Evaluation of Cardiac Function and Influencing Factors in Patients with Acute Lymphoblastic Leukemia Before Chemotherapy Using Three-Dimensional Speckle Tracking Echocardiography
Objective To evaluate the potential myocardial injury in adult acute lymphoblastic leukemia(ALL)patients before chemotherapy using three-dimensional speckle tracking echocardiography(3D-STE)and explore its related influencing factors.Methods A total of 50 patients with initial clinical diagnosis of ALL were selected as ALL group,and 30 healthy examination subjects were included as control group,both age and sex matched to the ALL group.The study subjects underwent routine echocardiography and 3D-STE to measure various functional indicators of the left ventricle.The clinical data,conventional echocardiographic parameters,as well as 3D-STE strain indicators between ALL group and control group were compared.The receiver operating characteristic(ROC)curve was protracted and the area under the curve(AUC)was calculated,the optimal cut off value for GLS was selected,and the diagnostic performance for ALL was calculated.Pearson correlation analysis was adopted to investigate the correlation between laboratory indicators and cardiac function with overall left ventricular global longitudinal strain(GLS)in ALL patients.Intraclass correlation coefficient method was chosen to test the consistency of 3D-STE parameters within and between observers.Results There were no differences in clinical parameters and conventional left ventricular function indicators between ALL group and control group(P＞0.05).The left ventricular end diastolic volume(EDV),left ventricular end systolic volume(ESV),left ventricular stroke volume(SV),left ventricular global circumferential strain(GCS)as well as left ventricular global radial strain(GRS)were similar in the above two groups(P＞0.05),while the GLS of ALL group was lower than that of control group(P＜0.05).The AUC for GLS diagnosis of ALL was 0.663(P=0.015),with an optimal cutoff value of-23.5％,sensitivity of 0.64,and specificity of 0.60.GLS showed a moderate positive correlation with hemoglobin concentration(r=0.343,P=0.015),a weak positive correlation with C-reactive protein(CRP)(r=0.289,P=0.042),a moderate negative correlation with blood lymphocyte count(r=-0.434,P=0.002),and no significant correlation with cardiac troponin I(cTnI),interleukin-6(IL-6),and left ventricular ejection fraction(LVEF)(r=-0.083,-0.276,0.268,P=0.569,0.052,0.060,respectively).All 3D-STE measurement indicators have good repeatability within and between observers,all in line with intraclass correlation coefficient＞0.75.Conclusion Left ventricular GLS damage in ALL patients occurs earlier than LVEF reduction,which is independently correlated with lymphocyte count,hemoglobin concentration,and CRP in the blood.It has predictive value for pre chemotherapy cardiac function damage in ALL patients.
万方数据
维普
