Abnormalities in 3-Dimensional Left Ventricular Mechanics With Anthracycline Chemotherapy Are Associated With Systolic and Diastolic Dysfunction.
Abnormalities in 3-Dimensional Left Ventricular Mechanics With Anthracycline Chemotherapy Are Associated With Systolic and Diastolic Dysfunction.
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DOI：
10.1016/j.jcmg.2018.01.015
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Ky B
中科院分区：
文献类型：
--
作者：
Zhang KW;Finkelman BS;Gulati G;Narayan HK;Upshaw J;Narayan V;Plappert T;Englefield V;Smith AM;Zhang C;Hundley WG;Ky B
本研究的目的是评估三维（3D）斑点追踪超声心动图（STE）衍生的力学指标的变化及其与蒽环类药物治疗后收缩和舒张功能障碍的相关性。对蒽环类药物的3D心脏力学变化的更好理解可能提供重要的机制见解，并确定检测心功能不全的新指标。142例接受阿霉素（240 mg/m2）联合或不联合曲妥珠单抗治疗的乳腺癌女性在化疗前、化疗期间和化疗后每年的标准化时间间隔接受3D STE。左心室射血分数（LVEF）、整体周向应变（GCS）、整体纵向应变（GLS）、主应变、扭转和扭转进行定量。线性回归分析确定了临床因素与3D参数之间的相关性。采用聚类稳健方差估计器的线性回归模型确定了3D测量与2D LVEF和多普勒衍生E/e'随时间的相关性。与对照组相比，多柔比星治疗后的3D LVEF、GCS、GLS和主应变存在显著异常（p<0.001）。3D参数在蒽环类药物治疗后恶化，在中位2.1年内仅部分恢复至基线水平（四分位距1，4）。较高的血压和体重指数分别与蒽环类药物治疗后3D GCS和GLS较差相关。在同一次访视中，所有3D测量值均与2D LVEF相关;在后续访视中，仅3D LVEF、GCS、GLS和主应变与2D LVEF相关（p<0.05）。在探索性分析中，3D LVEF和GCS与随后的收缩功能相关，独立于其相应的2D测量。3D LVEF、GCS、主应变和扭转与同时发生的E/e '显著相关，但与随后发生的E/e'无关。蒽环类药物导致3D力学的早期和持续异常。3D LVEF和应变测量与并发和后续收缩功能障碍以及并发舒张功能障碍相关。未来的研究需要定义异常3D力学的机制和临床相关性。
The objective of this study was to evaluate the changes in three-dimensional (3D) speckle-tracking echocardiography (STE)-derived measures of mechanics and their associations with systolic and diastolic dysfunction after anthracyclines. An improved understanding of the changes in 3D cardiac mechanics with anthracyclines may provide important mechanistic insight and identify new metrics to detect cardiac dysfunction. 142 women with breast cancer receiving doxorubicin (240 mg/m2) with or without trastuzumab underwent 3D STE at standardized intervals prior to, during, and annually after chemotherapy. Left ventricular ejection fraction (LVEF), global circumferential strain (GCS), global longitudinal strain (GLS), principal strain, twist, and torsion were quantified. Linear regression analyses defined the associations between clinical factors and 3D parameters. Linear regression models with cluster robust variance estimators determined the associations between 3D measures and 2D LVEF and Doppler-derived E/e’ over time. There were significant abnormalities in 3D LVEF, GCS, GLS, and principal strain post-doxorubicin as compared to controls (p<0.001). 3D parameters worsened post-anthracyclines and only partially recovered to baseline over a median of 2.1 years (interquartile range 1, 4). Higher blood pressure and body mass index were associated with worse post-anthracycline 3D GCS and GLS, respectively. All 3D measures were associated with 2D LVEF at the same visit; only 3D LVEF, GCS, GLS, and principal strain were associated with 2D LVEF at subsequent visits (p<0.05). In exploratory analyses, 3D LVEF and GCS were associated with subsequent systolic function independent of their corresponding 2D measures. 3D LVEF, GCS, principal strain, and twist were significantly associated with concurrent, but not subsequent, E/e’. Anthracyclines result in early and persistent abnormalities in 3D mechanics. 3D LVEF and strain measures are associated with concurrent and subsequent systolic dysfunction, and concurrent diastolic dysfunction. Future research is needed to define the mechanisms and clinical relevance of abnormal 3D mechanics.
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影响因子：
14
作者：
Narayan, Hari K.;French, Benjamin;Ky, Bonnie
通讯作者：
Ky, Bonnie
影响因子：
--
作者：
Mor-Avi, Victor;Lang, Roberto M.;Zamorano, Jose Luis
通讯作者：
Zamorano, Jose Luis
影响因子：
2.8
作者：
Maffessanti, Francesco;Nesser, Hans-Joachim;Mor-Avi, Victor
通讯作者：
Mor-Avi, Victor
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
DOI：
10.1016/j.echo.2013.02.008
发表时间：
2013-05-01
影响因子：
6.5
作者：
Negishi, Kazuaki;Negishi, Tomoko;Marwick, Thomas H.
通讯作者：
Marwick, Thomas H.