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Метод спекл-трекинг эхокардиографии в 3D-режиме в оценке деформационных свойств миокарда и выявлении субклинической кардиотоксичности при химиотерапии у больных раком молочной железы с артериальной гипертонией
Метод спекл-трекинг эхокардиографии в 3D-режиме в оценке деформационных свойств миокарда и выявлении субклинической кардиотоксичности при химиотерапии у больных раком молочной железы с артериальной гипертонией
Авалян А.А., Саидова М.А., Ощепкова Е.В., Чазова И.Е. Метод спекл-трекинг эхокардиографии в 3D-режиме в оценке деформационных свойств миокарда и выявлении субклинической кардиотоксичности при химиотерапии у больных раком молочной железы с артериальной гипертонией. Системные гипертензии. 2020; 17 (3): 42–47.DOI: 10.26442/2075082X.2020.3.200334
DOI: 10.26442/2075082X.2020.3.200334
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DOI: 10.26442/2075082X.2020.3.200334
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Изучить возможности технологии спекл-трекинг эхокардиографии (СТЭ) в режиме 3D в оценке деформационных свойств миокарда и выявлении субклинической кардиотоксичности при антрациклинсодержащей химиотерапии у больных раком молочной железы (РМЖ) с артериальной гипертонией (АГ).
Материалы и методы. В исследование включены 47 больных тройным негативным РМЖ с АГ и нормотензией. Всем участникам исследования проводилась трансторакальная эхокардиография (ЭхоКГ) с оценкой фракции выброса левого желудочка (ЛЖ), также применялась технология СТЭ в трехмерном режиме с оценкой глобальной продольной (global longitudinal strain – GLS), циркулярной (global circumferential strain – GСS), радиальной (global radial strain – GRS) деформаций ЛЖ и нового параметра деформации – площади деформации (global area strain – GAS).
Результаты. В проведенной работе продемонстрировано, что у больных РМЖ для более точной оценки систолической функции ЛЖ целесообразно применение 3D-ЭхоКГ. У больных РМЖ с АГ исходно показатели деформации ЛЖ статистически значимо хуже по сравнению с больными с нормотензией, и после химиотерапии наблюдалось дальнейшее ухудшение. Для определения чувствительности и специфичности параметров деформации по данным 3D-СТЭ проведен ROC-анализ. Наиболее диагностически значимым параметром деформации как маркера кардиотоксичности оказался новый показатель GAS, который при отрезном значении ≥-14,0% показал чувствительность, равную 81,5%, и специфичность – 73,3%, однако значение данного параметра деформации ЛЖ требует дальнейшего изучения.
Заключение. У больных РМЖ как с АГ, так и с нормотензией целесообразно применение метода СТЭ в режиме 3D для анализа деформационных свойств и систолической функции ЛЖ при проведении противоопухолевого лечения. Метод перспективен для выявления субклинической кардиотоксичности, но нужны дальнейшие исследования по разработке диагностических критериев.
Ключевые слова: спекл-трекинг эхокардиография в трехмерном режиме, кардиотоксичность, химиотерапия, рак молочной железы, артериальная гипертония.
Materials and methods. The study included 47 patients with triple negative breast cancer (BC) with AH and normotension. All patients underwent transthoracic echocardiography with an assessment of the left ventricular (LV) ejection fraction, also used STE in three-dimensional mode with an assessment of global longitudinal (GLS), circular (GCS), radial (GRS) strain and a new strain parameter – strain area (GAS).
Results. In patients with BC for a more accurate assessment of LV systolic function, it is advisable to use 3D echocardiography. In BC patients with AH, the initial parameters of LV strain were statistically significantly worse than in patients with normotension and further deterioration was observed after chemotherapy. To determine the sensitivity and specificity of the strain parameters from the 3D-STE data, an ROC analysis was performed. The most diagnostically significant parameter of strain, as a marker of cardiotoxicity, was the global area strain (GAS), which with a cut-off value ≥-14.0% showed a sensitivity equal to 81.5% and a specificity of 73.3%, but the value this parameter of LV deformation requires further study.
Conclusion. In BC patients with AH and normotension it is advisable to use the STE in 3D mode to analyze the strain and systolic function of the LV during antitumor treatment. The method is promising for identifying subclinical cardiotoxicity, but further research is needed to develop diagnostic criteria.
Key words: speckle-tracking echocardiography in three-dimensional mode, cardiotoxicity, chemotherapy, breast cancer, arterial hypertension.
