Evaluation Of Anthracycline On Right Ventricular Myocardial Damage In Breast Cancer Patients Using Three-dimensional Speckle Tracking Technique

Objective: To monitor the change of functional parameters of right ventricle in breast cancer patients after anthracyclines using three-dimensional speckle tracking technique.Methods: A total of 30 female patients diagnosed with breast cancer and admitted in Breast Surgery of our hospital from June 2020 to January 2021 were enrolled in the current study.Their age range was within 32-56 years old,with a mean age of 43±7.43 years.A chemotherapy regimen with epirubicin as the main drug was performed,with21 days as a chemotherapy cycle and a total of four cycles.The data of the right ventricular structure and function of all the subjects were measured by echocardiography before chemotherapy,within 24 hours after the first cycle of chemotherapy,the second cycle of chemotherapy,the third cycle of chemotherapy and the fourth cycle of chemotherapy,respectively,including right ventricular dimension(RVD1)in the basal segment,right ventricular dimension(RVD2)in the middle segment,right ventricular wall thickness(RVWT),right ventricular end-systole area(RVESA),right ventricular end-diastole area(RVEDA),in order to calculate the right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE),peak E and A of blood flow in early and late diastolic phases of tricuspid valve and E/A ratio,as well as MPI,namely,Tei index =(a-b)/b,peak S’ of systolic velocity of tricuspid valve,peak E’ and A’ of blood flow in the early and late diastole and E/E’ ratio.Meanwhile,the left ventricular ejection fraction was measured by Simpson method.The right ventricular global longitudinal strain(RVGLS)and the right ventricular free wall strain(RVFWS)during the systole were obtained using two-dimensional speckle tracking technique.Strain data were measured by three-dimensional speckle tracking technique,including global longitudinal strain(GLS),circular strain(GCS),radial strain(GRS)of left and right ventricles,as well as left ventricular global area strain(LVGAS)and right ventricular volume parameters,including right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV)and right ventricular ejection fraction(RVEF).All the results were compared between groups so as to discuss the changes of right ventricular function in breast cancer patients treated with chemotherapeutic anthracyclines.Results: 1.The two-dimensional parameters RVFAC and TAPSE decreased gradually after chemotherapy and the Tei and E/E’ increased(p<0.05)gradually compared with before chemotherapy.2.The strain parameters RVGLS and RVFWS measured by two-dimensional speckle tracking technique decreased(p<0.05)gradually after chemotherapy compared with before chemotherapy.3.The parameter RVEF measured by 3D echocardiography decreased(p<0.05)gradually with chemotherapy cycle compared with before chemotherapy.The sensitivity and specificity of RVEF on ventricular damage caused by chemotherapy were higher than those of RVFAC and TAPSE.4.The LVGAS and LVGLS decreased(p<0.05)gradually after the second cycle of chemotherapy compared with before chemotherapy;the LVGCS started decreasing(p<0.05)after the third cycle of chemotherapy;and the LVGRS was not significantly changed(p>0.05)throughout the chemotherapy cycle.The RVGLS and RVGCS began to decrease(p<0.05)after the second cycle of chemotherapy compared with before chemotherapy.The RVGLS,RVGCS and RVGRS decreased(p<0.05)after the fourth cycle of chemotherapy.5.There was a significant negative correlation(r=-0.889,pr=0.001)between RVGLS and dose accumulation,and a negative correlation(r=-0.762,pr=0.001)between LVGAS and dose accumulation.The RVGLS has a higher correlation with the cumulative dose of anthracyclines compared with LVGAS.6.The ROC graphs of RVGLS and LVGLS showed that the RVGLS has higher sensitivity and specificity on myocardial toxicity after chemotherapy compared with LVGLS.Conclusions: The 2D parameters RVFAC,TAPSE,Tei and E/E’ can be used as reference indexes to evaluate the changes of the right ventricular function,which indicate that the right ventricular systolic function has been changed in the early stage of chemotherapy.The 3D echocardiography can be used as a reference for monitoring myocardial damage.Moreover,when compared with 2D routine data RVFAC and TAPSE,it has higher sensitivity and specificity.The strain parameters of the right ventricle obtained by 3D speckle tracking technique are more sensitive and specific to evaluate myocardial damage than those of the left ventricle.It is suggested that the detection of right ventricular parameters is of great significance to evaluate the myocardial injury in breast cancer patients on chemotherapeutics.