门控心肌灌注成像对弥漫性大B细胞淋巴瘤蒽环类药物心脏毒性的早期诊断

中华核医学与分子影像杂志 Pub Date : 2019-10-25 DOI:10.3760/CMA.J.ISSN.2095-2848.2019.10.004

Chun Qiu, Yan Lin, Weiying Gu, Jian-feng Wang, Xiaoliang Shao, Feifei Zhang, Jiatian Chen, Xiaoxia Li, B. He, Xiao-bao Xie, Zhifang Wu, Yuetao Wang

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引用次数: 0

摘要

目的评价左室收缩同步性，探讨左室收缩不同步性对蒽环类药物引起的弥漫性大b细胞淋巴瘤(DLBCL)的早期诊断价值。方法2016年6月至2019年1月，32例蒽环类药物化疗前确诊DLBCL且门控心肌灌注成像(GMPI)正常的患者(男22例，女10例)，年龄22-73岁(54.4±14.2)岁。化疗6个周期或更长时间后进行GMPI。心肌标志物、心电图指标、左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、峰值充盈率(PFR)、运动总评分(SMS)、增厚总评分(STS)等左室功能指标的变化以及左室收缩同步性指标(相带宽(BW)、分析蒽环类药物化疗前后的相标准差(SD)和熵。数据分析采用配对t检验、Wilcoxon符号秩检验和χ2检验。结果与化疗前相比，左室收缩同步性指标均显著高于化疗前(BW:(42.81±11.37)°vs(29.28±8.68)°;SD:(11.65±4.64)°vs(8.79±3.14)°;熵:(39.84±5.51)% vs(36.19±5.94)%;t值为-9.132 ~ -3.173,P < 0.05)。32例患者中，13例(40.62%)存在左室收缩非同步化，化疗引起的左室收缩非同步化率明显高于左室功能不全(15.62%，5/32;χ2 = 4.947,P = 0.025)。化疗引起的5例左室功能障碍患者均存在左室收缩非同步化。化疗诱导的左室收缩非同步化组LVEF显著低于左室收缩同步化组((54.54±9.25)% vs(66.79±7.65)%;t = 4.087, P < 0.01)。结论DLBCL患者化疗后可出现左室收缩非同步化，且明显早于左室功能不全，可作为蒽环类药物化疗引起心脏毒性的早期指标。关键词:淋巴瘤，大B细胞，弥漫性;药物治疗、联合用药;蒽环霉素;左为心室功能;心肌灌注显像

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Phase analysis of gated myocardial perfusion imaging for early diagnosis of cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma

Objective To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Methods Thirty-two patients (22 males, 10 females, age: 22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak filling rate (PFR), summed motion score (SMS) and summed thickening score (STS) as well as left ventricular systolic synchrony indicators including phase bandwidth (BW), phase standard deviation (SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ2 test were used for data analysis. Results Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW: (42.81±11.37)° vs (29.28±8.68)°; SD: (11.65±4.64)° vs (8.79±3.14)°; entropy: (39.84±5.51)% vs (36.19±5.94)%; t values: -9.132 to -3.173, all P 0.05). Of 32 patients, 13 patients (40.62%) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchrony was significantly higher than that of left ventricular dysfunction (15.62%, 5/32; χ2=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssynchrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony group was significantly lower than that of the left ventricular systolic synchronization group ((54.54±9.25)% vs (66.79±7.65)%; t=4.087, P<0.01). Conclusion Left ventricular systolic dyssynchrony can be appeared in DLBCL patients after chemotherapy and is significantly earlier than left ventricular dysfunction, which can be an early indicator of cardiotoxicity caused by anthracycline chemotherapy. Key words: Lymphoma, large B cell, diffuse; Drug therapy, combination; Anthracyclines; Ventricular function, left; Myocardial perfusion imaging

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

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5088

期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.