南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (09): 1032-.doi: 10.12122/j.issn.1673-4254.2018.09.02

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三维斑点追踪成像技术评价乳腺癌患者接受吡柔比星化疗后右心室心肌力学特性改变

王燕，张平洋，刘琨，张洁，马小五，李林，李妙，刘菁菁   

  • 出版日期:2018-09-20 发布日期:2018-09-20

Evaluation of changes in right ventricular myocardial mechanical properties in breast cancer patients receiving pirarubicin using three-dimensional speckle tracking imaging

  • Online:2018-09-20 Published:2018-09-20

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摘要： 目的应用三维斑点追踪成像（3D-STI）评价乳腺癌化疗后右室心肌力学特性。方法选择术后接受吡柔比星化疗的乳腺 癌36例，采用3D-STI观察化疗前及化疗第2周期、第4周期、第6周期末（下简称C2、C4、C6）右室心肌力学改变，检测血hs-cTnI、 NT-proBNP水平，31例在C6进行99mTc-MIBI 和18F-FDG核素心肌灌注/代谢显像。测量参数：RV-V、FAC、TAPSE及S’、LV-V和 LV-EF；RVGLS、RVGCS、RVGRS及RVGAS，根据核素显像评判心肌灌注和存活。结果（1）与化疗前相比，C2时RVGLS明显 降低,C4时RVGLS、RVGAS均明显降低（P<0.05），且C6时进一步下降，与药物剂量累计有关。TAPSE、hs-cTnI水平及RV-FAC 下降程度不同患者的RVGLS、RVGAS显著不同（P<0.05）；（2）RVGLS、RVGAS与FAC，TAPSE，S’存在相关性（r=0.37，0.26； 0.43，0.51；0.21，0.36；P<0.01），RVGAS 、RVGLS判定RV-FAC下降>5%的敏感度和特异度高；（3）核素显像：17例右室心肌灌注 正常，14例右室出现灌注异常但18F-FDG 显示为存活心肌节段，且后者的RVGLS、RVGAS较前者显著减小；hs-cTnI明显增高 （P<0.05）。ROC曲线显示：RVGLS绝对值小于18.2%判断RV受损的敏感度92.9%，特异度88.2%，曲线下面积0.87；RVGAS绝 对值小于26.8%判断RV受损的敏感度94.8%，特异度86.6%，曲线下面积0.86。结论3D-STI可为评判乳腺癌接受吡柔比星化 疗时右室心肌力学改变提供早期、可靠的新方法。

Abstract: Objective To evaluate the changes in the mechanical properties of the right ventricular myocardium (RVM) after chemotherapy using three-dimensional speckle tracking echocardiography (3D-STI). Methods Thirty-six breast cancer patients receiving chemotherapy with pirarubicin underwent examinations with 3D-STI to test the mechanical properties of the RVM before chemotherapy and at the end of the second, fourth, and sixth cycles of chemotherapy (C2, C4, and C6, respectively). Blood levels of hs-cTnI and NT-proBNP were also examined at the same time points. Thirty-one of these patients also underwent 99mTc-MIBI and 18F-FDG myocardial perfusion/metabolism imaging at C6. Myocardial perfusion abnormalities and survival outcomes of the patients were analyzed according to radionuclide imaging results. Results Compared with that before chemotherapy, RVGLS at C2 was significantly lowered, and both RVGLS and RVGAS were significantly decreased at C4 and further decreased at C6 (P<0.05) in relation with the cumulative drug dose. The RVGLS and RVGAS differed significantly among patients with different levels of TAPSE, hs-cTnI, and RV-FAC decline after chemotherapy. RVGLS and RVGAS were found to significantly correlate with FAC (r=0.37, 0.26), TAPSE (r=0.43, 0.51), and S’ (r=0.21, 0.36) (P<0.01), and showed a high sensitivity and specificity for identifying RV-FAC decline by >5%. Myocardial perfusion/metabolic imaging showed normal myocardial perfusion in 17 patients, and abnormal myocardial segments of the RVM were detected in 14 patients, but 18F-FDG imaging showed that these myocardial segments were all viable; these 14 patients showed significantly decreased RVGLS and RVGAS and significantly increased hs-cTnI level compared with the patients with normal ventricular myocardial perfusion (P< 0.05). ROC curve analysis showed that an absolute value of RVGLS less than 18.2% had a sensitivity of 92.9% for diagnosis of RV impairment with a diagnostic specificity of 88.2% and an area under the curve of 0.87. RVGAS less than 26.8% had a sensitivity of 94.8% and a specificity of 86.6% for diagnosis of RV damage with an area under the curve of 0.86. Conclusion 3D-STI can provide a reliable new approach to early diagnosis of changes in the mechanical properties of the RVM related with chemotherapy with pirarubicin in breast cancer patients.