Research on changes of parameters of three-dimensional spot tracking imaging(3D-STI)in patients with renal cell carcinoma(RCC)before and after treatment with sunitinib and its early warning value for cardiotoxicity
Objective To investigate the change of the parameters of three-dimensional spot tracking ima-ging(3D-STI)before and after the treatment with sunitinib in patients with renal cell carcinoma(RCC)and its early warning value for cardiotoxicity.Methods A total of 226 patients with RCC in the Hospital from November 2020 to March 2022 were selected as observation group,and the occurrence of cardiac tox-icity events was recorded during a follow-up period of 18 months.And 226 healthy subjects were selected as control group.The 3D-STI parameter values[global area strain(GAS),global radial strain(GRS),glob-al longitudinal strain(GLS),global circumferential strain(GCS),left ventricular twist(LVtw),3D-left ventricular ejection fraction(3D-LVEF),myocardial composite index(MCI)]were compared between the observation group,control group,and the observation group for the patients with cardiac toxicity.The in-fluencing factors of cardiotoxicity induced by sunitinib adjuvant therapy in patients with renal cell carcino-ma were analyzed.Receiver operating characteristic curve(ROC curve)was used to analyze the early warning value of 3D-STI parameters for cardiotoxicity.The dose-response relationship between 3D-STI parameters and the risk of cardiotoxicity was analyzed with restricted cubic spline plots.Results GAS,GLS,LVtw and MCI after 1 cycle of the treatment were lower than before the treatment in observation group,and GAS,GLS,LVtw and MCI in observation group after 1 cycle of the treatment were lower than those in control group(P＜0.05).Among the 226 patients in the observation group,9 cases of shedding were followed up for 18 months,217 cases(96.02％)were effectively followed up,and 55 cases(25.35％)had cardiotoxic events.Compared with the patients without cardiotoxicity,the number of smoking cases,drinking cases,hypertension cases,local symptoms cases,IMDC score delamination,a-hydroxybutyrate dehydrogenase levels were increased,and GAS,GLS,LVtw and MCI was decreased after 1 cycle of the treatment(P＜0.05).The increase in α-hydroxybutyrate dehydrogenase levels was an independent risk factor for cardiac toxicity,while the elevation of GAS and MCI was an independent protective factor for cardiac toxicity(P＜0.05).After 1 cycle of the treatment,the AUC value of GAS and MCI alone in pre-dicting cardiotoxicity induced by sunitinib adjuvant therapy in patients with renal cell carcinoma was 0.814 and 0.875,respectively,and theAUC value of combined prediction was 0.910,and it had higher predictive value.There was a nonlinear dose-response relationship between GAS(x2=16.708,P＜0.001),MCI(x2=17.426,P＜0.001)and the risk of cardiotoxicity.When GAS＜32.73％,MCI＜168.74％×°,GAS(β=-0.709,95％CI=0.283～0.842,P＜0.001),MCI(β=-0.630,95％CI=0.356～0.811,P＜0.001)were negatively correlated with the risk of cardiotoxicity.Conclusion The change of 3D-STI pa-rameters during sunitinib is closely related to the risk of cardiotoxicity in patients with renal cell carcino-ma,and there is a"threshold effect",which can provide a reference for predicting the risk of cardiotoxicity in early clinical stage.
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