Using 2D and 3D strain to detect myocardial damage during anthracycline
chemotherapy in breast cancer patients
Abstract
Both two-dimensional (2D) and three-dimensional (3D) echocardiography
can be used in the early diagnosis of myocardial toxicity in patients
with anthracycline chemotherapy. However, there are few studies on the
detection of early myocardial damage in specific regions. This study
compared the role and significance of 2D strain and 3D strain in
discovering early segmental dysfunction. We prospectively studied 56
breast cancer patients who received anthracycline therapy. The mean age
of patients was 47.6 ± 8.1 years. They all received 4-6 cycles of
chemotherapy. Before chemotherapy and after every two cycles, patients
underwent standard echo, 2D and 3D speckle-tracking echocardiography
(STE) and real-time three-dimensional echocardiography (RT-3DE).
Compared with the baseline value (T0), 3D GLS was significantly reduced
after two cycles (T2) (P<0.05), after four cycles (T4) 3D GCS
was significantly reduced (P<0.05), after six cycles (T6) 2D
derived EF, 2D GLS, E/e’ ratio, Fractional shortening (FS), 3D derived
EF, 3D GAS, GRS were considerably decreased (P<0.05). The area
supplying blood from the anterior descending branch of the left coronary
artery was the most susceptible to chemotherapy, and 3D GLS was found
earlier than 2D GLS which was decreased considerably after two cycles
(P<0.05). In anthracycline chemotherapy patients, some regions
of early myocardial dysfunction may be more easily involved, through the
evaluation of 2D and 3D echocardiography, 3D speckle tracking
echocardiography may be more able to identify the involved segments of
myocardium early. Moreover, the apical segments of the left ventricle
seem to be more susceptible to cardiotoxicity.