Introduction
The survival rate of cancer patients
has been significantly improved in recent decades. Because of the
development of early diagnosis techniques, improved in the level of
treatment and the implementation of multidisciplinary treatment of
cancer, and advances in adjuvant chemotherapy and radiotherapy[1].
Although with the development of anti-tumor drug therapy towards the
direction of individual and targeted therapy, its toxic and side effects
should not be ignored. Research has shown that about half of cancer
deaths are caused by non-cancer causes, and cardiovascular disease plays
an important role[2].
Anthracyclines are secondary
metabolites produced by Streptomyces and are one of the most effective
anticancer drugs at present. It mainly includes daunorubicin,
Adriamycin, epirubicin, pirarubicin, mitoxantrone and so on. Although
the field of cancer treatment has changed dramatically in recent
decades, anthracyclines remain the cornerstone of modern chemotherapy
regimens for many cancers[3, 4]. However, the most severe adverse
reaction of anthracyclines is the cardiotoxicity caused by
anthracyclines. Numerous trials have
indicated that most of the cardiotoxicity caused by anthracyclines are
persistent and non-reversing, especially the first use of anthracyclines
easily cause cardiac damage. Therefore, early detection of cardiac
insufficiency can implement cardiac protection strategies before late
and potentially irreversible changes in cardiac function[5, 6].
Echocardiography
is a well-known non-invasive technique for assessment of cardiac
systolic and diastolic function, and it is the most commonly used method
for early identification and evaluation of cardiotoxicity caused by
antineoplastic drugs. Left-ventricular ejection fraction (LVEF) is the
most frequently used index to evaluate left ventricular systolic
function by conventional echocardiography, and the decrease of LVEF is
related to heart failure. However, its sensitivity to early
identification of cardiotoxicity is still
controversial[7].
The cardiotoxicity induced by anthracyclines was mostly positively
correlated with the dose, and in China the dose of anthracycline in the
treatment of breast cancer is relatively low. Therefore, more sensitive
monitoring methods are needed to monitor the cardiotoxicity associated
with low-dose anthracyclines. In
recent years, with the development of echocardiography
technology,
2D and 3D speckleātracking echocardiographic parameters have been proved
to be able to detect preclinical abnormalities reliably at an early
stage [8-10]. Standard echocardiography can detect abnormalities in
the presence of obvious clinical symptoms. In the preclinical state,
strain imaging can make up for its deficiency and is of great help in
early diagnosis and define prognosis.[11].
However,
because of the different distribution of myocardial fibres, some areas
of the myocardium may be more prone to dysfunction[12]. This study
aimed to compare the role and significance of 2D strain and 3D strain in
the detection of early segmental dysfunction, and to explore which is
more meaningful, including 3D global strain, longitudinal strain, radial
strain and circumferential strain.