| Objective Speckle tracking echocardiography for female breast cancer patients with Non-Her-2 over expression subtype who have received chemotherapy with anthracyclines but did not receive trastuzuma and female volunteers who had a physical examination during the same period of time were ultrasonic data monitoring.Follow-up of their ultrasound data was compared to identify parameters that could be used for early and effective evaluation of changes in cardiac function.The aim is to try to find out the ultrasonic parameters that can effectually assess the early changes of cardiac function.Methods 80 female breast cancer patients with Non-Her-2 over expression subtype who were pathologically confirmed to have received chemotherapy with anthracyclines but did not receive trastuzumab were identified from the Department of Thyroid and Breast surgery,the Northern of Jiangsu Pepole’s hospital from December 2018 to December 2020.At the same time,the control group was enrolled as 80 healthy women who underwent physical examination.After they have been formed into four separate groups.They included 40 cases in group a(≤40 years old),40 cases in group b(>40 years old),and healthy subjects.The healthy subjects included 40 cases in group a(≤40 years old)and 40 cases in group b(>40 years old).Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵwere used as markers pre-chemotherapy,2-cycle,4-cycle,6-cycle,6-month,and 12-month in this study.Conventional echocardiography,two-dimensional speckle tracking echocardiography(2D-STE),left ventricular pressure-strain loop(PSL)and three-dimensional speckle tracking echocardiography(3D-STE)were used to gather the corresponding ultrasonic sections of each chemotherapy period and the control group that met the requirements of the study.Then we analyze and compare the corresponding data of left ventricle and left atrium,and finally select the valuable diagnostic indicators that met the requirements.Result1.There was no significant difference in all parameters in I compared with the control group.(all P>0.05)2.Parameters of conventional echocardiography Compared with I,Early diastolic transmitral velocity(E),late diastolic transmitral velocity(A),early diastolic tissue velocity(Em)and late diastolic tissue velocity(Am)in the group a(Ⅳ,Ⅴ,Ⅵ)and the group b(Ⅲ,Ⅴ,Ⅵ)were obviously decreased(P<0.05).They decreased slightly from Ⅱ.The other parameters had no statistical significance(all P>0.05).3.Parameters of two-dimensional speckle-tracking echocardiography(2D-STE)and left ventricular pressure-strain loop(PSL)3.1 Global longitudinal strain(GLS),Global circumferential strain(GCS)and Left ventricular twist(LVtw)in the group a(Ⅲ、Ⅳ、Ⅴ、Ⅵ)and b(Ⅲ、Ⅳ、Ⅴ、Ⅵ)were significantly lower than those in group Ⅰ(P<0.05).They decreased slightly fromⅡ.Global radial strain(GRS)did not decrease significantly.LVtw in group b(Ⅲ)was significantly different from that in group a(Ⅲ)(P<0.05).3.2Compared with I,Global work index(GWI),Global constructive work(GCW),Global work efficiency(GWE)were significantly decreased in the group a and b(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05)and slightly decreased since Ⅱ.Global work waste(GWW)in the group a(Ⅲ、Ⅳ、Ⅴ、Ⅵ)and b(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05)and slightly increased from group Ⅱ.GWI in group B(Ⅲ)was lower than that in group A(Ⅲ)and the difference was significant(P<0.05).4.Parameters of three-dimensional speckle tracking echocardiography(3D-STE)4.1 Compared with a(Ⅰ),GLS,GCS,GAS and LVtw were slightly decreased at the beginning of the group Ⅱ.They had greater reductions in the group a(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).GRS did not decrease significantly.Compared with b(Ⅰ),GLS and GCS were slightly decreased at the beginning of the group Ⅱ.They deteriorated significantly in the group b(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).GAS and LVtw had greater reductions in the group b(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).GLS、GAS of the group a(Ⅳ)were higher than the group a(VI)(P<0.05).GRS did not decrease significantly.GAS and LVtw were lower in group b(Ⅱ,Ⅲ)than in group a(Ⅱ,,Ⅲ).(all P<0.05)4.2Compared with a(Ⅰ),Maximal left atrial volume(LAV max),Minimal left atrial volume(LAV min),Left atrial presytolic volume(LAV pre-A)were slightly increased at the beginning of the group Ⅱ.They showed a obviously worsening in the group a(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).There was no significant change in Left atrial ejection fraction(LAEF).Reservoir function(LASct),Left atrial peak longitudinal strain of conduit function(LAScd),Left atrial peak longitudinal strain of contractile function(LASr)were slightly decreased at the beginning of the group Ⅱ.They showed had greater reductions in the group a(Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).Compared with b(Ⅰ),LAV max,LAV min showed a obviously worsening in the group b(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ)(P<0.05).Compared with b(Ⅰ),LAScd,LASr and LAV pre-A in the group b(Ⅲ、Ⅳ、Ⅴ、Ⅵ)showed a obviously worsening.LASct in the group b(Ⅳ、Ⅴ、Ⅵ)showed a obviously worsening(all P<0.05).There was no significant change in LAEF.Conclusion1.Anthracyclines can cause tumor-related cardiovascular damage to a certain extent after use.2.When breast cancer patients are treated with anthracycline chemotherapy,2D-STE 3D-STE,PSL and other technologies can be used to evaluate the function of the left ventricle and left atrium,so as to minimize unnecessary cardiotoxicity and provide valuable monitoring means.3.The extent of parameter changes in elder breast cancer patients during the same course of treatment may be more significant than that in younger breast cancer patients,which may indicate to some extent that older breast cancer patients may have weaker tolerance to anthracycline chemotherapy than younger breast cancer patients4.Further studies are needed to validate whether the cardiac damage of young patients has improved after discontinuation of the drug.Cardiac damage in older patients after discontinuation of medication is still irreversible and even progressive. |
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