Материалы и методы. В исследование включены 47 больных тройным негативным РМЖ с АГ и нормотензией. Всем участникам исследования проводилась трансторакальная эхокардиография (ЭхоКГ) с оценкой фракции выброса левого желудочка (ЛЖ), также применялась технология СТЭ в трехмерном режиме с оценкой глобальной продольной (global longitudinal strain – GLS), циркулярной (global circumferential strain – GСS), радиальной (global radial strain – GRS) деформаций ЛЖ и нового параметра деформации – площади деформации (global area strain – GAS).
Результаты. В проведенной работе продемонстрировано, что у больных РМЖ для более точной оценки систолической функции ЛЖ целесообразно применение 3D-ЭхоКГ. У больных РМЖ с АГ исходно показатели деформации ЛЖ статистически значимо хуже по сравнению с больными с нормотензией, и после химиотерапии наблюдалось дальнейшее ухудшение. Для определения чувствительности и специфичности параметров деформации по данным 3D-СТЭ проведен ROC-анализ. Наиболее диагностически значимым параметром деформации как маркера кардиотоксичности оказался новый показатель GAS, который при отрезном значении ≥-14,0% показал чувствительность, равную 81,5%, и специфичность – 73,3%, однако значение данного параметра деформации ЛЖ требует дальнейшего изучения.
Заключение. У больных РМЖ как с АГ, так и с нормотензией целесообразно применение метода СТЭ в режиме 3D для анализа деформационных свойств и систолической функции ЛЖ при проведении противоопухолевого лечения. Метод перспективен для выявления субклинической кардиотоксичности, но нужны дальнейшие исследования по разработке диагностических критериев.
Ключевые слова: спекл-трекинг эхокардиография в трехмерном режиме, кардиотоксичность, химиотерапия, рак молочной железы, артериальная гипертония.
________________________________________________
Materials and methods. The study included 47 patients with triple negative breast cancer (BC) with AH and normotension. All patients underwent transthoracic echocardiography with an assessment of the left ventricular (LV) ejection fraction, also used STE in three-dimensional mode with an assessment of global longitudinal (GLS), circular (GCS), radial (GRS) strain and a new strain parameter – strain area (GAS).
Results. In patients with BC for a more accurate assessment of LV systolic function, it is advisable to use 3D echocardiography. In BC patients with AH, the initial parameters of LV strain were statistically significantly worse than in patients with normotension and further deterioration was observed after chemotherapy. To determine the sensitivity and specificity of the strain parameters from the 3D-STE data, an ROC analysis was performed. The most diagnostically significant parameter of strain, as a marker of cardiotoxicity, was the global area strain (GAS), which with a cut-off value ≥-14.0% showed a sensitivity equal to 81.5% and a specificity of 73.3%, but the value this parameter of LV deformation requires further study.
Conclusion. In BC patients with AH and normotension it is advisable to use the STE in 3D mode to analyze the strain and systolic function of the LV during antitumor treatment. The method is promising for identifying subclinical cardiotoxicity, but further research is needed to develop diagnostic criteria.
Key words: speckle-tracking echocardiography in three-dimensional mode, cardiotoxicity, chemotherapy, breast cancer, arterial hypertension.
Полный текст
Список литературы
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[Avalian A.A., Oshchepkova E.V., Saidova M.A. et al. Evaluation of subclinical cardiotoxicity of anthracycline-containing chemotherapy for breast cancer depending on the cumulative dose of doxorubicin and the initial blood pressure level. Systemic Hypertension. 2018; 15 (4): 59–64 (in Russian).]
12. Mondillo S, Galderisi M, Mele D et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med 2011; 30: 71–8.
13. Ciro Santorol et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. Eur Heart J Cardiovasc Imag 2017; p. 1–7.
14. Fei-Yan Song, Jing Shi, Ye Guo et al. Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy. Int J Cardiovasc Imag 2017; 33 (6): 857–68.
15. Jemal A, Ward E, Hao Y et al. Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005; 294: 1255–9.
16. Dorosz JL, Lezotte DC, Weitzenkamp DA et al. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 59 (20): 1799–808.
17. Cardinale D, Colombo A, Lamantia G et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. JACC 2010; 55 (3): 213–20.
