速度向量成像技术评估胸部放疗患者右心室功能变化的临床研究

Evaluation of right ventricular function in patients undergoing thoracic radiotherapy via velocity vector imaging

摘要:

目的 应用速度向量成像技术（VVI）评估中下段食管癌、左侧肺癌及左侧乳腺癌患者放疗前后的右心室功能的变化。方法 选取2020年5月—2021年5月在延边大学附属医院就诊的30例中下段食管癌、左侧肺癌、左侧乳腺癌患者，于放疗前后1周内行超声心动图检查，常规测量右心室基底部内径（RVD₁）、中间段内径（RVD₂）、右心室上下径（RVD₃）、面积变化分数（FAC）、三尖瓣收缩期位移（TAPSE）、三尖瓣环收缩期峰值速度（S′）、心肌做功指数（Tei）、等容收缩期心肌加速度（IVA）；应用VVI获得右心室收缩期整体纵向应变（RVGLS）、游离壁基底段应变（RVLSbas）、游离壁中间段应变（RVLSmid）、游离壁心尖段应变（RVLSapi），并计算出游离壁整体应变（RVLSfw），对放疗前后患者的常规参数和应变参数进行比较，分析RVGLS、RVLSfw 与常规超声心动图、游离壁各节段应变的相关性。结果 ①放疗前后患者RVD₁、RVD₂、RVD₃、S′比较，差异无统计学意义（P >0.05）；放疗后患者FAC、TAPSE、IVA下降（P <0.05），Tei指数升高（P <0.05）。②放疗后患者RVLSbas、RVLSmid、RVLSapi、RVLSfw、RVGLS升高（P <0.05）。③RVGLS与FAC、TAPSE、IVA呈负相关（r =-0.563、-0.398和-0.373，P =0.001、0.030和0.042），与S′呈正相关（r =0.387，P =0.035）；RVLSfw与TAPSE呈负相关（r =-0.489，P =0.006），与RVLSbas、RVLSmid呈正相关（r =0.582和0.378，P =0.001和0.040）。结论 VVI可以早期评估中下段食管癌、左侧肺癌及左侧乳腺癌患者放疗前后右心室功能的变化。

Abstract:

Objective To evaluate the changes in the right ventricular function via velocity vector imaging (VVI) in patients with middle and lower esophageal cancer, left lung cancer and left breast cancer before and after radiotherapy.Methods From May 2020 to May 2021, thirty patients with middle and lower esophageal cancer, left lung cancer and left breast cancer in the Affiliated Hospital of Yanbian University were examined by echocardiography within 1 week before and after radiotherapy. The right ventricular basal diameter (RVD1), right ventricular middle diameter (RVD2), right ventricular longitudinal dimension (RVD3), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity (S'), myocardial performance index (Tei), isovolumic acceleration (IVA) were evaluated. The VVI was applied to measure the right ventricular global longitudinal strain (RVGLS), and right ventricular free wall longitudinal strain of the basal (RVLSbas), mid (RVLSmid), and apical (RVLSapi) segments, which were used for calculating the right ventricular free wall longitudinal strain (RVLSfw). The general parameters and strain parameters were compared before and after radiotherapy, and the correlations of RVGLS and RVLSfw with the general parameters measured via conventional echocardiography and strains of each segment of free walls were analyzed.Results There was no statistically significant difference in RVD1, RVD2, RVD3, or S' before and after the radiotherapy (P > 0.05). Following the radiotherapy, FAC, TAPSE, and IVA were decreased, while Tei was increased (P < 0.05). Besides, RVLSbas, RVLSmid, RVLSapi, RVLSfw, and RVGLS were also increased after the radiotherapy (P < 0.05). RVGLS was negatively correlated with FAC, TAPSE, and IVA (r = -0.563, -0.398 and -0.373, P = 0.001, 0.030 and 0.042), but was positively correlated with S' (r = 0.387, P = 0.035). RVLSfw was negatively correlated with TAPSE (r = -0.489, P = 0.006), but was positively correlated with RVLSbas and RVLSmid (r = 0.582 and 0.378, P = 0.001 and 0.040).Conclusions VVI can be used to evaluate the early changes of the right ventricular function in patients with middle and lower esophageal cancer, left lung cancer and left breast cancer after thoracic radiotherapy.