ABSTRACT
Objective:To assess the prognostic potential of post systolic shortening (PSS) on cardiac injury in the breast cancer patients after chemotherapy.Methods:This was a prospective cohort study in breast cancer patients after chemotherapy who were followed up to observe the risk of cardiac injury. A total of 69 female patients with HER-2 negative breast cancer were selected in the Fourth Hospital of Hebei Medical University from February to August 2019. The post-systolic strain index (PSI) of each segment of left ventricular myocardium after chemotherapy was obtained by two-dimensional speckle tracking echocardiography. PSI (%) was defined as follows: [(peak strain in cardiac cycle-peak strain in systole)/peak strain in cardiac cycle]×100%. PSS was regarded as meaningful if PSI >20%. End point was cardiac injury, which could be manifested as cardiotoxicity, cardiogenic death, myocardial infarction, unstable angina pectoris, and severe arrhythmias. Occurence of any above mentioned cardiac injuries was considered as end point event. According to the number of myocardial walls with PSS, the patients were divided into three groups: group A (no walls), group B (1 wall), and group C (≥2 walls). Additionally, the patients were also stratified according to tertiles of PSI: layer A (the first tertile), layer B (the second tertile), and layer C (the third tertile).Results:During a median follow-up of 18 months (Q 1=17 months, Q 3=18 months), 17 patients (24.64%) were diagnosed as having end point events. The risk of end point increased with the increase in the number of myocardial walls with PSS and the increase in PSI stratification.After adjusting for age, hypertension, systolic blood pressure, global longitudinal strain, and E peak of mitral early diastolic inflow velocity/average peak early diastolic mitral annular velocity e′ (E/e′), the association remained significant, (Per 1 increase in number of walls with PSS, hazard ratio, 1.96, P=0.007. Per 1% increase in PSI, hazard ratio, 1.44, P<0.001). In terms of predictive ability, the Harrell′s C index of PSS and of PSI was 0.70 and 0.73, respectively, both P<0.01, which indicated moderate accuracy. Conclusions:The presence of PSS in breast cancer patients after chemotherapy can provide independent prognostic information for the future occurrence of cardiac injury.
ABSTRACT
Objective To observe the post-systolic shortening (PSS) during isovolumic relaxation phase and its clinical significance in regional myocardium in chronic heart failure (CHF) patients.MethodsLeft ventricular regional myocardium movement in 60 CHF patients (CHF group) and 30 healthy volunteers (control group) were assessed with tissue velocity imaging (TVI). QLAB software was used to measure the systolic peak velocity (V_s), regional systolic time (T_s), post-systolic shortening velocity (V_(pss)) and post-systolic shortening time (T_(pss)) at the basal and middle levels of left ventricle. Results In CHF patients, the rate of isovolumic relaxation phase PSS was 34.44% both in basal and mid segments, the rate of pathological PSS was 29.44% and 29.72%, respectively. The rate of isovolumic relaxation phase PSS in control group was 26.11% and 20.56%, respectively; none pathological PPS occured. Compared with the physiological PSS of control group, the pathological PSS of CHF group had a higher peak velocity and a longer time (P<0.05). Conclusion The pathological PSS of CHF patients has high peak velocity and long duration, which may be one of the causes leading to the asynchronous movement of left ventricle in CHF.