Application value of two-dimensional speckle tracking imaging technique in monitoring cardiac toxicity of anthracycline chemotherapy drugs

Abstract

Objective To measure cardiac biomechanical parameters in leukemia patients after chemotherapy with anthracycline (ANTH) drugs by ultrasonic two-dimensional speckle tracking imaging (2D-STI), and to evaluate the value of 2D-STI technique in monitoring cardiac toxicity of ANTH chemotherapy drugs. Methods From September 2016 to June 2018, 55 leukemia patients hospitalized in The First People's Hospital of Wenling were selected, and 40 healthy volunteers were selected as controls. The patients with leukemia received four cycles of chemotherapy with a regimen containing an ANTH drug. According to the results of 12-lead electrocardiogram, they were divided into either a normal electrocardiogram group (ANTH-A group, n=35) or an abnormal electrocardiogram group (ANTH-B group, n=20). Routine echocardiography was performed in the two groups to obtain conventional echocardiographic parameters, and the related biomechanical parameters were also measured by 2D-STI technique. The parameters of the three groups were compared, and the ROC curve was drawn to analyze the efficiency of 2D-STI technique and conventional echocardiography in predicting cardiac systolic function damage. Results There was no significant difference in conventional echocardiographic parameters among the control group, ANTH-A group, and ANTH-B group before chemotherapy (P>0.05). After four cycles of chemotherapy, E/A in the ANTH-B group was significantly lower than that in the control group and ANTH-A group (t=4.26, 3.89, P<0.05), and left ventricular end-diastolic volume (LVEDV) significantly was higher in the ANTH-B group than in the control group and ANTH-A group (t=3.16, 2.64, P<0.05). Basal segment longitudinal strain (bLS), middle segment longitudinal strain (mLS), apical segment longitudinal strain (aLS), and global longitudinal strain (GLS) were significantly lower and peak strain dispersion (PSD) was significantly higher in the ANTH-A group than in the control group (t=7.61, 8.47, 8.92, 10.04, 9.26, P<0.01). The bLS, mLS, aLS, and GLS were significantly lower and PSD was significantly higher in the ANTH-B group than in the control group and ANTH-A group (bLS: t=9.66, 8.28; mLS: t=10.46, 9.42; aLS: t=12.47, 10.82; GLS: t=15.28, 11.48; PSD: t=12.62, 10.86; P<0.01). The GLS and global radial strain (GRS) in the ANTH-A group were significantly lower than those in the control group (t=10.04, 6.62, P<0.05). The GLS, GRS, and global circumferential strain (GCS) in the ANTH-B group were significantly lower than those in the control group and ANTH-A group (GLS: t=15.28, 11.48; GRS: t=8.86, 7.42; GCS: t=7.72, 7.43; P<0.01). The peak rotation of apex (AP-Prot) and left ventricular peak twist (LV-Ptw) in the ANTH-A group were significantly lower than those in the control group (t=6.44, 7.18, P<0.05). The AP-Prot and LV-Ptw in the ANTH-B group were significantly lower than those in the control group and ANTH-A group (AP-Prot: t=8.23, 7.68; LV-Ptw: t=8.90, 7.92; P<0.01). The results of ROC curve analysis showed that the areas under the curves of GLS, GCS, GRS, and left ventricular ejection fraction (LVEF) in predicting cardiac systolic dysfunction after four cycles of chemotherapy were 0.96, 0.86, 0.62, and 0.45, respectively. The optimal cutoff point of GLS was-12.03%; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting cardiac systolic dysfunction were 90.0%, 97.1%, 92.3%, 85.2%, and 90.2%, respectively. Conclusion 2D-STI technique can monitor the cardiotoxicity induced by ANTH drugs in the early stage. Left ventricular longitudinal myocardial activity has more important clinical value in the evaluation of early cardiac systolic dysfunction. Key words: Echocardiography; Two-dimensional speckle tracing imaging; Anthracyclines; Cardiac toxicity