应变超声心动图早期检测蒽环类药物诱导的急性淋巴细胞白血病患儿左心室功能障碍

doi:10.20223/j.cnki.1000-8535.2024.11.011

摘要/Abstract

摘要： 目的探讨常规超声心动图联合二维斑点追踪技术评估急性白血病患儿在接受蒽环类药物治疗后产生的心脏毒性,早期检测左心功能障碍。方法采用前瞻性非随机观察研究,选取新诊断急性淋巴细胞白血病患儿20例,分别于确诊白血病后接受蒽环类药物治疗前、接受所有蒽环类药物剂量后以及确诊白血病1年后,进行常规超声心动图和二维斑点技术监测评估心脏毒性。结果左室流出道速度积分TVI和E、E/E’在治疗期间下降,并在诊断后1年恢复至治疗前数值。在二维斑点追踪纵向应变中,GLPS-LAX、GLPS-A2C、LV-GLPS在完成所有蒽环类药物剂量后与诊断后比较差异有统计学意义,以及诊断后1年与蒽环类药物治疗后比较差异有统计学意义。但GLPS-A4C各时间点比较差异无统计学意义。结论常规超声心动图联合二维斑点追踪技术的纵向整体应变可早期发现白血病患儿化疗所致的左室功能障碍。

关键词: 斑点追踪技术, 白血病, 蒽环类药物, 心脏毒性

Abstract: Objective To evaluate cardiotoxicity in children with acute lymphoblastic leukemia treated with anthracyclines by echocardiography combined with 2D speckle tracking imaging,and to detect left heart dysfunction early．Methods In this prospective nonrandomized study,20 children with newly diagnosed acute lymphoblastic leukemia were assessed for cardiotoxicity by echocardiography and 2D speckle tracking imaging in three periods during the treatment．Results The left ventricular outflow tract velocity integral TVI and E,E/E’ decreased during treatment,and went back to the pre-treatment value one year after diagnosis．In the longitudinal strain of 2D speckle tracking imaging,in GLPS-LAX,GLPS-A2C,LV-GLPS,there were statistical differences between treatment completed and after diagnosis,and between 1 year after diagnosis and treatment completed．However,GLPS-A4C has no statistical significance．Conclusion sThe conventional echocardiography combined with longitudinal overall strain of 2D speckle tracking imaging can comprehensively evaluate the early changes of left ventricular dysfunction caused by chemotherapy in children with leukemia．

Key words: speckle tracking imaging, leukemia, anthracycline drugs, cardiac toxicity

谢艳林, 董燕, 李翠玲, 董盖英. 应变超声心动图早期检测蒽环类药物诱导的急性淋巴细胞白血病患儿左心室功能障碍[J]. 广州医药, 2024, 55(11): 1308-1313.

XIE Yanlin, DONG Yan, LI Cuiling, DONG Gaiying. Strain echocardiography detecting left ventricular dysfunction in children with acute lymphocytic leukemia induced by anthracycloids[J]. Guangzhou Medical Journal, 2024, 55(11): 1308-1313.

参考文献

[1] SÁGI J C,EGYED B,KELEMEN A,et al.Possible roles of genetic variations in chemotherapy related cardiotoxicity in pediatric acute lymphoblastic leukemia and osteosarcoma[J].BMC Cancer,2018,18(1):704.
[2] BHAGAT A,KLEINERMAN E S.Anthracycline-induced cardiotoxicity:Causes,mechanisms,and prevention[J].Adv Exp Med Biol,2020(1257):181-192.
[3] KIM H,KANG H J,PARK K D,et al.Risk factor analysis for secondary malignancy in dexrazoxane-treated pediatric cancer patients[J].Cancer Res Treat,2019,51(1):357-367.
[4] LAZAR D R,CAINAP S,MANIU D,et al.Anthracycline’s effects on heart rate variability in children with acute lymphoblastic leukemia:Early toxicity signs-pilot study[J].J Clin Med,2023,12(22):7052.
[5] PLANA J C,GALDERISI M,BARAC A,et al.Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy:A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].J Am Soc Echocardiogr,2014,27(9):911-939.
[6] GALÁN-ARRIOLA C,VILLENA-GUTIÉRREZ R,HIGUERO-VERDEJO M I,et al.Remote ischaemic preconditioning ameliorates anthracycline-induced cardiotoxicity and preserves mitochondrial integrity[J].Cardiovasc Res,2021,117(4):1132-1143.
[7] CHOW E J,LEGER K J,BHATT N S,et al.Paediatric cardio-oncology:Epidemiology,screening,prevention,and treatment[J].Cardiovasc Res,2019,115(5):922-934.
[8] CARDINALE D,IACOPO F,CIPOLLA C M.Cardiotoxicity of anthracyclines[J].Front Cardiovasc Med,2020(7):26.
[9] 梁梦婕,金怡,郑哲岚.超声二维斑点追踪技术在蒽环类化疗药物心脏毒性监测中的应用价值[J].中华医学超声杂志(电子版),2019,16(10):749-755.
[10] THEETHA K P,KUMAR A,JAYARANGAIAH A,et al.Chemotherapy induced right ventricular cardiomyopathy;a systematic review and meta-analysis[J].Front Cardiovasc Med,2023(10):1103941.
[11] OIKONOMOU E K,KOKKINIDIS D G,KAMPAKTSIS P N,et al.Assessment of prognostic value of left ventricular global longitudinal strain for early prediction of chemotherapy-induced cardiotoxicity:A systematic review and meta-analysis[J].JAMA Cardiol,2019,4(10):1007-1018.
[12] LI V W,SO E K,WONG W H,et al.Myocardial deformation imaging by speckle-tracking echocardiography for assessment of cardiotoxicity in children during and after chemotherapy:A systematic review and meta-analysis[J].J Am Soc Echocardiogr,2022,35(6):629-656.
[13] ZHU M,CHEN H,FULATI Z,et al.The value of left ventricular strain-volume loops in predicting response to cardiac resynchronization therapy[J].Cardiovasc Ultrasound,2019,17(1):3.
[14] CHAGANTI B T,NEGISHI K,OKAJIMA K.Role of myocardial strain imaging in cancer therapy-related cardiac dysfunction[J].Curr Cardiol Rep,2022,24(6):739-748.
[15] MUGGEO P,SCICCHITANO P,MUGGEO V,et al.Assessment of cardiovascular function in childhood leukemia survivors:The role of the right heart[J].Children,2022,9(11):1731.
[16] BHAGAT A A,KALOGEROPOULOS A P,BAER L,et al.Biomarkers and strain echocardiography for the detection of subclinical cardiotoxicity in breast cancer patients receiving anthracyclines[J].J Pers Med,2023,13(12):1710.
[17] ARAUJO-GUTIERREZ R,CHITTURI K R,XU J,et al.Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity[J].Cardiooncology,2021,7(1):4.
[18] CHEN J,CHENG C,FAN L,et al.Assessment of left heart dysfunction to predict doxorubicin cardiotoxicity in children with lymphoma[J].Front Pediatr,2023(11):1163664.
[19] TSAI H R,GJESDAL O,WETHAL T,et al.Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy[J].Am J Cardiol,2011,107(3):472-477.
[20] ZHANG W,AZIBANI F,LIBHABER E,et al.The role of conventional echocardiographic parameters on detecting subclinical anthracycline therapy related cardiac dysfunction-The SATRACD study[J].Front Cardiovasc Med,2022(9):966230.