Value of DC,E/Em,LAVI in predicting cardio toxicity of trastuzumab emtansine in the treatment of breast cancer
Objective To explore the value of deceleration capacity of rate(DC),early diastolic mitral inflow velocity/early diastolic mitral annular velocity(E/Em),and left atrial volume index(LAVI)in predicting cardiotoxicity of trastuzumab emtansine(T-DM1)in the treatment of breast cancer.Methods A total of 90 breast cancer patients treated with T-DM1 in Jinhua Central Hospital from February 2021 to January 2022 were selected as the study subjects.The left ventricular ejection fraction(LVEF),DC,E/Em and LAVI levels were measured before T-DM1 treatment.During the treatment,regular follow-up was conducted on cardiac toxicity-related clinical indicators and symptoms.Echocardiogram indicators and muscle enzyme indicators before and after treatment were compared between the cardiotoxicity group and the non-cardiotoxicity group.The correlation between DC,E/Em,LAVI and LVEF were analyzed.Results Among the 90 patients,21(23％)developed cardiotoxicity and 69(77％)did not.After treatment,the LVEF and DC levels in the cardiotoxicity group was significantly lower than those before treatment(t=8.275,4.399,P＜0.001),while the of E/Em and LAVI levels were significantly higher than before treatment(t=7.362,9.011,P＜0.01).In the non-cardiotoxic group,there were no significant change in DC,E/Em,LAVI,late diastolic mitral valve velocity(Am),and Em/Am compared with before treatment(P＞0.05).The levels of creatine kinase isoenzyme(CK-MB),cardiac troponin Ⅰ(cTn Ⅰ),and B-type natriuretic peptide(BNP)in the cardiotoxicity group were significantly higher than those in the non-cardiotoxicity group(t=1 1.706,4.364,8.958,P＜0.001).DC was significantly positively correlated with LVEF(r=0.207,P=0.009),while E/Em and LAVI were significantly negatively correlated with LVEF(r=-0.474,-0.753,P＜0.01).The areas under the curve(AUC)of DC,E/Em,LAVI and combined prediction were 0.809,0.781,0.803 and 0.860,respectively.Conclusion DC,E/Em and LAVI have high predictive value for cardiotoxicity events in breast cancer patients treated with T-DM1,and the combined diagnostic value is the highest.
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