Eprirubincin-induced Cardiotoxity In Breast Cancer Patients By Speckle Tracking Imaging

Objectives：To examine the change the value of the evaluation of cardiac function inpatients with breast cancer after anthracycline chemotherapy drugs by using theultrasound speckle tracking imaging (STI).Methods：This is a case study. Samples are selected from our hospitalpathological diagnosis of breast cancer patients from May2011to February2012. They are divided into TEC group and TC group based on tumor sizeand grading in accordance with the chemotherapy regiments. Each group has20patients. They are being investigated and tracked by ultrasoundinstrument (PHILIPS IE33) before their chemotherapy. First of all, patientsaccept regular ultrasound tests. The goal is to obtain the high frame ratetwo-dimensional images of standard apical four chambers, two chambers,long axis and short axis of the mitral valve level, papillary muscle level andapical level. Then do analysis to measure the patients’ segmental myocardiallongitudinal strain, radial strain, circumferential strain; and also themeasurement of intima rotation of the short axis of the mitral valve and thelevel of papillary muscle, adventitia rotation, and flat overall rotation androtation angles, by using TMQA which is from Qlab6software package.Result:(1)Compared the diastolic mitral blood flow velocity E/A ratio betweenTEC group and TC after each chemotherapy cycle. The result demonstratedthat the patients’ anthracycline chemotherapy accumulation increased with the increase of the cycle of chemotherapy, and the E/A ratio showed a decreasingtrend. After the second cycle of chemotherapy, the E/A ratio decreasedsignificantly (P<0.05), and after the fourth cycle of chemotherapy, the E/Aratio decreased significantly (P<0.01).(2) The distribution law of the patients’ each segment myocardiallongitudinal max value: apical segment>middle segment>basal segment. Eachsegment longitudinal strain curves were normal in the TC group of three cyclesof chemotherapy and in the TEC group before chemotherapy. In TEC group,the curves slightly disordered after second and fourth cycle of chemotherapy,each segment longitudinal strain values decreased with the increase ofchemotherapy. However, there was no statistically significant difference afterthe second cycle of chemotherapy (P>0.05), and it was obviously reduced afterthe fourth cycle of chemotherapy (P<0.05).(3) The chemotherapy cycle curve shape in TEC group was similar to thecurve shape in TC group. However, the patients in TEC group’s short axiscircumferential strain max value decreased with the increase of the cycle ofchemotherapy, there were no statistically significant differences after thesecond cycle of chemotherapy (P>0.05); and the short axis circumferentialstrain max value significantly reduced after the fourth cycle of chemotherapy(P<0.05).(4) The patients’ left ventricular short axis RS curve systolic wereforward-peak curve. The level of papillary muscle was significantly higher thanthe mitral valve level. There was no significant difference before chemotherapy;RS value significantly increased after the second cycle of chemotherapy. Themitral valve level of the RS max value was not statistically significant, but thelevel of papillary muscle difference was statistically significant (P<0.05). RSmax value increased after the fourth cycle of chemotherapy, and it wasstatistically significant (P<0.01). In addition, compared the mitral valve level of the fourth cycle of chemotherapy with the second cycle of chemotherapy, RSmax value was statistically significant (P<0.05).(5) Observed from the apical direction: in TC group, left ventricularrotation and reversing curve shape were basically the same after each cycle ofchemotherapy. The endometrial rotation, the outer membrane rotation, theplane rotation were clockwise rotation, the max value was negative; the apexlevel were counter-clockwise, and the max value was positive. The TEC grouphad the same situation as the TC group before the cycle of chemotherapy andafter the second cycle of chemotherapy. However, after the fourth cycle ofchemotherapy, the TEC group patients’ left ventricular rotation and rotationmax value significant increased, and parts of the curve patterns were irregular.The TEC group patients’ rotation angel and torsion angel increased with theincrease of chemotherapy cycle, and the max value difference was statisticallysignificant after the fourth cycle of chemotherapy (P<0.05).Conclusions：The ultrasound speckle tracking Imaging (STI) can evaluate the influencesof anthracycline chemotherapy drugs on cardiac function of breast cancerpatients. Regional myocardial systolic dysfunction occurs earlier than thechange of left ventricular ejection fraction, so it is easier to find early cardiactoxicity, thus guiding and adjusting clinical medication uses.