Objectives The objective of this study was to evaluate the changes in three-dimensional (3D) speckle-tracking echocardiography–derived measures of mechanics and their associations with systolic and diastolic dysfunction after anthracyclines.

Background An improved understanding of the changes in 3D cardiac mechanics with anthracyclines may provide important mechanistic insight and identify new metrics to detect cardiac dysfunction.

Methods A total of 142 women with breast cancer receiving doxorubicin (240 mg/m²) with or without trastuzumab underwent 3D speckle-tracking echocardiography at standardized intervals prior to, during, and annually after chemotherapy. Left ventricular ejection fraction (LVEF), global circumferential strain (GCS), global longitudinal strain (GLS), principal strain, twist, and torsion were quantified. Linear regression analyses defined the associations between clinical factors and 3D parameters. Linear regression models with cluster robust variance estimators determined the associations between 3D measures and 2-dimensional (2D) LVEF and Doppler-derived E/eʹ over time.

Results There were significant abnormalities in 3D LVEF, GCS, GLS, and principal strain post-doxorubicin compared with control subjects (p < 0.001). The 3D parameters worsened post-anthracyclines, and only partially recovered to baseline over a median of 2.1 years (interquartile range: 1 to 4 years). Higher blood pressure and body mass index were associated with worse post-anthracycline 3D GCS and GLS, respectively. All 3D measures were associated with 2D LVEF at the same visit; only 3D LVEF, GCS, GLS, and principal strain were associated with 2D LVEF at subsequent visits (p < 0.05). In exploratory analyses, 3D LVEF and GCS were associated with subsequent systolic function independent of their corresponding 2D measures. The 3D LVEF, GCS, principal strain, and twist were significantly associated with concurrent, but not subsequent, E/eʹ.

Conclusions Anthracyclines result in early and persistent abnormalities in 3D mechanics. The 3D LVEF and strain measures are associated with concurrent and subsequent systolic dysfunction, and concurrent diastolic dysfunction. Future research is needed to define the mechanisms and clinical relevance of abnormal 3D mechanics.

目的本研究的目的是评估蒽环类药物在三维（3D）散斑跟踪超声心动图测量中的变化及其与收缩压和舒张功能障碍的关系。

背景技术对蒽环类药物对3D心脏力学变化的更好理解可能会提供重要的机理见解，并确定检测心脏功能障碍的新指标。

方法总共142例接受阿霉素（240 mg / m ²）联合或不联合曲妥珠单抗治疗的乳腺癌女性患者，在化疗之前，期间和之后，均应以标准间隔进行3D斑点追踪超声心动图检查。量化左心室射血分数（LVEF），整体周向应变（GCS），整体纵向应变（GLS），主应变，扭转和扭转。线性回归分析定义了临床因素和3D参数之间的关联。具有聚类鲁棒方差估计量的线性回归模型确定了3D量度与二维（2D）LVEF和多普勒推导的E / eʹ之间的关联。

结果与对照组相比，阿霉素后3D LVEF，GCS，GLS和主要毒株存在显着异常（p <0.001）。3D参数使蒽环类药后恶化，并且仅在中位2.1年（四分位间距：1至4年）内部分恢复到基线。较高的血压和体重指数分别与蒽环类药物3D GCS和GLS较差有关。在同一次访问中，所有3D量度均与2D LVEF相关；在随后的随访中，只有3D LVEF，GCS，GLS和主要菌株与2D LVEF相关（p <0.05）。在探索性分析中，3D LVEF和GCS与随后的收缩功能相关，而与它们相应的2D测量无关。3D LVEF，GCS，主应变和扭曲与并发（但不是随后的）E / eʹ显着相关。

结论蒽环类药物可导致3D力学的早期和持续异常。3D LVEF和应变测量值与并发和随后的收缩功能障碍以及并发的舒张功能障碍相关。需要进一步的研究来定义异常3D力学的机制和临床相关性。