Application Value Of 2D-STI In Evaluating Myocardial Injury In Breast Cancer Treatment Caused By Anthracyclines

Objectives:1. Use two-dimensional speckle tracking imaging technology to evaluateearly subclinical cardiac toxicity associated with anthracycline chemotherapy in breast cancer patients,and compare it with the value of conventional echocardiographic indicators.2.Observe the correlation of important parameters and influencing factors,and compare the sensitivity of each layer of myocardium in the left ventricle to cardiac toxicity caused by anthracyclines.Methods:1. Research objectThirty-three patients with breast cancer diagnosed between February2019 and December 2019 at the Breast Center of the Fourth Hospital of Hebei Medical University were selected,and the average age was 51.36±9.77 years old.Adopt anthracycline-based chemotherapy regimens.All patients underwent echocardiography at basal state(T0)before chemotherapy and within 48 hours after the completion of the second cycle(T2)and the fourth cycle(T4)of chemotherapy.2. EquipmentVivid E95 color doppler ultrasound system,M5Sc-D cardiac probe,frequency:1.4-4.6MHz,and Echo PAC PC 203 strain analysis software are used.3. Observation indicatorsCollection of basic information:Before performing echocardiography on all patients,record the patient's name,gender,age,height,weight,blood pressure,pulse,blood glucose,blood lipid,electrocardiogram,previous medical history,chemotherapy regimen and other basic information,and calculate body mass index(BMI)And body surface area(BSA).M-type and two-dimensional ultrasound parameters:Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal depth(IVSD),end-diastolic left ventricular posterior wall depth(LVPWD),right ventricular anterior wall(RVAW),transverse diameter of right ventricular basement(RVD-B),transverse diameter of middle right ventricular(RVD-M),long axle diameter of right ventricular(RVD-L),left ventricular fractional shortening(LVFS),mitral annulus plane systolic excursion(MAPSE),tricuspid annulus plane systolic excursion(TAPSE),fractionalarea change of right ventricular(RVFAC),biplane Simpson's method to measure left ventricular end-diastolic volume(LVEDV),end-systolic volume(LVESV),left ventricular ejection fraction(LVEF).Pulse doppler and tissue doppler ultrasound parameters:Measure peak mitral valve flow velocity in early diastole(E),peak mitral valve flow velocity in late diastole(A),the ratio of peak mitral valve flow velocity in early diastole/peak mitral valve flow velocity in late diastole(E/A),mitral annulus peak systolic velocity of the lateral wall(s'_L),average of mitral annulus peak early-diastolic velocity of the septum and the lateral wall(e'),the ratio of peak mitral valve flow velocity in early diastole measured by pulse doppler/mitral annulus early peak average velocity measured by tissue doppler(E/e'),tricuspid annulus peak systolic velocity of the free wall(s'_T).The sampling point was placed in the left ventricular outflow tract on the apical five-chamber cardiac section to obtain a pulse doppler spectrum.Related parameters of two-dimensional speckle tracking:The two-dimensional speckle tracking imaging(2D-STI)technique was used to measure the left ventricular myocardial systole global strain(LVGLS),subendocardial myocardial longitudinal strain(LVGLS-Endo),subepicardial myocardial longitudinal strain(LVGLS-Epi)and the right ventricular myocardial systole global longitudinal strain(RVGLS).4.Statistical analysisStatistical analysis was performed using SPSS 25.0 software.The measurement data are described by means±standard deviation(?x±s).The comparison of indicators in each group uses the paired sample t test,the comparison between the two groups of indicators uses the independent sample t test,and the comparison between multiple groups of indicators uses one-way analysis of variance,the correlation analysis of continuity data uses Pearson product moment correlation analysis,and the grade data uses Spearman rank correlation analysis.Data were tested by two-sided test,and P<0.05 was considered statistically significant.Results:1.Basic informationScreening 33 patients with breast cancer diagnosed between February2019 and December 2019 in the Breast Center of the Fourth Hospital of Hebei Medical University,nine patients with hypertension,and two patients'electrocardiogram before medication showed premature systole,but no obvious change during chemotherapy,and sinus tachycardia occurred in 5patients after the fourth cycle of chemotherapy,their heart rate was 105-112beats per minute,and they had no complaints of heart discomfort.2.Echocardiographic parameters(1)Comparison of ventricular cavity size and structural parameters:Compared with T0,the conventional echocardiographic parameters IVSD,LVPWD,LVEDD,LVESD,LVEDV,LVESV,and RVAW,RVD-B,RVD-M,RVD-L had no statistical difference during chemotherapy(P>0.05).