Сравнительные возможности метода спекл-трекинг- эхокардиографии в двумерном и трехмерном режимах в выявлении субклинической кардиотоксичности у больных раком молочной железы
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Saidova M.A., Avalyan A.A., Oshchepkova E.V., et al. Comparative capabilities of the speckle-tracking echocardiography technologiesin two-dimensional and three-dimensional modes in the detection of subclinical cardiotoxicity in patients with breast cancer. Therapeutic Archive. 2020; 92 (12): 142–147. DOI: 10.26442/00403660.2020.12.200431
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Материалы и методы. В исследование включены 99 больных тройным негативным РМЖ с артериальной гипертонией (АГ) и нормотензией. Всем больным проводилась стандартная трансторакальная эхокардиография (ЭхоКГ) с оценкой систолической функции ЛЖ. Для оценки показателя глобальной продольной деформации ЛЖ как маркера кардиотоксичности применялась технология СТЭ в двумерном и трехмерном режимах. В трехмерном режиме СТЭ оценен новый параметр деформации – площадь глобальной деформации (GAS).
Результаты. Проведенное исследование показало, что у больных РМЖ для более точной оценки систолической функции ЛЖ (по показателю фракции выброса) целесообразно применение трехмерной ЭхоКГ. Сравнительный анализ выявил статистически значимо низкие значения глобальной продольной деформации по данным трехмерного режима СТЭ по сравнению с двумерным. В исследовании также оценен новый параметр деформации – GAS (%). У больных РМЖ при проведении ROC-анализа при значении ≥-14,0 показатель GAS в отношении развития субклинической кардиотоксичности показал чувствительность 81,5% и специфичность 73,3%.
Заключение. Преимуществом метода СТЭ в трехмерном режиме, в отличие от двумерного, является одновременная и более точная оценка фракции выброса ЛЖ. Значение дополнительного параметра деформации ЛЖ – GAS – требует дальнейшего изучения.
Ключевые слова: спекл-трекинг-эхокардиография, кардиотоксичность, химиотерапия.
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Aim. The study was to assess the deformation properties of the left ventricle (LV) myocardium in patients with breast cancer initially and after anthracycline chemotherapy according to 2D and 3D speckle-tracking echocardiography (STE).
Material and methods. the study included 99 patients with triple negative breast cancer with hypertensionandnormotension. All patients underwent standard transthoracic echocardiography with assessment of systolic function of the LV. To assess the indicator of global longitudinal strain (GLS), as a marker of cardiotoxicity, STE was used in two-and three-dimensional modes. In the three-dimensional STE mode, a new strain parameter, the global area strain (GAS) was evaluated.
Results. The study showed that in patients with breast cancer for a more accurate assessment of LV systolic function (ejection fraction) it is advisable to use 3D-echocardiography. A comparative analysis revealed statistically significantly lower values of the GLS according to the three-dimensional mode of STE compared to two-dimensional. The study also evaluated a new strain parameter – GAS (%). In patients with breast cancer during ROC analysis with a value of ≥-14.0, the GAS indicator for the development of subclinical cardiotoxicity showed a sensitivity of 81.5% and a specificity of 73.3%.
Сonclusion. the advantage of the STE in the three-dimensional mode, in contrast to the two-dimensional mode, is the simultaneous and more accurate assessment of LVEF. The value of the additional parameter of LV deformation – the area of deformation requires further study.
Keywords: speckle tracking echocardiography, cardiotoxicity, chemotherapy.
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21. 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
22. 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. 2012;25(1):68-79. doi: 10.1016/j.echo.2011.10.009
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J Clin. 2016;66:309-25. doi: 10.3322/caac.21341
2. Curigliano G, еt al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020;31:171-90. doi: 10.1016/j.annonc.2019.10.023
3. Pizzino F, Vizzari G, Bomzeret C, et al. Diagnosis of Chemotherapy Induced Cardiotoxicity. J Patient Cent Res Rev. 2014:121-7. doi: 10.17294/2330-0698.1025
4. Bovelli D, Plataniotis G, Roila F. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann Oncol. 2010;21:277-82. doi: 10.1093/annonc/mdq200
5. 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. doi: 10.7863/jum.2011.30.1.71
6. Plana JC, et al. Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27:911-39. doi: 10.1016/j.echo.2014.07.012
7. [Avalyan AA, Saidova MA, Oshchepkova E V, et al. Modern approaches to detecting early subclinical cardiotoxicity induced by chemotherapy in patients with breast cancer. Eur Heart J. 2018;3:50-5 (In Russ.)].
8. 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. doi: 10.1093/eurheartj/ehw211
9. [Chazova IY, Tyulyandin SA, Vitsenia MV, et al. Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Part I. Systemic Hypertension. 2017;14(3):6-20 (In Russ.)]. doi: 10.26442/2075-082X_14.3.6-20
10. Kleijn SA, Mohamed FA Aly, 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. doi: 10.1016/j.echo.2011.01.014
11. Seo Y, Ishizu T, Atsumi A, et al. Three-Dimensional Speckle Tracking Echocardiography. Circ J. 2014:1290-301. doi: 10.1253/circj.CJ-14-0360
12. Santoro C, et al. 2D and 3D strain for detection of subclinicalanthracyclinecardiotoxicity in breast cancerpatients: a balance with feasibility. Eur Heart J Cardiovasc Imaging. 2017:1-7. doi: 10.1093/ehjci/jex033
13. 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. doi: 10.1016/j.jacc.2012.01.037
14. [Saidova MA. Three-dimensional echocardiography: yesterday, today, tomorrow. Consilium Medicum. 2006;8(5):127-32 (In Russ.)].
15. Sorrentino R, Esposito R, Pezzullo E, et al. Real-time three-dimensional speckle tracking echocardiography: technical aspects and clinical applications. Research Reports in Clinical Cardiology. 2016;2016(7):147-58. doi: 10.2147/RRCC.S107374
16. Radwan H, Hussein E. Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity. Egypt Heart J. 2017;69:95-101. doi: 10.1016/j.ehj.2016.08.001
17. Ky B, Putt M, Sawaya H, et al. Early increases in multiple biomarkers predict subsequent cardiotoxicity in patients with breast cancer treated with doxorubicin, taxanes, and trastuzumab. J Am Coll Cardiol. 2014; 63(8):809-16. doi: 10.1016/j.jacc.2013.10.061
18. Sawaya H, Sebag IA, Plana JC, et al. Early Detection and Prediction of Cardiotoxicity in Chemotherapy-Treated Patients. Am J Cardiol. 2011;107(9):1375-80. doi: 10.1016/j.amjcard.2011.01.006
19. Song F-Y, Shi J, Guo Y, 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 Imaging. 2017;33(6):857-68. doi: 10.1007/s10554-017-1082-6
20. Boyd A, Stoodley P, Richards D, et al. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study. PLoS One. 2017;12(4):1-15. doi: 10.1371/journal.pone.0175544
21. 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
22. 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. 2012;25(1):68-79. doi: 10.1016/j.echo.2011.10.009
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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M.A. Saidova, A.A. Avalyan, E.V. Oshchepkova, V.N. Shitov, I.E. Chazova
National Medical Research Center of Cardiology, Moscow, Russia