左房室整体纵向应变评价蒽环类化疗药物治疗后左心功能早期变化  

Evaluation of left ventricular function with left atrio-ventricular longitudinal strain in patients with lymphoma underwent anthracycline therapy

作　　者：李政 张群岭[5] 沈毅辉 舒先红 程蕾蕾 Li Zheng;Zhang Qunling;Shen Yihui;Shu Xianhong;Cheng Leilei(Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Cardiovascular disease,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China;National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Medical Oncology,Fudan University Shanghai Cancer Center,Shanghai,200032 China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心脏超声诊断科,上海200032 [2]上海市心血管病研究所,上海200032 [3]上海市影像医学研究所,上海200032 [4]国家介入治疗医学临床中心,上海200032 [5]复旦大学附属肿瘤医院肿瘤内科,上海200032 [6]复旦大学附属中山医院心脏内科,上海200032

出　　处：《中华心血管病杂志》2022年第11期1064-1068,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金(82170359);复旦大学附属中山医院临床研究专项基金(2020ZSLC21);复旦大学附属中山医院青年基金(2020ZSQN74);上海市放射与治疗(介入治疗)临床医学研究中心基金(19MC1910300);上海市卫生健康委员会基金(202040344)。

摘　　要：目的评价三维斑点追踪超声心动图(3D-STE)应变指标评估蒽环类药物化疗早期左心功能改变的价值。方法本研究为回顾性研究。选取2012年12月至2014年12月于复旦大学附属肿瘤医院接受以蒽环类药物为基础的化疗方案治疗的弥漫大B淋巴瘤(DLBCL)患者37例。分别于化疗前、化疗2周期后及化疗结束后行3D-STE检查。应用TTA工作站分析患者的超声心动图图像,测量指标包括左心房最小容积(LAVmin)、左心房排空指数(LAEF)、左心房主动排空指数(LAAEF)等左心容积指标,及左心室整体纵向应变(LVGLS)、左心室整体环向应变(LVGCS)、左心房整体纵向应变(LAGLS)等左心应变指标。计算LVGLS与LAGLS的绝对值之和得出左房室整体纵向应变(LAVGLS)。观察纳入患者不同时间点3D-STE测量的左心应变指标变化情况。结果本研究共纳入37例DLBCL患者,年龄(48.3±12.1)岁,其中男性23例(63.9%)。与基线测量值相比,患者化疗2周期后及化疗结束时LVGLS[化疗2周期后:(-18.63±4.73)%比(-22.13±4.40)%,P=0.001;化疗结束:(-18.26±4.64)%比(-22.13±4.40)%,P<0.001]、LAGLS[化疗2周期后:(20.41±5.56)%比(23.98±5.59)%,P=0.003;化疗结束:(17.60±3.96)%比(23.98±5.59)%,P<0.001]和LAVGLS[化疗2周期后:(39.05±7.60)%比(46.11±7.77)%,P<0.001;化疗结束:(40.34±8.55)%比(46.11±7.77)%,P<0.001]均降低;LVGCS[(-21.98±5.82)%比(-26.15±7.51)%,P=0.010]、LAVmin[(23.93±7.29)ml比(20.33±7.03)ml,P=0.029]、LAEF[(28.94±11.16)%比(35.79±11.12)%,P=0.002]、LAAEF[(11.93±10.00)%比(18.10±9.96)%,P=0.013]仅在化疗结束后改变,而在化疗2周期后无明显变化(P均>0.05)。结论3D-STE左心应变指标能发现蒽环类药物化疗早期心肌功能改变,可为化疗过程中的心肌毒性监测提供更加敏感的指标。Objective To analyze the value of 3-dimensional speckle tracking echocardiograghy(3D-STE)derived strain parameters on the detection of subclinical myocardial deformation alterations in patients with lymphoma treated with anthracycline agents.Methods This study was a retrospective study.A total of 37 patients with newly diagnosed diffuse large B cell non-Hodgkin lymphoma between December 2012 and December 2014 in Cancer Center,Fudan university were included.3D-STE strain measurements were performed at baseline(T0),after the completion of two therapy circles(T1)and at the end of anthracycline regimen chemotherapy(Te).Echocardiography images were analyzed on the TTA workstation,and the indexes included left atrial minimum volume(LAVmin),left atrial emptying index(LAEF),left atrial active emptying index(LAAEF),as well as the left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left atrial global longitudinal strain(LAGLS).The overall left atrioventricular longitudinal strain(LAVGLS)was calculated,which was the sum of the absolute values of LVGLS and LAGLS.The changes of left ventricular strain indexes measured by 3D-STE at different time points of patients were evaluated.Results Thirty-seven patients with DLBCL,aged(48.3±12.1)years,including 23 males(63.9%),were enrolled.Compared with baseline,LVGLS(T1:(-18.63±4.73)%vs.(-22.13±4.40)%,P=0.001;Te:(-18.26±4.64)%vs.(-22.13±4.40)%,P<0.001),LAGLS(T1:(20.41±5.56)%vs.(23.98±5.59)%,P=0.003;Te:(17.60±3.96)%vs.(23.98±5.59)%,P<0.001)and LAVGLS(T1:(39.05±7.60)%vs.(46.11±7.77)%,P<0.001;Te:(40.34±8.55)%vs.(46.11±7.77)%,P<0.001)were all deteriorated at the T1 and Te.While LVGCS((-21.98±5.82)%vs.(-26.15±7.51)%,P=0.010),LAVmin((23.93±7.29)ml vs.(20.33±7.03)ml,P=0.029),LAEF((28.94±11.16)%vs.(35.79±11.12)%,P=0.002)and LAAEF((11.93±10.00)%vs.(18.10±9.96)%,P=0.013)were decreased only until Te.Conclusions 3D-STE strain measurements could detect early myocaridial function alteration in patients receiving anthracycline

关 键 词：超声心动描记术 心室功能 左 蒽环类 淋巴瘤 大B细胞 弥漫性 

分 类 号：R733.1[医药卫生—肿瘤]