摘要目的 探讨三维斑点追踪成像(3D-STI)技术评价蒽环类药物致乳腺癌化疗患者早期心肌功能损害的临床价值.方法 40例乳腺癌术后患者,采用以表柔比星为主的AC-T化疗方案,分别于化疗前和化疗2个周期、4个周期后行常规及三维超声心动图检查,比较化疗前后心功能参数的变化.结果 化疗后左室整体面积应变(GAS)、整体纵向应变(GLS)及右室整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)均较化疗前明显减低(P<0.05),与蒽环类药物累积剂量呈负相关性,其中左室GAS的ROC曲线下面积为0.897(P=0.000),以-30.55%为诊断界点,敏感性为0.857,特异性为0.917;右室部分应变参数变化早于左室.结论 3D-STI有助于早期发现蒽环类药物致乳腺癌患者左、右室心肌功能的损害,为临床早期进行干预提供诊断依据.

abstractsObjective To probe the clinical value of three-dimensional speckle tracking echocardiography in evaluating the early ventricular myocardial dysfunction in breast cancer patients treated with anthracycline.Methods A group of 40 breast cancer postoperative patients were received a epirubicin-based chemotherapy.Conventional and 3D dynamic echocardiography were measured before chemotherapy and 2 cycles and 4 cycles after chemotherapy during 24 hours,and to compare the change of the parameters before and after the chemotherapy.Results Left ventricular global area strain(LVGAS),left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS),right ventricular global circular strain(RVGCS) and right ventricular global radial strain(RVGRS) were significantly lower after the chemotherapy than those before the chemotherapy,and negatively correlated to cumulative anthracycline dose,in which the area under the ROC curve of LVGAS was 0.897(P = 0.000).If-30.55% was selected as the diagnosis cut-off point,the sensitivity was 0.857,and the specificity was 0.917;some of right ventricular strain parameters were earlier than those of the left.Conclusions 3D-STI is useful to find the early left and right ventricular myocardial dysfunction in breast cancer patients treated with anthracycline and early access the subclinical cardiactoxicity,and right ventricular dysfunction may emerge earlier than the left,which can provide diagnosis basis to intervene timely for the clinical.