Real-time three-dimensional echocardiography predicts cardiotoxicity induced by postoperative chemotherapy in breast cancer patients

Table 1 Comparison of routine detection indicators before and after chemotherapy in the toxic and non-toxic groups

Routine de-tection in-dicator	Group	T0	T1	T2	T3	T4	Fwithin group	Pwithin group value	Fbetween group	Pbetween group value	Finteraction	Pinteraction value
LAd (mm)	Toxic	3.31 ± 0.46	3.34 ± 0.45	3.40 ± 0.57	3.37 ± 0.62	3.42 ± 0.89	0.921	0.401	1.111	0.332	1.442	0.241
	Non-toxic	3.21 ± 0.88	3.31 ± 0.69	3.20 ± 0.82	3.27 ± 0.92	3.23 ± 0.87
LVDd (mm)	Toxic	4.39 ± 0.45	4.47 ± 0.62	4.45 ± 0.65	4.55 ± 0.58	4.61 ± 0.54	0.971	0.382	1.540	0.220	0.201	0.823
	Non-toxic	4.22 ± 0.63	4.21 ± 0.73	4.28 ± 0.89	4.30 ± 0.84	4.25 ± 0.93
Mitral valve E/A	Toxic	1.34 ± 0.38	1.33 ± 0.37	1.31 ± 0.31	1.29 ± 0.41	1.27 ± 0.34	0.533	0.593	1.251	0.291	1.252	0.473
	Non-toxic	1.51 ± 0.51	1.44 ± 0.46	1.47 ± 0.52	1.43 ± 0.46	1.41 ± 0.51
LVEF (%)	Toxic	64.92 ± 5.38	63.29 ± 6.39	63.27 ± 6.83	62.36 ± 6.90	62.39 ± 5.59	0.754	0.628	0.473	0.183	0.982	0.377
	Non-toxic	65.24 ± 6.49	65.37 ± 7.49	64.63 ± 6.72	63.93 ± 5.89	63.28 ± 7.39
ΔLVEF (%)	Toxic	-	0.93 ± 0.31	1.38 ± 0.38	1.42 ± 0.33	2.39 ± 0.48	0.552	0.579	1.583	0.211	0.942	0.392
	Non-toxic	-	0.68 ± 0.35	1.09 ± 0.41	1.28 ± 0.52	2.01 ± 0.45
LVFS (%)	Toxic	37.2 ± 3.4	37.4 ± 3.3	36.8 ± 2.9	36.7 ± 3.6	36.9 ± 3.1	0.764	0.472	1.622	0.203	0.740	0.481
	Non-toxic	36.8 ± 3.6	37.1 ± 3.5	37.4 ± 4.2	36.4 ± 3.8	36.5 ± 2.9
E/e'	Toxic	6.36 ± 1.04	6.89 ± 1.38	7.02 ± 1.62	7.19 ± 1.48	7.82 ± 1.49a	3.912	0.023	3.172	0.072	3.961	0.022
	Non-toxic	6.17 ± 1.67	6.53 ± 1.58	6.88 ± 1.49	7.08 ± 1.63	7.32 ± 1.73
cTnI (μg/L)	Toxic	0.0231 ± 0.0106	0.0247 ± 0.0128	0.0256 ± 0.0193	0.0289 ± 0.0147	0.0422 ± 0.0166a	5.201	0.007	2.974	0.084	4.123	0.019
	Non-toxic	0.0204 ± 0.0148	0.0226 ± 0.0175	0.0214 ± 0.0149	0.0218 ± 0.0128	0.0228 ± 0.0145
Pro-BNP (ng/L)	Toxic	94.44 ± 19.39	95.92 ± 19.73	100.93 ± 21.49	112.38 ± 20.38	128.68 ± 22.29a	5.573	0.005	3.063	0.082	4.452	0.014
	Non-toxic	91.29 ± 28.94	92.39 ± 31.29	94.92 ± 29.30	95.93 ± 28.39	97.11 ± 30.61

^aP < 0.05. LAd: Left atrial diameter; LVDd: Left ventricular diastolic diameter; E/A: Maximum peak velocity in late diastole (A peak)/maximum peak velocity in early diastole (E peak); LVEF: Left ventricular ejection fraction; LVFS: Left ventricular fraction shortening; E/e': Maximum peak velocity in early diastole (E peak)/mitral annulus lateral tissue Doppler (e' peak); cTnI: Cardiac troponin I; Pro-BNP: Pro-brain natriuretic peptide.

