AIM:Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12 months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients. METHODS:Seventy-eight consecutive anthracycline naïve breast cancer patients were studied before and immediately after anthracycline chemotherapy. Fifty HER2/neu negative patients were studied over 12 months with serial echocardiograms at four time points. All patients were treated with standard regimens containing anthracyclines. RESULTS:Global systolic strain was significantly reduced immediately after, and 6 months after anthracyclines (-19.0 ± 2.3% to -17.5 ± 2.3% (P<0.001) and -18.2 ± 2.2% (P=0.01) respectively). A non-uniform reduction in strain was observed each time with relative sparing of the LV apex. LVEF remained largely unchanged at both time points. Global strain normalised by 12 months in the majority of patients. Persistently reduced strain was observed in 16% (n=8); these patients had a greater reduction in strain at 6 months (≤ -17.2%), and had received higher cumulative anthracycline doses. CONCLUSION:Myocardial strain imaging is more sensitive than LVEF for the early detection and intermediate term monitoring of LV systolic function following anthracycline chemotherapy in HER2/neu negative breast cancer patients, and may aid in the development of improved monitoring protocols.

译文

目的:蒽环类药物被其心脏毒性所破坏。随着治疗后预期寿命的大大提高,确保早期发现和及时处理心脏毒性的技术至关重要。本研究的目的是评估蒽环类药物化疗后长达12个月的左心室(LV)收缩功能,左室射血分数(LVEF)和二维心肌劳损,特别是在HER2 / neu阴性乳腺癌患者中。
方法:在蒽环类药物化疗之前和之后立即研究了88例连续使用蒽环类药物的初治乳腺癌患者。在12个月的时间里,通过四个系列的连续超声心动图研究了50例HER2 / neu阴性患者。所有患者均接受含蒽环类药物的标准治疗方案。
结果:蒽环类药物治疗后和治疗后6个月,整体收缩应变显着降低(分别为-19.0±2.3%至-17.5±2.3%(P <0.001)和-18.2±2.2%(P = 0.01))。每次观察到应变不均匀降低,但LV根尖相对较少。在两个时间点,LVEF基本上保持不变。大多数患者的总应变在12个月后恢复正常。观察到永久降低的应变为16%(n = 8);这些患者在6个月时的应变降低更大(≤-17.2%),并且接受了更高的蒽环类药物累积剂量。
结论:对于HER2 / neu阴性乳腺癌患者,蒽环类药物化疗后,心肌应变成像对LV收缩功能的早期检测和中期监测比LVEF更为敏感,可能有助于开发改进的监测方案。

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