Real-time Three-dimensional Echocardiography Monitoring Of Cardiovascular Injury In Breast Cancer Patients After Chemotherapy

Objective:Cardiovascular complications caused by anti-tumor therapy have become an important factor affecting the survival and prognosis of breast cancer patients.Previous studies have shown that when breast cancer patients have clinical signs and left ventricular ejection fraction?LVEF?significantly reduced after chemotherapy,the patient's cardiac function has often been irreversibly damaged.In this study,three-dimensional speckle tracking imaging?3D-STI?was used to monitor the dynamic changes of left ventricular function of breast cancer patients during the whole follow-up period.We want to explore the clinical significance of multiple parameter changes in 3D-STI.Methods:A total of 414 female breast cancer patients who underwent chemotherapy from April 2017 to December 2018 in our hospital were selected,aged 26-75 years,averaged?45.81±9.22?years,had no history of other malignant tumors and cardiovascular disease.All patients received either EC regimen or targeted drug therapy alone.All patients underwent electrocardiogram,two-dimensional echocardiography,and three-dimensional echocardiography examination before chemotherapy and 1,3,6,12,and 20 months after chemotherapy.Conventional bilateral carotid long-axis and short-axis dynamic image were acquired before chemotherapy and 1,3,6,12,and 20 months after chemotherapy.Results:Compared with the pre-chemotherapy basal state,there was no significant difference in heart rate?HR?and blood pressure?BP?at 20 months after chemotherapy?all P>0.05?.Compared with the pre-chemotherapy basal state,left ventricular end-systolic volume?LVESV?and left ventricular ejection fraction?LVEF,Simpson's method?began to decrease at 6 months after chemotherapy(LVESV_Basas vs LVESV_6M:29±7ml vs 26±6ml LVEF_Basas vs LVEF_6M:65±5%vs 63±6%;all P<0.05);left ventricular end-diastolic volume?LVEDV?began to decrease at 12 months after chemotherapy(LVEDV_Basas vs LVEDV_12M:78±12ml vs 76±10ml;LVEDV_Basas vs LVEDV_20M:78±12ml vs 73±6ml;P<0.05).The Left ventricular global longitudinal strain?GLS?began to differ statistically at 1month after chemotherapy,which was lower than the basal state(GLS_Basas vs GLS_1M:-20.12±2.20%vs-18.97±1.56%;P<0.05).Three months after chemotherapy,the global circumferential strain?GCS?and area strain?GAS?were lower than the basal state(GCS_Basas vs GCS_3M:-20.37±3.12%vs 18.68±2.36%;GAS_Basas vs GAS_1M:-38.43±9.72%vs-30.67±9.56%;all P<0.05).Six months after chemotherapy,the global radial strain?GRS?was lower than the basal state(GRS_Basas vs GRS_6M:51.76±14.98%vs 44.15±16.82%;P<0.05).Left ventricular rotation was lower than basal state at 6,12,and 20 months after chemotherapy(Rotation_Basas vs Rotation_6MM vs Rotation_12M2M vs Rotation_20M:8.80±2.64 vs7.61±2.30 vs 7.09±1.82 vs 6.89±1.84;P<0.05).Left ventricular torsion at 12 and 20months after chemotherapy is lower than the basal state(Torsion_Basas vs Torsion_12M2M vs Torsion_20M:1.71±0.98 vs 1.46±0.53 vs 0.96±0.58;all P<0.05).After 20 months of chemotherapy,there was no statistical difference between LVEDV,LVESV,LVEF in the EC group and targeted treatment Group?both P>0.05?.Compared with the EC group,patients in the target group had lower ratios of GLS,GCS,GRS and GAS at 20 months after chemotherapy(GLS_ECC vs GLS _target:-17.13±1.98%vs-12.90±1.62%;GCS_ECC vs GCS _target:-19.58±2.14%vs-16.48±2.47%;GRS_ECC vs GRS _target:46.82±6.98%vs 32.34±10.65%;GAS_ECC vs GAS _target:-22.34±6.76%vs-17.96±5.32%;all P<0.05).After 20 months of chemotherapy,Carotid artery diameter and intima-media thickness?IMT?,peak diastolic velocity?PDV?,peak systolic velocity?PSV?,the maximum positive peak circumferential strain?CS?and the circumferential strain rate?CSr?of carotid artery compared with the pre-chemotherapy basal state were no significant differences?p>0.05?.Conclusion:3D-STI can detect heart function damage early.GLS is the most sensitive indicator of myocardial function damage of 3D-STI parameters.Different chemotherapy regimens have different degrees of damage to myocardial function,which may be related to different mechanisms of drug action.Chemotherapy drugs may have different mechanisms of damage to the heart and carotid arteries.The damage of chemotherapy drugs to the heart may be caused by direct damage of cardiomyocytes,and the damage to blood vessels may be mainly caused by endothelial function damage.