically significant?P<0.01?.Conclusion:?1?Compared with conventional two-dimensional echocardiography,3D-HM and aCMQ can detect early changes of left ventricular function in breast cancer patients after chemotherapy.The correlation between 3D-HM and aCMQ is good,simple and easy to implement,and the simultaneous use of the two plays a certain application value in guiding clinical early discovery and and intervention of cardiac function damage of breast cancer patients after chemotherapy.?2?Subclinical changes of left ventricular diastolic function before and after chemotherapy are positively correlated with subclinical changes of left ventricular systolic function.The effect of chemotherapy drugs on left ventricular function in patients with breast cancer is firstly diastolic function,followed by contractile function.