Evaluation Of Left Ventricular Myocardial Diastolic Dysfunction By Two-Dimensional Speckle Tracking Imaging In Patients With Thoracic Tumor After Radiotherapy

Purpose:To explore the application of two-dimensional speckle tracking imaging technology to evaluate the early subclinical myocardial diastolic dysfunction in patients with chest cancer after radiotherapy,and to provide evidence for the early diagnosis and treatment of radiation cardiomyopathy.Meterials and methods:A total of 50 patients who were treated by radiotherapy and had cardiac involvement had been selected in our hospital from November2021 to December2022.36 patients(including 19 males and 17 females)were finally meeting the ultrasound examines and completing the follow-up,aged from 40 to 74 years,with an average age of(57.19 ±7.81)years,.Among them,10 patients with left breast cancer,8 patients with middle and lower esophageal cancer,18 patients with left lung cancer,5 patients with breast cancer and 3 patients with lung cancer were combined with chemotherapy at the same time.Anthracycline and trastuzumab were not used.Measurements were taken before radiotherapy(this group is the self control group),immediately after radiotherapy,and 3 months after radiotherapy.Relevant parameters were measured by two-dimensional and tissue Doppler:LAd、LVIDd、IVSd、LVPWd、LVEF、E、A、E/A、e’、E/e’、a’、s’.In addition,the parasternal short-axis sections through mitral valve,papillary muscle,apical;and apical two-chamber,three-chamber and four-chamber sections were collected.QLAB13.0 workstation was used to process and analyze the images of the patients in the group.We measure GLS、Sr LMV、Sr LPM、Sr LAP、Sr CMV、Sr CPM、Sr CAP、Sr RMV 、 Sr RPM 、 Sr RAP before radiotherapy,immediately after radiotherapy,and 3months after radiotherapy;and calculate LSRs、LSRe、LSRa.Result:1.Conventional echocardiography parameters comparisonCompared with the baseline level before radiotherapy,there was no statistically significant difference in the parameters of cardiac morphology such as LAd,IVSd,LVIDd,and LVPWd immediately after radiotherapy and 3 months after radiotherapy(P>0.05).However,LVEF,a parameter reflecting left ventricular systolic function,has a downward trend.Compared with the baseline level before radiotherapy,there was no statistically significant difference in left ventricular diastolic function parameters E and A immediately after radiotherapy and 3 months after radiotherapy(P>0.05);The differences of e’,a’,S’,E/e’ and LAVI were statistically significant(P<0.05).2.2D-STI parameters comparisonThe two-dimensional strain parameters reflecting ventricular systolic function showed statistically significant differences in left ventricular longitudinal strain(GLS)during systole and overall longitudinal peak strain rates(LSRs)during systole(P<0.05)Two-dimensional strain parameters reflecting the ventricular diastolic function,including the overall longitudinal peak strain rate at the early stage of left ventricular diastole(LSRe),the overall longitudinal peak strain rate at the late stage of left ventricular diastole(LSRa),LSRe/LSRA,and E/LSRe,were showed statistically significant differences(P < 0.05)except for the LSRe/LSRA immediately after radiotherapy(P>0.05).3.Correlation analysis of diastolic parameters and systolic parametersChanges of LSRe before therapy and 3 months after radiotherapy(ΔLSRe)and GLS before therapy and 3 months after radiotherapy(ΔGLS)was positively correlated(r=0.728,P<0.05).Changes of LSRe before therapy and 3 months after radiotherapy(ΔLSRe)and LSRs before therapy and 3 months after radiotherapy(ΔLSRs)was positively correlated(r=0.686,P<0.05)4.Comparison of sensitivity of different two-dimensional speckle tracking parameters in predicting subclinical myocardial diastolic dysfunction after radiotherapyThe two-dimensional speckle tracking parameters LSRe,LSRa,LSRe/LSRA and E/LSRe were used to predict subclinical myocardial diastolic dysfunction.From the ROC curves of LSRe,LSRa,LSRe/LSRA and E/LSRe,it can be seen that LSRe,LSRa,LSRe/LSRA and E/LSRe were ranked as LSRe(0.936)>E/LSRe(0.906)>LSRa(0.871)>LSRe/LSRA(0.685)according to the area under the curve(AUC).Conclusion:1.The indexes for evaluating diastolic function by two-dimensional echocardiography are not sensitive to subclinical cardiac diastolic dysfunction,but LAVI and tissue Doppler parameters such as e’,a’,S’,E/e’ are of great significance in predicting subclinical cardiac diastolic dysfunction.2.The indexes for evaluating diastolic function by 2D-STI such as LSRe、LSRa、E/LSRe and LSRe/LSRa can detect radiation-induced left ventricular myocardial diastolic dysfunction at an early stage,and LSRe have obvious correlation with GLS and LSRs.3.Echocardiographic technique can early detect radiation-induced left ventricular myocardial diastolic dysfunction.