左心室心肌应变对无症状蒽环类药物化疗后相关心功能不全的预测价值  

Predictive Value of Left Ventricular Myocardial Strain in Asymptomatic Patients with Anthracycline Chemotherapy-Associated Cardiac Insufficiency

作　　者：张诗渊[1] 应康[2] 钟勇 熊祎玭[2] 胡震[2] 易烽明[4] ZHANG Shiyuan;YING Kang;ZHONG Yong;XIONG Yipin;HU Zhen;YI Fengming(Department of Ultrasound,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;不详)

机构地区：[1]南昌大学第二附属医院心血管内科,江西南昌330006 [2]南昌大学第二附属医院超声科,江西南昌330006 [3]南昌市洪都中医院超声科,江西南昌330006 [4]南昌大学第二附属医院肿瘤科,江西南昌330006

出　　处：《中国医学影像学杂志》2023年第10期1018-1023,共6页Chinese Journal of Medical Imaging

基　　金：江西省卫生计生委科技计划(20185249)。

摘　　要：目的探讨左心室心肌应变对乳腺癌患者行蒽环类药物化疗后发生癌症治疗相关心功能不全(CTRCD)的预测价值。资料与方法纳入2018年1月—2019年10月于南昌大学第二附属医院经蒽环类药物治疗的乳腺癌患者216例进行前瞻性研究,共29例出现无症状CTRCD,根据无症状CTRCD患者治疗结束后24个月内是否发生主要不良心脏事件(MACE)分为MACE组和无MACE组。获取二维左心室整体纵向应变(2D-LVGLS)、三维左心室整体纵向应变(3D-LVGLS)、三维左心室整体径向应变(3D-LVGRS)、三维左心室整体圆周应变(3D-LVGCS)、三维左心室整体面积应变(3D-LVGAS)。采用多因素Cox比例风险模型识别用于预测后期发生MACE的独立预测因子。结果多因素Cox回归分析发现,3D-LVGLS(HR=1.496,95%CI 1.397~1.775,P<0.001)、2D-LVGLS(HR=1.154,95%CI 1.036~1.369,P=0.023)是无症状CTRCD患者发生MACE的独立预测因子,受试者工作特征曲线下面积分别为0.862、0.746,3D-LVGLS以-16.1%作为截断值预测发生MACE的敏感度和特异度分别为75%和64%。结论超声三维斑点追踪成像评估左心室心肌应变可定量预测乳腺癌患者行蒽环类药物化疗后CTRCD的发生,为临床早期干预提供依据。Purpose To investigate the predictive value of left ventricular myocardial strain in cancer treatment related cardiac insufficiency(CTRCD)in breast cancer patients treated with anthracycline.Materials and Methods A total of 216 breast cancer patients treated with anthracycline in the Second Affiliated Hospital of Nanchang University from January 2018 to October 2019 were enrolled for a prospective study.Twenty-nine patients developed asymptomatic CTRCD.Asymptomatic CTRCD patients were divided into major adverse cardiac events(MACE)group and non-MACE group according to whether they developed MACE during the 24-month follow-up after the end of treatment.Two-dimensional left ventricular global longitudinal strain(2D-LVGLS),three-dimensional left ventricular global longitudinal strain(3D-LVGLS),three-dimensional left ventricular global radial strain(3D-LVGRS),three-dimensional left ventricular global circumferential strain(3D-LVGCS),three-dimensional left ventricular global area strain(3D-LVGAS)were obtained.A multivariate Cox proportional risk model was used to identify independent predictors for predicting the occurrence of MACE.Results Multivariate Cox regression analysis showed that 3D-LVGLS(HR=1.496,95%CI 1.397-1.775,P<0.001)and 2D-LVGLS(HR=1.154,95%CI 1.036-1.369,P=0.023)were independently associated with the occurrence of late MACE,and were independent predictors of MACE in asymptomatic CTRCD patients,and the area under of curve of 3D-LVGLS and 2D-LVGLS was 0.862 and 0.746,respectively.The sensitivity and specificity of 3D-LVGLS to predict MACE with-16.1%as cut-off values were 75%and 64%,respectively.Conclusion The evaluation of left ventricular myocardial strain via three-dimensional ultrasonic speck tracking technique can quantitatively predict the occurrence of CTRCD after anthracycline chemotherapy in breast cancer patients,providing a basis for early clinical intervention.

关 键 词：乳腺肿瘤 超声心动描记术 斑点追踪成像 心肌应变 化学疗法 辅助 蒽环类药物 心脏不良事件 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]