Tissue Doppler imaging (TDI) was investigated for its applicability for detecting cardiac function and early cardiotoxicity in breast cancer patients treated with anthracyclines. A total of 40 women (age range 18 to 65 years) were enrolled, who had not received anthracyclines previously and had normal systolic and diastolic cardiac function. All healthy patients in the control group were of the same age. Each patient underwent not only standard echocardiographic measurements (ventricular dimensions and wall thickness, ejection fraction, E-wave deceleration time (DT), E/A ratio), but also specific imagings (E-septum separation, pulmonary venous flow), and in addition the myocardial velocity of many segments of mitral anulus obtained with pulsed wave tissue Doppler imaging were performed during the one year of observation period. Based on the results we found that systolic left ventricular function did not change significantly - neither in the study nor in the control group. Diastolic left ventricular function was impaired in 39 patients (97.5%), and 30 (75%) of these showed clear changes by means of both the traditional E/A ratio and TDI. Diastolic dysfunction in 9 patients (22.5%), however, could be detected only with TDI. The analysis of myocardial velocity in different segments showed that diastolic dysfunction does not develop in a homogeneous way but in a different way in segments. Diastolic function was intact in the control group during the study. The detectable myocardial damage occurred in the study group of young female patients without risk factors as a result of one year anthracycline therapy was so severe that the possible outcome might be serious congestive heart failure or death. Our results confirmed our assumptions that TDI is a more precise and useful examination method than traditional ones (E/A ratio or deceleration time) to demonstrate isolated diastolic dysfunction as a result of chemotherapy. Relevant extra information might be given by TDI compared to parameters describing diastolic functions depending on several changing values. TDI may become a regularly and more widely used noninvasive method to detect subclinical cardiotoxicity emerging after chemotherapy.

译文

研究了组织多普勒成像 (TDI) 在检测蒽环类药物治疗的乳腺癌患者的心脏功能和早期心脏毒性中的适用性。共有40名女性 (年龄在18至65岁之间) 被纳入,她们以前没有接受过蒽环类药物,并且具有正常的收缩和舒张功能。对照组中所有健康患者的年龄相同。每位患者不仅接受了标准的超声心动图测量 (心室尺寸和壁厚,射血分数,E-波减速时间 (DT),E/A比),而且还接受了特定的成像 (E-隔膜分离,肺静脉血流),此外,在一年的观察期内,还通过脉冲波组织多普勒成像获得了二尖瓣环的许多段的心肌速度。根据研究结果,我们发现左心室收缩功能没有显着变化-无论是在研究还是在对照组中。39例患者 (97.5% 例) 的左心室舒张功能受损,其中30例 (75% 例) 通过传统的E/A比和TDI显示出明显的变化。然而,只有TDI才能检测到9例患者 (22.5%) 的舒张功能障碍。对不同节段心肌速度的分析表明,舒张功能障碍不是以均匀的方式发展,而是以不同的方式发展。在研究期间,对照组的舒张功能完好无损。在没有危险因素的年轻女性患者中,由于接受了一年的蒽环类药物治疗,可检测到的心肌损害非常严重,可能的结果可能是严重的充血性心力衰竭或死亡。我们的结果证实了我们的假设,即TDI是一种比传统方法 (E/a比或减速时间) 更精确,更有用的检查方法,可以证明化疗导致的孤立舒张功能障碍。与描述舒张功能的参数相比,TDI可能会提供相关的额外信息,具体取决于几个变化的值。TDI可能成为一种定期且更广泛使用的无创方法,用于检测化疗后出现的亚临床心脏毒性。

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