CardioSomaticsCardioSomaticsCardioСоматика2221-71852658-5707Eco-Vector26306410.17816/CS626047Original study articlesОригинальные статьиResearch ArticleUse of indicators of systolic and diastolic functions of the left ventricle in the diagnosis of early cardiotoxicity during chemotherapy with doxorubicin: An open, prospective, nonrandomized studyПрименение показателей систолической и диастолической функции левого желудочка в диагностике ранней кардиотоксичности на фоне химиотерапии доксорубицином: открытое проспективное, нерандомизированное исследованиеhttps://orcid.org/0000-0003-0478-94199036-3155KarputsIrina A.КарпутьИрина Александровна
Belarus

аспирант

graduate student

karputirina@gmail.comhttps://orcid.org/0000-0002-1706-12431697-0116СнежицкийВиктор АлександровичSnezhitskiyVictor A.
Belarus

MD, Dr. Sci. (Med.), Corresponding member of NAS (Belarus), department professor

д-р мед. наук, профессор кафедры, чл.-корр. НАН Республики Беларусь

vsnezh@mail.ruhttps://orcid.org/0000-0002-8518-24502216-7032КурбатМихаил НиколаевичKurbatMikhail N.
Belarus

MD, Cand. Sci. (Med.), associate professor, laboratory head

канд. мед. наук, доцент, заведующий лабораторией

vwmisha@mail.ruhttps://orcid.org/0009-0007-3089-85437423-5368ГорустовичОльга АнатольевнаHarustovichVolga A.
Belarus

MD, Cand. Sci. (Med.), senior lecturer

канд. мед. наук, старший преподаватель

gorustovich1206@gmail.comhttps://orcid.org/0000-0001-8548-64141248-1214КарповичЮлия ИвановнаKarpovichYulia I.
Belarus

MD, Cand. Sci. (Med.), associate professor

канд. мед. наук, доцент

poluhovich1@gmail.comРубинскийАлександр ЮрьевичRubinskijAlexander Y.
Belarus

младший научный сотрудник, врач УЗД

MD, junior researcher, ultrasound diagnostics doctor

kardio@mail.grodno.byСмирноваТатьяна АнатольевнаSmirnovaTatiana A.
Belarus

MD, junior researcher, oncologist

младший научный сотрудник, врач-онколог

smir-tat.anat@mail.ruhttps://orcid.org/0000-0002-5513-970X9715-4070BabenkaAndrei S.БабенкоАндрей Сергеевич
Belarus

канд. хим. наук, доцент

Cand. Sci. (Chem.), associate professor

labmdbt@gmail.comGrodno State Medical UniversityГродненский государственный медицинский университетGrodno Regional Clinical Cardiological CenterГродненский областной клинический кардиологический центрGrodno University ClinicГродненская университетская клиникаБелорусский государственный медицинский университетBelarusian State Medical Universityru17082024202415210712304092024Received:04092024Published:17082024Copyright ©; 2024, ООО "Эко-Вектор"Copyright ©; 2024, Eco-Vector2024ООО "Эко-Вектор"Eco-Vectorhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journals.rcsi.science/2221-7185/article/view/263064

BACKGROUND: The search for new markers of early cardiotoxicity (CT) may help reduce the incidence of severe complications in the cardiovascular system during chemotherapy with doxorubicin.

AIM: To determine echocardiography (EchoCG) parameters with the potential as CT markers in patients with primary breast cancer (BC) 12 months after the end of chemotherapy with doxorubicin.

MATERIAL AND METHODS: An open, prospective, nonrandomized study included 100 patients with verified BC who were treated at the Grodno University Clinic (Grodno, Belarus). Twelve months after the end of chemotherapy, 10 patients were excluded from the general group (7 women refused inclusion, the global longitudinal deformation of the myocardium could not be measured in 3 because of a poor acoustic window). All patients underwent transthoracic echocardiography with the assessment of systolic and diastolic myocardial function before and 12 months after the end of chemotherapy.

