心脏磁共振特征追踪技术对乳癌患者化疗期间心脏功能的评估价值OA北大核心CSTPCD
Value of cardiac magnetic resonance feature tracking technique in evaluating cardiac function during chemotherapy in breast cancer patients
目的 探讨心脏磁共振特征追踪(cardiac magnetic resonance imaging feature tracking,CMR-FT)技术对乳腺癌患者化疗期间早期心功能亚临床改变的评估价值.材料与方法 本研究为前瞻性研究,在2023年6月至2023年11月期间于河南大学第一附属医院连续入组了73例乳腺癌患者.所有研究对象均进行一次1.5 T心脏磁共振检查,根据乳腺癌患者当次检查所处的不同化疗周期对患者进行分组,分为基线组(还未进行化疗)20例、化疗早期组(3～4个周期)27例和化疗晚期组(7～8个周期)26例.通过CVI42后处理软件得到所有乳腺癌患者常规心功能的相关参数及左心室2D整体应变参数:左心室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI)、整体径向应变(global radial strain,GRS)、整体纵向应变(global longitudinal strain,GLS)、整体周向应变(global circumferential strain,GCS)等.验证各指标数据正态性之后,以单因素方差分析比较三组组间连续性变量的差异,用Pearson相关系数进行心功能和心肌应变数据的相关性分析,P<0.05差异有统计学意义.结果 心功能指标LVEF、右室射血分数(right ventricular ejection fraction,RVEF)和每搏容积指数(stroke volume index,SVI)化疗晚期组相较于基线组有明显的降低,差异有统计学意义(P<0.05).而主要心肌应变指标GRS、GCS、GLS在化疗早期组相较于基线组就有明显降低(P<0.05).相关性分析发现LVEF、RVEF、SVI分别与GRS、GCS、GLS存在线性正相关(r=0.26～0.45,P均<0.05).其余心功能数据LVMI、LVEDVI、LVESVI、心脏指数(cardiac index,CI)与心肌应变数据无显著相关性.可重复性分析显示GRS、GCS和GLS的观察者间和观察者内的组内相关系数值均>0.75,一致性较好.结论 相较于常规心功能指标,通过CMR-FT技术测得的心肌应变指标能更敏感地发现乳癌患者早期亚临床心功能损伤.这为乳腺癌患者提供了采取预防及治疗方案的机会,以避免严重的心脏损害.
Objective:To investigate the value of cardiac magnetic resonance feature tracking(CMR-FT)in evaluating early subclinical changes in cardiac function during chemotherapy in breast cancer patient.Materials and Methods:This was a prospective study,in which 73 breast cancer patients were enrolled.All subjects underwent a once-time 1.5 T cardiac magnetic resonance examination with a scan sequence heart cinema.According to different chemotherapy cycles,breast cancer patients were divided into three groups,i.e.,baseline group(no chemotherapy yet;n=20),early chemotherapy group(3-4 cycles;n=27),and late chemotherapy group(7-8 cycles;n=26).Conventional cardiac function parameters and myocardial strain parameter including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(LVEDVI),global radial strain(GRS),global longitudinal strain(GLS),and global circumferential strain(GCS)were obtained using CVI42 post-processing software.Normality tests were performed,moreover,a one-way analysis of variance was to compare intergroup differences.Pearson correlation coefficient was utilized to analyze the relationship between cardiac function and myocardial strain data,with statistical significance set at P<0.05.Results:When compared to the baseline group,a pronounced decrease was detected in the cardiac function indexes of LVEF,right ventricular ejection fraction(RVEF),and stroke volume index(SVI)in the late chemotherapy group(all P<0.05),while the main myocardial strain indexes GRS,GCS,and GLS in the early chemotherapy group(all P<0.05).Correlation analysis revealed a linear positive correlation between LVEF,RVEF,SVI and GRS,GCS,GLS respectively(r=0.26-0.45,all P<0.05).LVMI,LVEDVI,LVESVI,and cardiac index(CI)showed no significant correlation with myocardial strain data(all P>0.05).Repeatability analysis indicated good inter-and intra-observer agreement for GRS,GCS,and GLS measurements.Conclusions:Compared to conventional cardiac function indexes,the cardiac strain index measured by CMR-FT technology is more sensitive in detecting subclinical cardiac function injury in breast cancer patients,providing an opportunity for early prevention and treatment of severe cardiac damage.
徐淑菲;申小顺;王志学;赵森;尹晓翔;庄琰;郭帅康;闫曼可;杨文茹;陈婕
河南大学第一附属医院放射科,开封 475000
临床医学
乳腺癌化疗心脏毒性心肌应变心脏磁共振磁共振成像
breast cancerchemotherapycardiotoxicitymyocardial straincardiac magnetic resonancemagnetic resonance imaging
《磁共振成像》 2024 (005)
87-93 / 7
Scientific Research Project of Henan Provincial Health Commission(No.LHGJ20210565). 河南省卫健委科研项目(编号:LHGJ20210565)
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