Echocardiographic Evaluation Of The Effects Of PD-1/PD-L1 Inhibitors On Left Ventricular Systolic Function In Cancer Patients

Objective: Two-dimensional echocardiography and real-time three-dimensional echocardiography(RT-3DE)were used to evaluate the changes in left ventricular systolic function after treatment with immunosuppressants(PD-1/PD-L1 inhibitors)in cancer patients and to evaluate the cardiotoxicity effects of this drug,so as to provide an important monitoring met hod for the prevention and treatment of cardiovascular damage structure to clinical anti-tumor therapy.Methods: According to the inclusion and exclusion criteria,30 cancer patients who underwent PD-1/PD-L1 inhibitor treatment were collected at the 940 th Hospital of the Joint Logistics Support force of Chinese People’s Liberation Army between January 2019 and October 2020.Two-dimensional echocardiography and RT-3DE were used to observe heart structure,function and blood flow respectively.And the left ventricular systolic function parameters of the subject before medication,12 weeks after medication,and 24 weeks after medication were recorded.Two-dimensional echocardiographic parameters include: left ventricular end diastolic diameter(LVIDd),left ventricular end systolic diameter(LVIDs),ventricular septal thickness(IVSd)and left ventricular posterior wall thickness(LVPW),and left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)and left ventricular ejection fraction(LVEF)measured by the two-dimensional biplane Simpson method,and the patients’ left ventricular global longitudinal strain(GLS)and left ventricular global annular strain(LVGCS)measured by two-dimensional speckle tracking technology(2D-STI).Left ventricular end-diastolic volume(3D-LVEDV),left ventricular end-systolic volume(3D-LVESV)and left ventricular ejection fraction(3D-LVEF)were measured by RT-3RE.All the above parameters were measured 3 times and averaged to compare the left ventricular systolic function parameters before medication,12 weeks after medication,and 24 weeks after medication between groups,and to analyze the correlation between LVGLS and LVEF measured by 2D-STI.Results: Routine two-dimensional echocardiographic measurement results: There wereno statistically significant differences in LVDd,LVIDs,IVSd,LVPW at 12 weeks and 24 weeks after medication compared with those before medication(all P>0.05).Two-dimensional biplane Simpson method measurement results: There were no statistically significant differences in LVEDV,LVESV,LVEF at 12 weeks and 24 weeks after medication compared with those before medication(all P>0.05).RT-3DE measurement results: There were no statistically significant differences in LVEDV,LVESV,LVEF at 12 weeks and 24 weeks after medication compared with those before medication(all P>0.05).There were no statistically significant differences between LPGLS at 12 weeks aftermedication and before medication(P>0.05).The value of LGFLS at 24 weeks after medication increased compared with that before medication and the difference was statistically significant(P<0.05).GLS and LVEF were negatively correlated and the correlation was statistically significant(P<0.05).Conclusion:With PD-1/PD-L1 inhibitors,the overall left ventricular systolic function was not significantly reduced within 24 weeks,and the drug would not produce significant cardio toxic effects within half a year.GLS can be used as an important indicator to monitorearly heart damage.