RESULTS: In 24/90 (26.6%) patients, a relative (before / after 12 months) decrease in global longitudinal myocardial deformity >12% (cardiotoxicity manifestation, CT+ subgroup) was detected. The cutoff point of the absolute decrease in global longitudinal myocardial deformation after 12 months was 18.0% (sensitivity, 87.9%; specificity, 83.7%). Significant differences were found between the absolute values of echocardiography in the CT+ and CT− (without CT manifestations) subgroups 12 months after the end of chemotherapy: the indexed final diastolic volume (FDV) was in 54 (49; 61) CT+ and 61 (53; 65) in CT− (p=0.034), the indexed final systolic volume (FSV) was 17 (15; 20) in CT+ and 20 (17; 23) in CT− (p=0.031), and the ratio of the rates of peaks of early and late filling of the left ventricle (E/A) in was 1.13 (1.10; 1.27) in CT+ and 1.29 (1.15; 1.45) in CT− (p=0.031). The specificity, sensitivity, and cutoff points for these parameters were established. The cutoff, sensitivity, and specificity were 57.7 62.1%, and 66.7% for FDV; 18.8, 60.6%, and 62.5% for FSV; and 1.18, 68.2%, and 66.7% for E/A, respectively.

CONCLUSION: The E/A, FDV, and FSV are candidate markers of CT 12 months after the end of chemotherapy with doxorubicin in patients with BC.

Обоснование. Поиск новых маркёров ранней кардиотоксичности (КТ) может способствовать снижению частоты развития тяжёлых осложнений со стороны сердечно-сосудистой системы на фоне химиотерапии (ХТ) доксорубицином.

Цель. Определить показатели эхокардиографии (ЭхоКГ), обладающие потенциалом маркёров КТ, у пациенток с первичным раком молочной железы (РМЖ) через 12 мес. после окончания ХТ доксорубицином.

Материал и методы. В открытое, проспективное, нерандомизированное исследование были включены 100 пациенток с верифицированным РМЖ, проходивших лечение на базе Гродненской университетской клиники (Гродно, Беларусь). Через 12 мес. после окончания ХТ 10 пациенток были исключены из общей группы (7 женщин отказались от исследования, у 3 не удалось измерить глобальную продольную деформацию миокарда из-за плохого акустического окна). Всем пациенткам выполнена трансторакальная ЭхоКГ с оценкой систолической и диастолической функции миокарда до и через 12 мес. после окончания ХТ.

Результаты. У 24/90 (26,6%) пациенток диагностировано относительное (до/через 12 мес.) снижение глобальной продольной деформации миокарда >12% (проявление КТ, подгруппа КТ+). Определена точка отсечения абсолютного снижения глобальной продольной деформации миокарда через 12 мес. — 18,0% (чувствительность — 87,9%, специфичность — 83,7%). Установлен ряд статистически значимых различий между абсолютными значениями показателей ЭхоКГ в подгруппах КТ+ и КТ- (без проявлений КТ) через 12 мес. после окончания ХТ: индексированный конечный диастолический объём (иКДО) в КТ+ 54 (49; 61) / КТ- 61 (53; 65) при р=0,034; индексированный конечный систолический объём (иКСО) в КТ+ 17 (15; 20) / КТ- 20 (17; 23) при р=0,031; отношение скоростей пиков раннего и позднего наполнения левого желудочка (E/A) в КТ+ 1,13 (1,10; 1,27) / КТ- 1,29 (1,15; 1,45) при р=0,031. Установлены критерии специфичности и чувствительности, а также точки отсечения для показателей E/A, иКДО и иКСО. Для иКДО точка отсечения составила 57,7, чувствительность — 62,1%, специфичность — 66,7%. Для иКСО точка отсечения — 18,8, чувствительность — 60,6%, специфичность — 62,5%. Для Е/А точка отсечения оказалась равной 1,18, чувствительность — 68,2 %, специфичность — 66,7%.

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