实时三维超声心动图联合速度向量成像技术评价乳腺癌蒽环类药物化疗后患者的左心房功能  

Evaluation of left atrial function in breast cancer patients treated with anthracycline by real-time three-dimensional echocardiography combined with velocity vector imaging

作　　者：刘洁 彭雪莲 梁杉 赵香芝 LIU Jie;PENG Xuelian;LIANG Shan;ZHAO Xiangzhi(Department of Heart Ultrasound,Affiliated Hospital of Southwest Medical University,Sichuan Luzhou 646000,China.)

机构地区：[1]西南医科大学附属医院心脏超声科,四川泸州646000

出　　处：《现代肿瘤医学》2023年第5期916-921,共6页Journal of Modern Oncology

摘　　要：目的:采用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)及速度向量成像技术(velocity vector imaging,VVI)评价蒽环类药物(anthracycline,ATC)化疗后乳腺癌患者的左心房功能。方法:纳入我院行ATC化疗的女性乳腺癌术后患者72例,分别采集化疗前、化疗3个周期(化疗中)、化疗6个周期(化疗后)三个阶段的超声心动图参数。获取RT-3DE图像,得到左心房舒张末容积(left atrial end-diastolic volume,LAV_(max))、左心房收缩前容积(left atrial pre-systolic volume,LAV_(prep))、左心房收缩末容积(left atrial end-systolic volume,LAV_(min)),计算左心房主动射血分数(left atrial active ejection fraction,LAAEF)、左心房总射血分数(left atrial total ejection fraction,LATEF);获取心尖四腔心二维图像,得到左心房收缩期峰值应变(S_(s))及应变率(s-SR)和舒张晚期峰值应变(Sa)及应变率(a-SR)。结果:化疗后较化疗中LAV_(max)、LAV_(prep)、LAV_(min)增大(P<0.05);化疗后较化疗前和化疗中LAAEF、LATEF减低(P<0.05);与化疗前比较,化疗中和化疗后Ss、s-SR、a-SR减低,化疗后较化疗中S_(s)、s-SR、a-SR亦减低(P<0.05)。S_(a)三个时期间差异无统计学意义(P>0.05)。结论:ATC化疗可导致乳腺癌患者左心房储器功能及泵功能减低,化疗后期损害更为严重,RT-3DE及VVI可以从不同角度敏感地发现乳腺癌术后化疗患者的左心房功能变化,为临床早期发现及时更改治疗方案提供参考依据。Objective:To evaluate the left atrial function of breast cancer patients with anthracycline(ATC)chemotherapy by real-time three-dimensional echocardiography(RT-3DE)and velocity vector imaging(VVI).Methods:72 female breast cancer patients who underwent ATC chemotherapy in our hospital were enrolled.Echocardiographic parameters were collected at three stages,including before chemotherapy,3 cycles of chemotherapy(during chemotherapy)and 6 cycles of chemotherapy(after chemotherapy).Left atrial end-diastolic volume(LAV_(max)),left atrial pre-systolic volume(LAV_(prep))and left atrial end-systolic volume(LAV_(min))were obtained by RT-3DE imaging.Left atrial active ejection fraction(LAAEF)and left atrial total ejection fraction(LATEF)were calculated.The peak systolic strain(S_(s))and strain rate(s-SR)of left atrium and peak diastolic strain(S_(a))and strain rate(a-SR)of left atrium were obtained by four cavity heart apex 2D image.Results:LAV_(max),LAV_(prep) and LAV_(min) increased after chemotherapy compared with during chemotherapy(P<0.05).LAAEF and LATEF were lower after chemotherapy than before and during chemotherapy(P<0.05).Compared with before chemotherapy,S_(s),s-SR and a-SR decreased in during chemotherapy and after chemotherapy,and S_(s),s-SR and a-SR also decreased after chemotherapy compared with during chemotherapy(P<0.05).There was no significant difference in Sa among the three stages(P>0.05).Conclusion:ATC chemotherapy can reduce the function of left atrial storage and pump in breast cancer patients,and the damage is more serious in the later stage of chemotherapy.RT-3DE and VVI can sensitively detect the changes of left atrial function in breast cancer patients after chemotherapy from different angles,providing good application value for early clinical detection and timely change of treatment plan.

关 键 词：超声心动描记术 实时三维 速度向量成像技术 乳腺癌 左心房 蒽环类 

分 类 号：R737.9[医药卫生—肿瘤]