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实时三维超声心动图评估高剂量蒽环类药物化疗后左心室形态及收缩同步性的临床研究: 5年回顾性随访

Late detection of left ventricular mechanical dyssynchrony and impaired morphology after high dose of anthracycline chemotherapy using real-time three-dimensional echocardiography: a 5-year retrospective follow-up study

    摘要
  • 摘要:
    目的 运用实时三维超声心动图（real-time three-dimensional echocardiography，RT-3DE）和三维斑点追踪成像技术（three-dimensional speckle tracking imaging，3D-STI）评价蒽环类药物化疗对长期生存弥漫大B细胞淋巴瘤（diffuse large B-cell non-Hodgkin lymphoma，DLBCL）患者左心室（左室）形态及收缩同步性的影响，为评价高、低剂量蒽环类药物的心脏毒性提供影像学证据。
    方法 选择长期生存的DLBCL患者20例（病例组）及36例年龄、性别匹配的健康人（对照组）。20例DLBCL患者中55%为男性，末次蒽环类药物治疗后平均随访年限为（4.8±1.0）年。根据接受蒽环类药物的累计剂量，将病例组分为高剂量组（n=15，>360 mg/m2）和低剂量组（n=5，≤360 mg/m2）。所有研究对象均行二维超声心动图和RT-3DE，行3D-STI评估左室整体纵向应变（global longitudinal strain，GLS）、整体圆周应变（global circumferential strain，GCS）、扭转和扭转力矩。左室收缩不同步指数（systolic dyssynchrony index，SDI）以经RR间期校正后的16节段达最小收缩容积离散度表示。
    结果 与对照组相比，病例组三维左室射血分数LVEF，（60.0±7.9）%vs（63.2±2.3）%，P=0.02、GLS（-17.6±3.4）%vs（-22.3±3.0）%，P < 0.01、GCS（-28.4±6.0）%vs（-31.5±2.7）%，P=0.01均显著降低，舒张末期左室容积明显缩小（73.8±18.4）mL vs（92.0±26.2）mL，P=0.01。病例组左室3D-SDI参数大于对照组（P < 0.01）。与低剂量组相比，高剂量组16节段达最小容积时间最大差值占心动周期的百分率Tmsv16-Dif%；20.83%（15.09%，49.71%）vs 13.75%（7.10%，15.26%），P=0.02显著增大；而两亚组患者3D-STI应变参数差异无统计学意义。
    结论 RT-3DE是评价蒽环类药物治疗后肿瘤长期生存者左室收缩功能障碍和收缩不同步化改变敏感且有效的手段，其Tmsv16-Dif%可用于进一步识别高剂量蒽环类药物对肿瘤生存者心脏收缩同步性的损伤。

     

    Abstract:
    Objective To identify the left ventricular (LV) geometric deformation and mechanical dyssynchrony using real-time three-dimensional echocardiography (RT-3DE) and three-dimensional speckle tracking imaging (3D-STI) in long-term diffuse large B-cell non-Hodgkin lymphoma (DLBCL) survivors after high and low dosage anthracycline chemotherapy.
    Methods A total of 20 long-term survival DLBCL patients and 36 age-matched healthy controls were selected. In the case group, twenty patients (55% male) with DLBCL were followed for (4.8±1.0) years after the last cycle of anthracycline-based treatment. Survivors were divided into high dose (n=15, >360 mg/m2) and low dose (n=5, ≤ 360 mg/m2) subgroups according to their exposure to the cumulative dosage of anthracycline. All participants in the case and control groups underwent two-(2D-) and three-dimensional (3D-) echocardiographic assessments. 3D-STI was performed to estimate LV global longitudinal strain (GLS), global circumferential strain (GCS), torsion, and twist. LV systolic dyssynchrony index (SDI) was calculated as the percentage of the dispersion of time-to-minimum regional volume using a 16-segment model divided by the RR interval.
    Results Compared with controls, significant decreases in LVEF (60.0±7.9% vs63.2±2.3%, P=0.02), GLS (-17.6±3.4% vs-22.3±3.0%, P < 0.01), GCS(-28.4±6.0% vs-31.5±2.7%, P=0.01), and the end-diastolic LV chamber volume (73.8±18.4 mL vs92.0±26.2 mL, P=0.01) were observed in case group using RT-3DE. All 3D-SDI indices reflecting LV dyssynchrony were significantly greater in the case group than those in the healthy controls (P < 0.01). The patients receiving high anthracycline dose were found to have increasedTmsv16-SD% (7.7±5.5% vs3.5±1.2%, P < 0.01) andTmsv16-Dif%(28.2±18.0 vs 11.7±4.3, P=0.004) (20.83%15.09%, 49.71% vs 13.75%7.10%, 15.26%, P=0.02) compared with those in the low dose group, while 3D-STI strain parameters failed to distinguish the two subgroups.
    Conclusions RT-3DE is a valuable modality to sensitively detect decreased systolic dysfunction and mechanical dyssynchrony in long-term cancer survivors after anthracycline therapy, and Tmsv16-Dif% may be a better index to further differentiate the deteriorating dyssynchrony in survivors exposed to high dose anthracycline from those treated with low dose.

     

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