Evaluation Of The Effect Of Anthracycline On Left Atrial Function In Breast Cancer Patients By Two-Dimensional Speckle Tracking Imaging

Objective:To evaluate the effect of anthracyclines on left atrial function in patients with breast cancer by the two dimensional speckle tracking imaging(2D-STI),and to explore the value of 2D-STI in the detection of cardiotoxicity of anthracycline drugs.Methods:A total of 60 breast cancer patients admitted to our hospital from January 2017 to April 2019 were selected.All patients received TAC(epirubicin 110mg/m~2+cyclophosphamide+docetaxel)chemotherapy regimen with anthracycline as the main chemotherapy regimen for 6 cycles.8 patients changed their chemotherapy regimen due to the deterioration of their disease,and 52 breast cancer patients were included in the study group.According to the chemotherapy cycles,the patients were divided into four groups:the A0 group(before chemotherapy),the A2 group(2 cycles),the A4 group(4cycles)and the A6 group(6 cycles).30 healthy volunteers in the same period were selected as the control group.Philips EPIQ 7C color Doppler ultrasonography with S5-1probe(1?5MHz)and equipped with Qlab 9.0 offline quantitative workstation were used.The parameters of conventional echocardiography were measured,such as left ventricular end diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),left anterior and posterior atrial diameter(LAD),E peak(E),A peak(A),the ratio of E peak to A peak(E/A)and the left atrial ejection fraction(LAEF).The global longitudinal strain(GLS),systolic strain rate(SRs),early diastolic strain rate(SRe)and atrial systolic strain rate(SRa)of left atrial were obtained by the two-dimensional speckle tracking imaging.The differences between the groups were compared.Pearson correlation analysis was used to analyze the correlation between GLS and drug dose and LAEF.ROC curve was drawn to analyze the sensitivity of GLS in detecting left atrial function damage.Bland-Altman test was used to analyze the repeatability of results.Results:(1)Compared with the control group,A0 group and A2 group,LAD and A in A4group increased significantly.Compared with the A4 group,LAD and A increased,E,E/A and LAEF decreased,the difference was statistically significant(P<0.05).The GLS,SRs,SRe and SRa of the left atrium in A4 and A6 group were lower than those in the control group,A0 group and A2 group,and the difference was statistically significant(P<0.05).Compared with A4 group,the GLS,SRs,SRe and SRa of the left atrium in the A6 group were lower,and the difference was statistically significant(P<0.05).(2)There was a negative correlation between the left atrial longitudinal strain and the cumulative dose of the drug(r=-0.615,P<0.01).There was a positive correlation between left atrial longitudinal strain and LAEF(r=0.582,P<0.01).(3)The area under ROC curve of left atrial overall GLS was 0.846.When the Jordan index was 0.571,the cross-sectional value was 24.2,the sensitivity was 86.1%,and the specificity was 65.3%.(4)Bland-altman test showed that the 2D-STI technique had good repeatability.Conclusion:(1)Cardiac toxicity of anthracyclines is linearly related to drug dose.With the extension of chemotherapy cycles,left atrial function of breast cancer patients decreases in different degrees.(2)2D-STI technology has certain clinical value in evaluating the impact of anthracyclines on left atrial function of breast cancer patients with normal ejection fraction.And the GLS can be used as a sensitive index for detecting left atrial myocardial damage.