18. Kleijn SA, Aly MF, Terwee CB et al. O. Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr 2011; 24: 314–21.
19. Chen J et al. Early Detection of Cardiotoxicity by 3D Speckle Tracking Imaging of Area Strain in Breast Cancer Patients Receiving Chemotherapy. Еchocardiography 2019; 36 (9): 1682–8. DOI: 10.1111/echo.14467
20. Reant P, Barbot L, Touche C et al. Evaluation of global left ventricular systolic function using three-dimensional echocardiography speckle-tracking strain parameters. J Am Soc Echocardiogr 2011; 25 (1): 68–79.
21. Gregorova Z, Meluzin J, Stepanova R. Longitudinal, circumferential and radial systolic left ventricular function in patients with heart failure and preserved ejection fraction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (3): 385–92.
2. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica – J Clin Med 2013; 8 (1): 59–67.
3. Yuand Jones. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardio-Oncol 2016; 2: 1–15.
4. Force T, Kolaja KL. Cardiotoxicity of kinase inhibitors: the prediction and translation of preclinical models to clinical outcomes. Nat Rev Drug Dis 2011; 10: 111–26.
5. Zamorano JL, Lancellotti P, Rodriguez Muñoz D et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37: 2768–801.
6. Chazova I.E., Tiuliandin S.A., Vitsenia M.V. et al. Guidelines for the diagnosis, prevention and treatment of cardiovascular complications of anticancer therapy. Part I. Systemic Hypertension. 2017; 14 (3): 6–20 (in Russian).
7. Curigliano G еt al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 2020; 31: 171–90.
8. Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. et al. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12 (in Russian).
9. Curigliano G, Cardinale D, Dent S et al. Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management. CA Cancer J Clin 2016; 66: 309–25.
10. Ranpura V, Pulipati B, Chu D et al. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens 2010; 23 (5): 460–8.
11. Avalian A.A., Oshchepkova E.V., Saidova M.A. et al. Evaluation of subclinical cardiotoxicity of anthracycline-containing chemotherapy for breast cancer depending on the cumulative dose of doxorubicin and the initial blood pressure level. Systemic Hypertension. 2018; 15 (4): 59–64 (in Russian).
12. Mondillo S, Galderisi M, Mele D et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med 2011; 30: 71–8.
13. Ciro Santorol et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. Eur Heart J Cardiovasc Imag 2017; p. 1–7.
14. Fei-Yan Song, Jing Shi, Ye Guo et al. Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy. Int J Cardiovasc Imag 2017; 33 (6): 857–68.
15. Jemal A, Ward E, Hao Y et al. Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005; 294: 1255–9.
16. Dorosz JL, Lezotte DC, Weitzenkamp DA et al. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 59 (20): 1799–808.
17. Cardinale D, Colombo A, Lamantia G et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. JACC 2010; 55 (3): 213–20.
18. Kleijn SA, Aly MF, Terwee CB et al. O. Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr 2011; 24: 314–21.
19. Chen J et al. Early Detection of Cardiotoxicity by 3D Speckle Tracking Imaging of Area Strain in Breast Cancer Patients Receiving Chemotherapy. Еchocardiography 2019; 36 (9): 1682–8. DOI: 10.1111/echo.14467
20. Reant P, Barbot L, Touche C et al. Evaluation of global left ventricular systolic function using three-dimensional echocardiography speckle-tracking strain parameters. J Am Soc Echocardiogr 2011; 25 (1): 68–79.
21. Gregorova Z, Meluzin J, Stepanova R. Longitudinal, circumferential and radial systolic left ventricular function in patients with heart failure and preserved ejection fraction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (3): 385–92.
2. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica – J Clin Med 2013; 8 (1): 59–67.
3. Yuand Jones. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardio-Oncol 2016; 2: 1–15.
4. Force T, Kolaja KL. Cardiotoxicity of kinase inhibitors: the prediction and translation of preclinical models to clinical outcomes. Nat Rev Drug Dis 2011; 10: 111–26.
5. Zamorano JL, Lancellotti P, Rodriguez Muñoz D et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37: 2768–801.
6. Чазова И.Е., Тюляндин С.А., Виценя М.В. и др. Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Часть I. Системные гипертензии. 2017; 14 (3): 6–20.
[Chazova I.E., Tiuliandin S.A., Vitsenia M.V. et al. Guidelines for the diagnosis, prevention and treatment of cardiovascular complications of anticancer therapy. Part I. Systemic Hypertension. 2017; 14 (3): 6–20 (in Russian).]
7. Curigliano G еt al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 2020; 31: 171–90.
8. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4–12.
[Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. et al. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12 (in Russian).]
9. Curigliano G, Cardinale D, Dent S et al. Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management. CA Cancer J Clin 2016; 66: 309–25.
10. Ranpura V, Pulipati B, Chu D et al. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens 2010; 23 (5): 460–8.
11. Авалян А.А., Ощепкова Е.В., Саидова М.А. и др. Оценка субклинической кардиотоксичности антрациклинсодержащей химиотерапии рака молочной железы в зависимости от кумулятивной дозы доксорубицина и исходного уровня артериального давления. Системные гипертензии. 2018; 15 (4): 59–64.
[Avalian A.A., Oshchepkova E.V., Saidova M.A. et al. Evaluation of subclinical cardiotoxicity of anthracycline-containing chemotherapy for breast cancer depending on the cumulative dose of doxorubicin and the initial blood pressure level. Systemic Hypertension. 2018; 15 (4): 59–64 (in Russian).]
12. Mondillo S, Galderisi M, Mele D et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med 2011; 30: 71–8.
13. Ciro Santorol et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. Eur Heart J Cardiovasc Imag 2017; p. 1–7.
14. Fei-Yan Song, Jing Shi, Ye Guo et al. Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy. Int J Cardiovasc Imag 2017; 33 (6): 857–68.
15. Jemal A, Ward E, Hao Y et al. Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005; 294: 1255–9.
16. Dorosz JL, Lezotte DC, Weitzenkamp DA et al. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 59 (20): 1799–808.
17. Cardinale D, Colombo A, Lamantia G et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. JACC 2010; 55 (3): 213–20.
18. Kleijn SA, Aly MF, Terwee CB et al. O. Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr 2011; 24: 314–21.
19. Chen J et al. Early Detection of Cardiotoxicity by 3D Speckle Tracking Imaging of Area Strain in Breast Cancer Patients Receiving Chemotherapy. Еchocardiography 2019; 36 (9): 1682–8. DOI: 10.1111/echo.14467
20. Reant P, Barbot L, Touche C et al. Evaluation of global left ventricular systolic function using three-dimensional echocardiography speckle-tracking strain parameters. J Am Soc Echocardiogr 2011; 25 (1): 68–79.
21. Gregorova Z, Meluzin J, Stepanova R. Longitudinal, circumferential and radial systolic left ventricular function in patients with heart failure and preserved ejection fraction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160 (3): 385–92.
________________________________________________
2. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica – J Clin Med 2013; 8 (1): 59–67.
3. Yuand Jones. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardio-Oncol 2016; 2: 1–15.
4. Force T, Kolaja KL. Cardiotoxicity of kinase inhibitors: the prediction and translation of preclinical models to clinical outcomes. Nat Rev Drug Dis 2011; 10: 111–26.
5. Zamorano JL, Lancellotti P, Rodriguez Muñoz D et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37: 2768–801.
6. Chazova I.E., Tiuliandin S.A., Vitsenia M.V. et al. Guidelines for the diagnosis, prevention and treatment of cardiovascular complications of anticancer therapy. Part I. Systemic Hypertension. 2017; 14 (3): 6–20 (in Russian).
7. Curigliano G еt al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 2020; 31: 171–90.
8. Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. et al. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12 (in Russian).
9. Curigliano G, Cardinale D, Dent S et al. Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management. CA Cancer J Clin 2016; 66: 309–25.
10. Ranpura V, Pulipati B, Chu D et al. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens 2010; 23 (5): 460–8.
11. Avalian A.A., Oshchepkova E.V., Saidova M.A. et al. Evaluation of subclinical cardiotoxicity of anthracycline-containing chemotherapy for breast cancer depending on the cumulative dose of doxorubicin and the initial blood pressure level. Systemic Hypertension. 2018; 15 (4): 59–64 (in Russian).
12. Mondillo S, Galderisi M, Mele D et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med 2011; 30: 71–8.
13. Ciro Santorol et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. Eur Heart J Cardiovasc Imag 2017; p. 1–7.
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Авторы
А.А. Авалян*, М.А. Саидова, Е.В. Ощепкова, И.Е. Чазова
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*ani_avalian@mail.ru
National Medical Research Center for Cardiology, Moscow, Russia
*ani_avalian@mail.ru
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*ani_avalian@mail.ru
________________________________________________
National Medical Research Center for Cardiology, Moscow, Russia
*ani_avalian@mail.ru
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