Mitral Annular Displacement Technique Detects Changes In Left Ventricular Systolic Function After Chemotherapy In Patients With Breast Cancer

Objective: To investigate the clinical value of mitral annular displacement automatic tracing technique(TMAD)in quantitative evaluation of left ventricular systolic function after chemotherapy in patients with breast cancer.Methods: Forty-five(30~65 years old,average 47.2 + 8.2 years old)patients with breast cancer,who were predominantly enrolled epirubicin,were chosen in this study.Before chemotherapy and after the second,fourth,sixth cycles of chemotherapy,the application of TMAD technology in the apical four chamber view on dynamic measurement of the maximum displacement of mitral annular ventricular septum(TMAD1),the maximum displacement of left ventricular lateral wall(TMAD2),the maximum displacement of in the midpoint of the septal-lateral wall ring line(TMADmidpt)and the total percentage of left ventricle the long diameter(TMADmidpt%);Two-dimensional speckle tracking technique(2D-STI)was used to observe the left ventricular global longitudinal peak strain value(GLS)and the global circumferential peak strain value(GCS)in the long axis and short axis of the heart.The left ventricular end diastolic volume(EDV),end systolic volume(ESV)and left ventricular ejection fraction(3D-LVEF)were measured on three-dimensional dynamic picture by three-dimensional cardiac quantification.Simultaneous measurement of conventional echocardiographic parameters of diastolic interventricular septal thickness(IVSd),left ventricular posterior wall thickness(LVPWd),left ventricular end diastolic diameter(LVEDd),maximum left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS)as well as Doppler ultrasound parameters of mitral peak early diastolic velocity(E),the atrial systolic peak velocity(A)and mitral annular septal diastolic early peak velocity(e),then calculate the value of E/A,E/e.The differences of ultrasound parameters between the two groups before and after chemotherapy were compared.At the same time,the correlation,between TMAD displacement parameters,GLS and 3D-LVEF,was analyzed before and after chemotherapy.Results:(1)Compared with before chemotherapy,there was no statistically significant difference between the conventional ultrasound parameters of IVSd,LVPWd,LVEDd,LVEF,LVFS as well as Doppler parameters E and A at the end of each chemotherapy cycle(P>0.05),E/A(1.27±0.36 vs 1.04±0.30,P=0.001),E(9.00±1.73 vs 8.24±2.12,P=0.034)and E/e(9.30±2.78 vs 10.44±3.02,P=0.011)had statistically significant differences after the end of the 6th cycle of chemotherapy.(2)Compared with before chemotherapy,the measured value of GLS has decreased at the end of the 4th cycle of chemotherapy(-23.42±2.03 vs-19.40±1.92,P=0.000)and the 6th cycle of chemotherapy(-23.42±2.03 vs-19.00±2.34,P=0.000),and there was no statistically significant difference in GCS between the chemotherapy cycles(P>0.05).(3)Compared with before chemotherapy,3D-LVEF,the parameter of single cardiac cycle real-time three-dimensional echocardiography(s RT-3DE),has decreased at the end of the 4th cycle of chemotherapy(66.86±3.95 vs 59.30±3.74,P=0.000)and 6th cycle of chemotherapy(66.86±3.95 vs 57.73±3.02,P=0.000);EDV(88.73±12.51 vs 80.96±11.02,P=0.000)and ESV(30.44±4.65 vs 33.74±6.98,P=0.05)had significant difference at the end of chemotherapy 6th cycles.(4)Compared with before chemotherapy,the measured values of TMAD1,TMAD2,TMADmidpt,and TMADmidpt% have decreased at the end of the 4th cycles of chemotherapy(12.41±2.50 vs 10.06±1.82,P=0.000 / 14.23±2.20 vs 11.29±2.92,P=0.000 / 13.83±1.84 vs 11.05±1.93,P=0.000 / 17.17±2.14 vs 13.75±2.12,P=0.000)and 6th cycles of chemotherapy(12.41±2.50 vs 10.08±2.53,P=0.000 / 14.23±2.20 vs 10.13±3.35,P=0.000 / 13.83±1.84 vs 10.49±2.38,p=0.000 / 17.17±2.14 vs 12.57±3.06,P=0.000).What’s more,TMAD2 and TMADmidpt% were the most significant.(5)The correlations between TMAD1,TMAD2,TMADmidpt,TMADmidpt% and GLS,3D-LVEF were analyzed at each cycle before and after chemotherapy.They were negatively correlated with GLS significantly.Before chemotherapy(r values were-0.885,-0.762,-0.660,-0.779,respectively,all P<0.001),the 2nd cycle of chemotherapy(r values were-0.987,-0.975,-0.981,-0.976,respectively,all P<0.001),the 4th cycle of chemotherapy(r values were-0.801,-0.964,-0.688,-0.987,respectively,all P<0.001),the 6th cycle of chemotherapy(r values were-0.662,-0.728,-0.890,-0.701,respectively,all P<0.001);With 3D-LVEF has significant correlation,were positively correlated,before chemotherapy(r values were 0.933,0.933,0.791,0.739,respectively,all P<0.001),the 2nd cycle of chemotherapy(r values were 0.980,0.980,0.970,0.983,respectively,all P<0.001),the 4th cycle of chemotherapy(r values were 0.869,0.869,0.965,0.967,respectively,all P<0.001),the 6th cycle of chemotherapy(r values were 0.583,0.583,0.748,0.656,respectively,all P<0.001).Conclusion: The mitral annulus displacement(TMAD)technique detects the left ventricular global systolic function change earlier than that of conventional two-dimensional echocardiography.TMAD technology has a good correlation with 2D-STI and s RT-3DE.It is simple and easy to implement,and is expected to become a new method to monitor the damage of left ventricular systolic function after anthracycline chemotherapy.It will play a certain role in the guidance of clinical early prevention and intervention.