Evaluation Of Cardiotoxicity After Receiving Anthracycline In Patients With Breast Cancer By Using Myocardial Composite Index Based On 3D-STI

Objective Breast cancer is a malignant tumor of breast epithelial tissue.In recent years,with the changes of people’s living environment,diet and pressure,the mortality and morbidity of breast cancer have been increasing year by year among the female population,which seriously affects women’s physical and mental health.Anthracycline(AC)is a commonly used drug for a broad spectrum of hematological malignancies and solid tumors.It has been reported that AC combined with other chemotherapeutic drugs can achieve potent anticancer effect and the combined chemotherapy is currently the most commonly used chemotherapy regimen after breast cancer surgery,greatly improving the patient’s postoperative survival rate.However,its clinical value is limited by its irreversible myocardial damage.Therefore,early detection of anthracycline induced myocardial damage is particularly important for achieving a balance between potential cardiac adverse events and antitumor efficacy.Three dimensional speckle tracking imaging(3D-STI)is a method to evaluate myocardial function by tracking the three dimensional position of myocardial plaque during the exercise,rebuilding the plaque to obtain real time three dimensional data.As a new parameter based on 3D-STI technique,myocardial composite index(MCI),which integrates the longitudinal strain and rotation angle of left ventricular myocardium,reflects the change of myocardial mechanics.This study aims to evaluate the abnormalities of heart during the exercise of anthracycline-induced breast cancer patients by using 3D-STI technique and the value of myocardial parameters associated with subclinical myocardial dysfunction,and to guide clinical rational drug use.Methods Sixty four patients with postoperative breast cancer scheduled for epirubicin(A 60 mg/m~2)+cyclophosphamide(C 60 mg/m~2)adjuvant chemotherapy were enrolled in this study.The exclusion criteria are as follows:patients receiving concurrent radiotherapy or taking other cardiotoxicity drugs,and patients with all kinds of cardiovascular,liver,kidney and other basic diseases;during chemotherapy,electrocardiogram,serology and other tests showed no abnormalities,the expected survival of patients is more than 24 months and patients have good compliance ultimately determine the eligible and follow up of 51 patients.The electrocardiogram,two dimensional and three dimensional echocardiography were performed within 1-2days after cumulative doses of epirubicin reached 0 mg/m~2、180 mg/m~2 and 360mg/m~2.The receiver operating characteristic(ROC)curves of MCI and 3D-STI were plotted to evaluate their diagnostic value for cardiotoxicity induced by anthracycline in patients with breast cancer.Results1.Compared with the control group,there was no statistically significant difference in the routine ultrasound parameters LVIDd,IVSd,LVPWd,CO,HR,SPI,EDmass,ESmass before,during and after chemotherapy(P<0.05).The difference of GCS and LVEF between the chemotherapy group and the prechemotherapy group was statistically significant(P<0.05).There is no statistical significance for GRS between the chemotherapy group and prechemotherapy group.3.The LVEF measured by 3D-STI technique showed statistically significant ab-normalities with the progress of chemotherapy,but no obvious abnormal change-s of LVEF measured by the Simption method were found at this time.4.The area under the curve(AUC)of MCI,GAS,LVtw,GLS,GCS,GRS and LVEF were 0.951,0.914,0.876,0.623,0.650,0.581 a-nd respectively.The cut-off value of the parameter was identified.The AUC of MCI and GAS was greater than 0.9 and the cut-off value of MCI was 235.75.The sensitivity and specifici-ty of anthracycline che-motherapy for left ventricular dysfunction were 94.1%and 90.2%,respectively.The diagnostic cutoff value of GAS was-31.5,of which the sensitive was 90.2%and specificity was 82.4%.Conclusion The sensitivity and specificity of MCI to detect cardiotoxicity of an-thracyclines during chemotherapy are high.3D-STI can early detect the impair-ment of left ventricular myocardial function in patients with breast cancer by anthracycline and provide a reliable basis for treatment..