(2)Comparison of left ventricular systolic function parameters:Compared with T0,the conventional parameters LVEF did not change significantly at T2(P>0.05),decreased at T4(P<0.05),and LVFS,MAPSE,and s'_L had no statistical difference(P>0.05)during chemotherapy,but with the increase of the chemotherapy cycle,the drug dose continued to accumulate,LVFS and s'_L showed a downward trend;the two-dimensional strain parameters LVGLS,LVGLS-Endo,and LVGLS-Epi were significantly reduced at T2 and T4(P<0.01).(3)Comparison of parameters of left ventricular diastolic function:Compared with T0,e'decreased at T4(P<0.05),and other parameters E,A,E/A,E/e'were not statistically different during chemotherapy(P>0.05),but E and A showed a decreasing trend.(4)Comparison of right ventricular systolic function parameters:Compared with T0,the conventional parameters RVFAC,TAPSE,and s'_T were not statistically different during chemotherapy(P>0.05),and showed a decreasing trend as the drug dose accumulating;The dimensional strain parameter RVGLS was significantly reduced at T4(P<0.01).3. Correlation analysis of main left ventricular systolic function parameters and influencing factors(1)Correlation analysis between the average cumulative dose of anthracyclines and LVGLS,LVEF:At T2,the average cumulative dose of anthracyclines was about 180mg/m2,and at T4 it increased to 360mg/m2.LVGLS was negatively correlated with the average cumulative dose of drugs(r=-0.457,P<0.01),but LVEF had no significant correlation with it(P>0.05).(2)The effect of age on the reduction of systolic function?LVGLS,?LVEF:Patients were roughly divided into three groups:A,B,and C according to age?50y,51-60y,?61y.Statistical analysis showed that after T4,there was no significant difference in?LVGLS between group A and group B(P=0.131).There was a statistical difference(P<0.05)in?LVGLS between group A and group C(P=0.001),and between group B and group C(P=0.028),That is,when the patient is over 60 years of age,the degree of damage to the left ventricular systolic function is significantly increased by anthracyclines.There was no significant difference in?LVEF value of conventional left ventricular systolic function between different age groups(P>0.05).(3)Effect of hypertension on the degree of reduction of systolic function?LVGLS,?LVEF:After T4,there was no significant difference in?LVGLS,?LVEF between patients with hypertension and normal blood pressure(P>0.05).(4)Effect of body mass index(BMI)on the degree of reduction of systolic function?LVGLS,?LVEF:Divided these patients into three groups according to the Chinese reference standards of body mass index:normal,overweight and obese,statistical analysis showed that after T4,overweight and obese patients had no significant difference in both?LVGLS and?LVEF compared with those with normal body mass index(P>0.05).Conclusions:1.Anthracycline chemotherapy damages left ventricular systolic and diastolic function.The damage of systolic function is earlier and more obvious.It can appear at lower doses,and it gradually decreases with the increase of cumulative drug dose.Right ventricular systolic function was also reduced during chemotherapy,but appeared after left ventricular systolic function reduced.2.In monitoring the systolic function of breast cancer patients treated with anthracyclines,the two-dimensional strain parameter GLS is more sensitive than the conventional echocardiographic parameters LVEF,RVFAC,etc.,and can find early subclinical cardiac toxicity.The older the patient,the more the GLS decreases,and the more obvious the cardiotoxicity.3. The different levels of left ventricular myocardium was damaged tovarying degrees with the cumulative dose of anthracyclines.Endocardial myocardial strain decreased most significantly after chemotherapy,suggesting that endocardial myocardial fibers are more sensitive and more easily involved during chemotherapy.