Evalution Of Left Ventricular Function And Synchronicity In Patients With Breast Cancer Before And After Anthracycline Chemotherapy By Real-Time Triplane Automated Function Imaging

BackgroundBreast cancer is one of the most common malignant tumors in women.The incidence of breast cancer is increasing year by year,which seriously threatens women's health.In recent years,with the development and progress of comprehensive treatment strategy for breast cancer,the survival time of breast cancer patients has been greatly improved.Anthracyclines,as the basic drug for breast cancer patients,have a milestone in the treatment.Because anthracyclines can cause obvious cardiotoxicity and have obvious dose-effect linear relationship,the affinity of myocardium is obviously higher than that of other tissues.As the dosage of anthracyclines increases,myocardium is more vulnerable to injury,which greatly reduces the quality of life and increases the risk of death.Therefore,it is very important to detect myocardial toxicity early and guide clinicians to use drugs.At present,echocardiography is a commonly used method to evaluate cardiac function in breast cancer patients undergoing chemotherapy.Left ventricular ejection fraction?LVEF?,as the most commonly used ultrasound monitoring index,can not reflect the subtle changes of left ventricular systolic function and abnormal ventricular wall segmental function because of its relatively low sensitivity.Real-time triplane automated function imaging?AFI?is a new ultrasound technology developed in recent years.Left ventricular global longitudinal strain,different sections strain and peak strain dispersion?PSD?can be automatically obtained by software.However,at present,this technology is used to evaluate cardiac function of female breast cancer patients.The application value is not very clear.ObjectiveTo explore the value of real-time triplane automated function imaging?AFI?in evaluating left ventricular function and synchronization of breast cancer patients before and after anthracycline chemotherapy by evaluating the difference and correlation of left ventricular geometry,global longitudinal strain?LVGLS?,different sections strain and peak strain dispersion?PSD?in breast cancer patients treated with anthracycline before and after chemotherapy.MethodsThirty-one women with breast cancer diagnosed by operation and histopathology in our hospital?Henan provincial people's hospital?from November 2017 to September 2018were selected.Aged 26-65 years and average 44.9±9.5.All patients were treated with EC-T chemotherapy regimen?including Epirubicin,Cyclophosphamide and Docetaxel?based on anthracycline drugs.The chemotherapy lasted for 6 to 8 cycles.Blood pressure,blood glucose,electrocardiogram,liver and kidney function were normal;Exclusion criteria:hypertension,diabetes,coronary heart disease,severe arrhythmia,severe valvular diseases,primary cardiomyopathy,prosthetic implant recipients,patients who had received chemotherapy and/or radiotherapy before,unable to obtain clear images and patients who can't cooperate well.Echocardiography was performed 24 hours before chemotherapy,24hours after the end of the first and third cycles of chemotherapy,and the parameters of LVEDV,LVESV,IVSd,LVPWd,LVFS,LVEF,E,A and e were measured routinely.Real-time three-plane acquisition of dynamic images,EchoPAC software analysis,automated function imaging technology?AFI?to obtain LVGLS,PSD,longitudinal strain values of each section,analysis and comparison of anthracycline treatment of breast cancer patients before and after chemotherapy left ventricular myocardial function and synchronicity parameters and the correlation between parameters.Results1.General parameters comparison:Compared with the baseline state before chemotherapy,there was no significant difference in height,weight,BMI,heart rate,systolic blood pressure and diastolic blood pressure?P>0.05?.2.Conventional echocardiographic parameters Comparison:Compared with the basal state before chemotherapy,there was no significant difference in the size of each atrioventricular,there was no significant difference in LVEF?E/A and E/e?P>0.05?.3.Longitudinal strain parameters comparison:Compared with the basal state before chemotherapy,LVGLS decreased significantly from 1 to 3 cycles of chemotherapy?P<0.05?;GLS_3ch and GLS_4chch had significant difference at the end of 3 cycles of chemotherapy?P<0.05?,and GLS_2ch was significantly different at the end of one cycle of chemotherapy and three cycles of chemotherapy?P<0.05?.4.Synchronicity parameters Comparison:Compared with the basal state before chemotherapy,PSD increased significantly in three cycles of chemotherapy?P<0.05?;although one cycle of chemotherapy increased,there was no significant difference?P>0.05?.Conclusions1.Left ventricular systolic function and synchronization of ventricular myocardium have been reduced to some extent before the changes of routine ultrasound parameters in breast cancer patients treated with anthracycline drugs.2.Automatic Functional Imaging?AFI?is a clinical application software based on the principle of two-dimensional speckle tracking.As a new parameter,PSD can be used to evaluate the synchronization of myocardial motion.It is simple,convenient and fast,and has clinical application value.3.GLS and PSD can indicate the damage of left ventricular myocardial function in early stage,and provide objective basis for early clinical intervention.