肿瘤影像学2024，Vol.33Issue(1) ：82-88.DOI:10.19732/j.cnki.2096-6210.2024.01.012

超声心肌做功指数评估乳腺癌化疗后癌症治疗相关心脏功能障碍的临床意义

Clinical significance of ultrasonic myocardial work index in evaluating cancer therapy-related cardiac dysfunction after breast cancer chemotherapy

包成明 冉红 贾绘 陈孝园 钱晓凤 鲁安奎 张仁敏
肿瘤影像学2024，Vol.33Issue(1) ：82-88.DOI:10.19732/j.cnki.2096-6210.2024.01.012
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  • 维普
  • 万方数据

超声心肌做功指数评估乳腺癌化疗后癌症治疗相关心脏功能障碍的临床意义

Clinical significance of ultrasonic myocardial work index in evaluating cancer therapy-related cardiac dysfunction after breast cancer chemotherapy

包成明 1冉红 2贾绘 1陈孝园 1钱晓凤 1鲁安奎 1张仁敏3
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作者信息

  • 1. 南京市溧水区人民医院(东南大学附属中大医院溧水分院)超声科,江苏 南京 211200
  • 2. 南京市第一医院(南京医科大学附属南京医院)心血管超声科,江苏 南京 210000
  • 3. 南京市溧水区人民医院(东南大学附属中大医院溧水分院)放疗科,江苏 南京 211200
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摘要

目的:探讨超声心肌做功指数评估乳腺癌化疗后癌症治疗相关的心脏功能障碍(cancer therapy-related cardiac dysfunction,CTRCD)的临床意义.方法:收集2021年1月—2022年6月南京市溧水区人民医院45例接受蒽环类药物序贯治疗的人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)+乳腺癌妇女,包括33例非CTRCD患者和12例CTRCD患者.所有患者在开始蒽环类药物治疗前(T0)、蒽环类药物化疗2个周期后(T1)、4个周期后(T2)和整个化疗周期结束时(T3)接受二维经胸超声心动图和二维斑点追踪超声心动图(speckle tracking echocardiography,STE)检查.结果:在CTRCD和无CTRCD的患者中,整体纵向应变(global longitudinal strain,GLS)、左心室心肌做功指数(myocardial work index,GWI)和整体有用功(global constructive work,GCW)的轨迹显著不同(P分别为＜0.001、0.017、0.006).在整个化疗期间,CTRCD患者的GLS、GWI和GCW呈时间依赖性降低(P＜0.05),并且在T3时降至最低.多变量分析显示,GLS[OR(95%CI)=1.94(1.02～3.69),P=0.044]和GWI[OR(95%CI)=1.78(1.05～3.03),P=0.032]降低与CTRCD独立相关.T1期GLS和GWI作为CTRCD独立预测因子的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积(area under curve,AUC)分别为0.749(95%CI 0.550～0.948)和0.837(95%CI 0.675～0.998).当T1期GLS和GWI两者结合时诊断CTRCD的AUC提高至0.942(95%CI 0.878～1.000),灵敏度和特异度分别为74.7%、92.1%.结论:左心室GLS和GWI可以作为蒽环类药物诱导的CTRCD的独立预测因子.

Abstract

Objective:To explore the clinical significance of ultrasonic myocardial work index in evaluating cancer therapy-related cardiac dysfunction(CTRCD)after breast cancer chemotherapy.Methods:A total of 45 women with human epidermal growth factor receptor 2(HER2)+ breast cancer who received anthracycline sequential therapy participated in Nanjing Lishui District People's Hospital from January 2021 to June 2022 were selected,including 33 patients with non-CTRCD and 12 patients with CTRCD.All patients were examined by two-dimensional transthoracic echocardiography and two-dimensional speckle tracking imaging(STI)before starting anthracycline therapy(T0),after 2 cycles of anthracycline chemotherapy(T1),after 4 cycles(T2)and at the end of the whole chemotherapy cycle(T3).Results:In patients without CTRCD,the trajectories of GLS,GWI and GCW were significantly different(P＜0.001,0.017 and 0.006,respectively).During the whole chemotherapy period,GLS,GWI and GCW of patients with CTRCD decreased in a time-dependent manner(P＜0.05),and reached the lowest level at T3.Multivariate analysis showed that GLS[OR(95%CI)=1.94(1.02-3.69),P=0.044]and GWI[OR(95%CI)=1.78(1.05-3.03),P=0.032]was independently related to CTRCD.The area under curve(AUC)of GLS and GWI in T1 as independent predictors of CTRCD were 0.749(95%CI 0.550-0.948)and 0.837(95%CI 0.675-0.998),respectively.When GLS and GWI were combined in T1 phase,the AUC of diagnosing CTRCD increased to 0.942(95%CI 0.878-1.000),and the sensitivity and specificity were 74.7%and 92.1%respectively.Conclusion:Left ventricular GLS and GWI can be used as independent predictors of anthracycline-induced CTRCD.

关键词

乳腺癌/超声/心肌做功指数/化疗/心脏功能障碍

Key words

Breast cancer/Ultrasound/Myocardial work index/Chemotherapy/Cardiac dysfunction

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基金项目

国家自然科学基金(82102058)

出版年

2024
肿瘤影像学
复旦大学附属肿瘤医院

肿瘤影像学

CSTPCD
影响因子：0.67
ISSN：1008-617X
参考文献量17
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