The Changes Of Left Ventricular Torsion And Strain In Breast Cancer Patients Receiving Anthracyclines Be Detected By Three-dimensional Speckle Tracking Imaging

Objective The incidence of female breast cancer in China is increasing year by year.The timely treatment of surgery combined with adjuvant radiotherapy and chemotherapy is directly related to the prognosis and survival rate of patients.Chemotherapy has become an indispensable part of breast cancer comprehensive treatment in clinical.This study applies three-dimensional speckle tracking imaging(3D-STI)technology monitors the changes of left ventricular torsion and strain in postoperative patients with breast cancer receiving Anthracyclines(ATC),detecting early myocardial toxicity of ATC.Provide a more accurate basis in clinical for preventing its toxic effects and adjusting medication program timely.Methods From November 2015 to May 2017,in our hospital,47 patients with postoperative breast cancer who underwent ATC chemotherapy were enrolled in this study,exclude patients who underlying cardiovascular diseases and severe abnormalities of liver and kidney functions.Conventional echocardiography was performed at cumulative time points of T0: 0mg / m2,T2: 120 mg / m2,T6: 240 mg / m2,and T6: 360 mg / m2 respectively.The relative parameters including left ventricular internal dimension at end–diastole(LVIDd),interventricular septal thickness at end-diastole(IVSd),left ventricular posterior wall thickness attend-diastole(LVPWd),left ventricular frational shortening(LVFS),and left ventricular ejection fraction(LVEF)(modified biplane Simpson method)were measured.Then obtained high-frame-rate three-dimensional dynamic images in the apex by 4V-D probe,imported the data into the GE Echo PAc and analyzed by software,then output the relevant left ventricular torsion and strain parameters: left ventricular twist(Ptw),left ventricular torsion(Tor),global longitudinal strain(GLS),global circular strain(GCS)and global radial strain(GRS).Statistical analysis was performed and receiver operating characteristic curves(ROCs)were plotted,in order to assess and compare the value of each parameter for monitoring early changes in left ventricular myocardial function.Twenty-two female volunteers served as healthy controls.Results 1.The comparison of routine non-strain parameters: There was no significant difference in LVIDd,IVSd,LVPWd,LVEF,LVFS,EDV and ESV between T0,T2,T4,T6 and control group(P> 0.05).2.The comparison of torsion and strain parameters obtain by 3D-STI technique showed that: T6,T4,T2,T0 comparison between the four groups,Ptw,Tor differences were statistically significant(P< 0.05);Ptw,Tor,GLS and GRS of T6 group were significantly lower than those in T0 group and control group(P< 0.05).There was no significant difference in GCS between T6 group and T0 group(P >0.05).3.The values of 3D-STI technique in monitoring the early myocardial damage of ATC: The area under the curve(AUC)of Ptw,Tor,GLS,GRS and GCS were 0.958,0.896,0.794,0.628,0.564.Among them,the AUC of Ptw,Tor and GLS were both greater than 0.7.Take the the corresponding value as the cut-off value when Youden index at its maximum,the cut-off value Ptw is 11.0 o,that is,the value to determine sensitivity of ATC’s myocardial toxicity was 93.6%,specificity of 85.1 % when the left ventricular torsional angle peak reduce to determine;the cut-off value of Tor is 1.25 o / cm,that is,the value to determine the sensitivity of ATC’s myocardial toxicity was 89.4%,specificity of 80.0% when the left ventricular torque reduce to determine.Conclusion 3D-STI can be used to monitor the early myocardial damage of ATC in patients with postoperative breast cancer.Among them,Ptw and Tor can be used as sensitive indicators of early detection of left ventricular dysfunction,is conducive to guide the adjustment of chemotherapy regimens and medication in clinical.Without affecting the efficacy of breast cancer treatment in patients under the premise of myocardial damage will be minimal.