标题：RT-3DE、TDI及2D-STI超声技术对乳腺癌蒽环类化疗患者亚临床心脏毒性的预测价值

      作者：贾玄慧 1，亢春苗 1，沈亚梅 1，刘莹 2，朱媛 1    贾玄慧 1，亢春苗 1，沈亚梅 1，刘莹 2，朱媛 1陕西省人民医院超声诊断中心 1、肿瘤内科 2，陕西 西安 710068

      卷次： 2023年34卷22期

      【摘要】 目的 探讨实时三维心脏超声(RT-3DE)、组织多普勒成像(TDI)及二维斑点追踪成像(2D-STI)超声技术对乳腺癌蒽环类化疗患者亚临床心脏毒性的预测价值。方法 回顾性分析2021年8月至2022年10月陕西省人民医院收治的30例选择蒽环类药物化疗的乳腺癌患者的临床资料，所有患者均于化疗前、化疗3周期后及化疗6周期后进行RT-3DE、TDI及 2D-STI检查，比较患者不同时间点的左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、三维左室射血分数(3D-LVEF)、二尖瓣环口舒张早期流速(E)与二尖瓣环舒张早期组织舒张速度平均值之比(E/e')、2D整体纵向应变(2D-GLS)指标的变化，统计化疗6个周期后乳腺癌患者的亚临床心脏毒性发生率，并绘制受试者工作特征曲线(ROC)分析RT-3DE、TDI及2D-STI参数诊断亚临床心脏毒性的效能。结果 化疗3个周期及6个周期后，患者的LVEDV、LVESV、E/e'分别为(94.72±11.26) mL、(38.25±4.58) mL、(7.03±1.65)和(94.59±10.03) mL、(39.01±5.07) mL、(7.12±1.70)，与化疗前的(96.46±12.04) mL、(39.20±5.14) mL、(6.89±1.76)比较，差异均无统计学意义(P>0.05)；化疗3个周期及6个周期后，3D-LVEF、2D-GLS分别为(61.58±3.09)%、(-18.17±2.06)%和(58.61±2.60)%、(17.31±1.97)%，明显低于化疗前的(64.01±3.61)%、(20.79±2.58)%，且化疗6周期后，患者的3D-LVEF明显低于化疗3周期后，差异均有统计学意义(P<0.05)；化疗 6周期后，30例乳腺癌化疗患者中，4例出现亚临床心脏毒性，占比13.33%；经ROC分析结果显示，3D-LVEF、2D-GLS、3D-LVEF+2D-GLS诊断亚临床心脏毒性的曲线下面积(AUC)值分别为0.784、0.752、0.815，其中3D-LVEF+2D-GLS诊断效能最高，其次为3D-LVEF、2D-GLS。结论 RT-3DE能够在早期识别出乳腺癌蒽环类化疗患者亚临床心脏毒性，且有较高的诊断效能，但是于部分患者中其价值在一定程度上受到了限制，针对此类患者需结合2D-STI进行诊断。
      【关键词】 心脏毒性；乳腺癌；化疗；实时三维心脏超声；组织多普勒成像；二维斑点追踪成像；诊断效能
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2023）22—3293—04

Predictive value of RT-3DE, TDI, and 2D-STI ultrasound techniques for subclinical cardiotoxicity in patientswith breast cancer undergoing anthracycline chemotherapy.
JIA Xuan-hui 1, KANG Chun-miao 1, SHEN Ya-mei 1,LIU Ying 2, ZHU Yuan 1. Ultrasonic Diagnosis Center 1, Department of Oncology 2, Shaanxi Provincial People's Hospital,Xi'an 710068, Shaanxi, CHINA
【Abstract】 Objective To investigate the predictive value of real-time three-dimensional cardiac ultrasound(RT-3DE), tissue Doppler imaging (TDI), and two-dimensional spot tracking imaging (2D-STI) for subclinical cardiotox-icity in patients with breast cancer undergoing anthracycline chemotherapy. Methods The clinical data of 30 patientswith breast cancer who received chemotherapy with anthracyclines in Shaanxi Provincial People's Hospital from August2021 to October 2022 were retrospectively analyzed. All patients underwent RT-3DE, TDI, and 2D-STI examinations be-fore, after 3, 6 cycles of chemotherapy. The changes of left ventricular end-diastolic volume (LVEDV), left ventricularend-systolic volume (LVESV), three-dimensional left ventricular ejection fraction (3D-LVEF), the ratio of early diastolicmitral valve velocity (E) to mean diastolic velocity of early mitral annulus tissue (E/e'), and 2D-global longitudinal strain(2D-GLS) were compared at different time points. The incidence of subclinical cardiotoxicity in the patients after 6 cyclesof chemotherapy was analyzed, and receiver operating characteristic (ROC) curve was drawn to analyze the efficacy ofRT-3DE, TDI, and 2D-STI parameters in diagnosing subclinical cardiotoxicity. Results After 3 and 6 cycles of chemo-therapy, LVEDV, LVESV, and E/e' were (94.72±11.26) mL, (38.25±4.58) mL, 7.03±1.65 and (94.59±10.03) mL, (39.01±5.07) mL, 7.12±1.70, which showed no statistically significant difference with (96.46±12.04) mL, (39.20±5.14) mL, and6.89±1.76 before chemotherapy (P>0.05). After 3 and 6 cycles of chemotherapy, the 3D-LVEF, 2D-GLS were (61.58±3.09)%, (-18.17±2.06)% and (58.61±2.60)%, (17.31±1.97)%, which were significantly lower than (64.01±3.61)% ,(20.79±2.58)% before chemotherapy; the 3D-LVEF after 6 cycles of chemotherapy was significantly lower than that af-ter 3 cycles of chemotherapy; the differences were statistically significant (P<0.05). After 6 cycles of chemotherapy, 4 ofthe 30 breast cancer patients showed subclinical cardiotoxicity, accounting for 13.33%. ROC analysis results showed thatthe area under the curve (AUC) values of 3D-LVEF, 2D-GLS, and 3D-LVEF+2D-GLS in the diagnosis of subclinical car-diotoxicity were 0.784, 0.752, and 0.815, among which 3D-LVEF+2D-GLS had the highest diagnostic efficiency, fol-lowed by 3D-LVEF and 2D-GLS. Conclusion RT-3DE can identify subclinical cardiotoxicity in breast cancer patientsundergoing anthracycline chemotherapy at an early stage and has high diagnostic efficacy. However, its value in some pa-tients is limited to a certain extent, and 2D-STI should be combined for diagnosis in such patients.
      【Key words】 Cardiotoxicity; Breast cancer; Chemotherapy; Real-time three-dimensional cardiac ultrasound; Tis-sue doppler imaging; Two-dimensional speckle tracking imaging; Diagnostic efficacy