摘要
目的:探讨运用二维斑点追踪技术(2D-STI)评价乳腺癌患者接受化疗及后续放射治疗(RT)后早期左心功能改变。方法:选取靖江市人民医院放疗科,2017年5月至2019年10月收治的,接受化疗及RT序贯疗法的30例乳腺浸润性导管癌(Ⅱ级)患者,平均年龄(49.4±8.7)岁,分别于RT前(T0)、RT结束首日(T1)、RT后6个月(T6)随访。常规超声心动图测量LVEF,LVDd、LAD、avg E/e’值、E/A及三尖瓣反流峰值速度(TR Vmax)。使用QLAB软件2D-STI测量左心室心肌18节段纵向峰值应变、纵向峰值应变达峰时间,并得到左心室整体纵向峰值应变(GLPS)及纵向应变达峰时间标准差(TTPLS-SD),以牛眼图显示。结果:T6与T0比较,GLPS绝对值由(-17.23±2.96)%下降为(-13.58±3.81)%(P=0.015);TTPLS-SD由(34.62±16.48)ms延长为(53.44±13.34)ms,P=0.008,变化差异有统计学意义。三个时间点对比GLPS绝对值与TTPLS-SD呈负相关(P均<0.01);其中在T1、T6时,GLPS绝对值与TTPLS-SD的r均>0.8,两者强相关。avg E/e’在[T1(10.49±0.39)、T6(9.51±0.37)分别与T0(7.58±0.01),P分别=0.019、0.000]差异有统计意义。LAD在[T1(3.29±0.30)cm较T0(3.42±0.34)cm扩大(P=0.019),T6(3.37±0.30)cm与T0],差异无统计学意义。TR Vmax在[T6(2.03±0.62)m/s较T0(1.87±0.60)m/s,P=0.025]流速稍有增快。但LVEF、LVDd、E/A比值在随访中无明显变化。结论:应用2D-STI测量左心室GLPS及TTPLS-SD可监测乳腺癌患者化疗及RT序贯治疗后的左心早期收缩功能变化,优于LVEF、LVDd、E/A比值;结合E/e’、LAD、TR Vmax观察舒张功能早期改变,可为临床监测乳癌治疗后心肌损害和预防性治疗决策提供更好的手段。
Objective:To evaluate the early left ventricular function change in breast cancer patients after the radiotherapy succeeding to chemo using two-dimensional speckle tracking imaging(2D-STI).Meth-ods:Thirty patients with left breast cancer(gradeⅡ)who undergone the radiotherapy followed chemotherapy were enrolled from May 2017 to August 2019(mean age:49.4±8.7 years).Echocardiography were performed on the day before radiotherapy(T0),the first day after radiotherapy(T1)and 6 months after radiotherapy(T6).Traditional echocardiographic parameters,including biplane Simpson’s LVEF,LVDd,LAD,mitral in-flow E/A ratio,Avg E/e’ratio derived from mitral inflow spectrum and tissue Doppler spectrum of bilateral mi-tral annulus,and the maximal velocity of tricuspid regurgitation(TR Vmax)were measured following the current echocardiography guideline.Using 2D-STI,LV regional longitudinal peak strains(LPS)and time to LPS(TTPLS)of 18-segments were determined automatically by QLAB analysis software(Philips)from the 3 standard apical LV longitudinal views.The result were rendered as colorized bull eye map,while the values of LV global longitudinal peak strain(GLPS)and standard deviation of the time to peak longitudinal strain(TTPLS-SD)were shown on the report.Results:After radiotherapy,the absolute value of GLPS was diminished,while TTPLS-SD was prolonged,the change of two parameters,between T6 and T0,was statistically significant.[GLPS:(-13.58±3.81)%vs.(-17.23±2.96)%,P=0.015];TTPLS-SD:[(53.44±13.34)vs.(34.62±16.48)ms,P=0.008].Furthermore,the negative co-relationship of the 2 parameters values was found at all 3 time point(T0,T1 and T6);both at T1 and T6,the r value were more than 0.8,indicated a strong correla-tion.There were also some clues of diastolic dysfunction.The avg E/e’ratio increased significantly both at T1[(10.49±0.39),P=0.019 and T6(9.51±0.37),P=0.000],compared with T0(7.58±0.01).LA size di-lated early after RT[LAD,T1 Vs T0:(3.42±0.34)vs.(3.29±0.30)cm,P=0.019],but it recovered 6 month later[LAD-T6:(3.37±
作者
闻应时
黄国倩
严彬
王春英
徐坡
张文青
熊琰
WEN Yingshi;HUANG Guoqian;YAN Bin;WANG Chunying;XU Po;ZHANG Wenqing;XIONG Yan(Department of Echocardiography,Jingjiang People's Hospital,Jingjiang 214500,China)
出处
《心肺血管病杂志》
2020年第12期1490-1494,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
应变
斑点追踪
乳腺癌
放射治疗
Strain
Speckle tracking imaging
Breast cancer
Radiotherapy
