Results
In our study, 56 patients were enrolled, and two cases were excluded due to poor image quality. All 54 patients completed anthracycline adjuvant chemotherapy in our hospital. The patients were all women age from 29 to 69 years old, none of the patients had cardiac symptoms, and all patients received dexrazoxane during the chemotherapy process. The cumulative dose during chemotherapy was 483.5 ± 149.0 mg/m2. Three of the 54 patients began radiotherapy after finished chemotherapy with anthracyclines. The baseline characteristics of the study population are presented in Table 1.
According to the standard 2D echocardiography evaluation: there were no significant changes in the diametral lines of the heart during chemotherapy; the LVEF values and FS values were significantly reduced after six cycles (P<0.05), although there was a statistically significant reduction in LVEF after anthracycline therapy, none of the patients had heart-related symptoms. In the echo-Doppler parameters, only the E/e′ ratio (P<0.05) was significantly decreased after six cycles, and there was no significant change in left ventricular diastolic function parameters. Of note, representing the overall function of the left ventricle TEI index also was decreased considerably after six cycles (Table 2).
2D STE analyses are shown in Table 2, 3. Compared with the baseline value, left ventricular global longitudinal strain (GLS) were reduced significantly after two, four and six cycles (all p<0.05). Moreover, the decreasing trend was more obvious with the increase of the dose anthracycline (Table 2). We further discovered that after four cycles the basal anterior segment (BA) and the apical septal segment (AS) were altered significantly (all P<0.05); after six cycles the basal anteroseptal segment (BAS) and apex segment were decreased significantly (all P<0.05) (Table 2).
The 3D volumetric analyses are shown in Table 4. We found that EDV, ESV, and LVEF were reduced significantly after six cycles compared to the baseline values (all P<0.05), but all patients’ LVEF was within the normal range (LVEF>55%).
3D STE analyses are shown in Table 4,5. We found that all 3D strain parameters were significantly decreased after chemotherapy, GLS has reduced dramatically after two cycles, especially. Additionally, compared with baseline values, the basal anterior segment (BA), the apical septal segment (AS) and the Apex segment were significantly reduced after two cycles (all P < 0.05); the mid-anterior segment (MA), the mid-anteroseptal segment (BAS) and the apical lateral segment (AL) were altered significantly after six cycles (all P < 0.05). (Figure 3)