超声二维应变技术在肿瘤心脏病学中的应用及思考

田锦润 闵杰青

[摘要]肿瘤和心血管疾病，尤其是心力衰竭（HF），是备受关注的两大类疾病。肿瘤治疗手段的多样性和心脏并发症的复杂性，使得肿瘤心脏病学作为一个新的专业出现。在肿瘤治疗过程中，患者常因发生肿瘤治疗相关心功能障碍（CTRCD）中断治疗，甚至因严重 HF 而病死。因临床治疗面临着多重困境，故肿瘤合并 HF 的患者需要更多的关注。超声心动图二维应变（2D-strain）技术，尤其是左心室整体纵向应变（LV GLS），能及时识别 CTRCD，协助肿瘤患者完成治疗及降低发生 HF 的风险，被逐渐应用于肿瘤患者的治疗管理中。故本文就近年2D-strain 在肿瘤心脏病学中应用的相关内容进行归纳、总结，并提出思考，以期能更好地认识该技术在肿瘤心脏病学中的价值及不足。

[关键词]肿瘤心脏病学;肿瘤治疗相关心功能障碍;心力衰竭;二维应变;左心室整体纵向应变

[中图分类号] R541.6+1  [文献标识码] A   [文章编号]2095-0616（2021）23-0048-05

The application of ultrasonic two-dimensional strain technique in cardio-oncology and some considerations on it

TIAN  Jinrun    MIN  Jieqing

Department of Cardiac Function， Kunming Children's Hospital， Yunnan， Kunming 650034， China

[Abstract] Tumors and cardiovascular diseases， especially heart failure （HF）， are two kinds of diseases that attract much attention. The diversity of tumor treatments and the complexity of cardiac complications have made cardio- oncology emerge as a new specialty. In the process of tumor treatment， the patients often have their treatment discontinued due to the occurrence of cancer treatment-related cardiac dysfunction （CTRCD）， and even die of severe HF. Because of the multiple difficulties in clinical treatment， the patients with tumor complicated with HF need more attention. Two-dimensional strain （2D-strain） technology of echocardiography， especially left ventricular global longitudinal strain （LV GLS）， can identify CTRCD in time， assist tumor patients to complete treatment and reduce the risk of HF， so it is gradually applied to the management of the treatment of tumor patients. Therefore， this paper generalized and summarized the related contents of the application of 2D-strain in cardio-oncology in recent years and put forward some considerations， so as to better understand the value and shortcomings of this technology in cardio-oncology.

[Key words] Cardio-oncology; Cancer treatment-related cardiac dysfunction; Heart failure; Two-dimensional strain; Left ventricular global longitudinal strain

近年來，肿瘤患者的病死率逐年下降，但其心血管事件的发生率却呈上升趋势[1-3]。肿瘤患者可因治疗而发生一系列的不良心血管事件（major adverse cardiovascular events，MACE）[4]，最常见的是肿瘤治疗相关心功能障碍（cancer treatment-related cardiac dysfunction，CTRCD）与心力衰竭（heart failure，HF），可导致多种严重不良后果，需要多学科协作来为其提供最优的临床治疗决策[2]。

因此，在肿瘤患者的治疗管理流程中，不同风险程度的患者均进行经胸超声心动图检查是必要的[5]。欧洲肿瘤内科学会（European Society for Medical Oncology， ESMO）[6]、欧洲心脏病学会（European Society of Cardiology，ESC）[7]均强调了超声心动图检查的重要价值。中华医学会于2020年发表了《抗肿瘤治疗心血管损害超声心动图检查专家共识》[8]，提出了符合国情的建议与规范。……