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Abstract：
Background: During the physiological cardiac cycle, the helix orientation of the muscle fibres induces the rotation of the apex relative to the base of the left ventricular (LV). In heart failure, LV torsion is impaired, and rotation at basal and apical levels occurs in the same direction, a phenomenon called rigid body rotation (RBR). We aimed to evaluate whether the RBR pattern and GLS together could improve the diagnosis of cardiotoxicity in patients treated with anthracyclines and/or anti-HER2. Methods: With an observational, retrospective study involving 175 patients (mean age 55 ± 12 years, 94% females), we evaluated the development of cancer therapeutic-related cardiac dysfunction (CTRCD) defined according to ESC guidelines. We characterised LV dysfunction by echocardiographic standard and speckle-tracking (GLS and RBR pattern) measurements. Patients with a previous diagnosis of structural heart disease or atrial fibrillation were excluded. Results: At the time of enrolment, the chemotherapy regimen included trastuzumab (96%), pertuzumab (21%), and anthracyclines (13%). Twenty-two patients (12.5%) developed cardiotoxicity, and thirteen patients developed an RBR within 6 months of follow-up. In all cases, the RBR pattern was associated with cardiotoxicity (p < 0.001), reporting an optimal specificity but poor sensitivity at three and six months. However, the addition of the RBR pattern to the global longitudinal strain (GLS) ≥ -16% increased the odds ratio (OR) from 25.6 to 32.6 at three months and from 32.5 to 49.6 at six months rather than GLS alone. Conclusions: The RBR pattern improves the diagnostic accuracy of GLS for the detection of cardiotoxicity secondary to anthracyclines and anti-HER2-based treatments.
摘要：
背景：在生理心动周期中，肌肉纤维的螺旋方向引起顶点相对于左心室（LV）的底部旋转。在心力衰竭中，LV扭转受损,在基底和根尖水平的旋转发生在同一方向，一种称为刚体旋转(RBR)的现象。我们旨在评估RBR模式和GLS一起是否可以改善蒽环类和/或抗HER2治疗患者的心脏毒性诊断。方法：通过观察，回顾性研究涉及175例患者(平均年龄55±12岁，94%女性），我们评估了根据ESC指南定义的癌症治疗相关心功能不全(CTRCD)的发展.我们通过超声心动图标准和斑点追踪（GLS和RBR模式）测量来表征LV功能障碍。先前诊断为结构性心脏病或心房颤动的患者被排除在外。结果：在入学时，化疗方案包括曲妥珠单抗（96%），帕妥珠单抗（21%），和蒽环类药物(13%)。22例患者（12.5%）出现心脏毒性，13例患者在随访6个月内出现RBR。在所有情况下,RBR模式与心脏毒性相关(p<0.001)，在3个月和6个月时报告最佳特异性，但敏感性较差。然而,在全球纵向应变(GLS)≥-16%基础上增加RBR模式,3个月时比值比(OR)从25.6增加到32.6,6个月时比值比从32.5增加到49.6,而不是单独增加GLS.结论：RBR模式提高了GLS对蒽环类药物和基于抗HER2的治疗继发心脏毒性的诊断准确性。