Table 2 Comparison of three-dimensional parameters of the left atrium before and after chemotherapy in the toxic and non-toxic groups

Three-dimen-sional in-dicator	Group	T0	T1	T2	T3	T4	Fwithin group	Pwithin group value	Fbetween group	Pbetween group value	Finteraction	Pinteraction value
LAVmin (mL)	Toxic	14.93 ± 2.07	16.93 ± 2.51	19.62 ± 2.07	21.94 ± 1.91a	23.11 ± 2.04a	5.201	0.007	4.533	0.013	10.072	0.000
	Non-toxic	14.73 ± 3.92	15.63 ± 3.29	17.39 ± 2.84	18.84 ± 2.72	17.96 ± 2.28
LAVmax (mL)	Toxic	34.82 ± 4.96	35.11 ± 5.23	35.28 ± 5.28	36.82 ± 6.02	37.72 ± 7.62	2.941	0.057	2.563	0.082	2.792	0.066
	Non-toxic	32.18 ± 5.29	33.72 ± 6.28	34.13 ± 5.65	34.89 ± 5.39	35.27 ± 6.39
LAVprep (mL)	Toxic	23.92 ± 5.29	24.29 ± 4.68	25.83 ± 5.17	27.99 ± 5.53a	29.79 ± 4.40a	4.713	0.011	5.063	0.008	8.391	0.000
	Non-toxic	22.88 ± 4.02	23.18 ± 3.79	23.69 ± 4.03	23.11 ± 4.18	22.89 ± 3.03
LAEF (%)	Toxic	58 ± 8	58 ± 7	57 ± 8	56 ± 8	56 ± 7	1.240	0.294	1.731	0.182	1.582	0.211
	Non-toxic	60 ± 9	59 ± 8	59 ± 9	58 ± 8	57 ± 8

^aP < 0.05. LAVmin: Minimum left atrial volume; LAVmax: Maximum left atrial volume; LAVprep: Left atrial volume before the start of the P wave; LAEF: Left atrial ejection fraction.

Table 3 Multivariate logistic regression analysis of cardiotoxicity in patients with breast cancer after chemotherapy

Indicator	B	S.E.	Wald	P value	OR	95%CI
						Lower limit	Upper limit
T4 E/e'	0.250	0.204	2.183	0.125	1.284	0.861	1.915
T4 cTnI	0.733	0.317	5.024	0.025	2.081	1.118	3.874
T4 Pro-BNP	0.171	0.021	6.072	0.016	1.187	1.139	1.237
T3 LAVmin	0.387	0.021	9.024	0.003	1.472	1.413	1.534
T4 LAVmin	0.467	0.182	9.592	0.001	1.595	1.116	2.279
T3 LAVprep	0.290	0.017	8.815	0.005	1.336	1.292	1.381
T4 LAVprep	0.344	0.013	9.723	0.000	1.411	1.376	1.447

E/e': Maximum peak velocity in early diastole (E peak)/mitral annulus lateral tissue Doppler (e' peak); cTnI: Cardiac troponin I; Pro-BNP: Pro-brain natriuretic peptide; LAVmin: Minimum left atrial volume; LAVprep: Left atrial volume before the start of the P wave.

Table 4 Receiver operating characteristic curve analysis of potential indicators in predicting the cardiotoxicity after chemotherapy

Indicator	AUC	95%CI	Cut off point	Sensitivity (%)	Specificity (%)
T3LAVmin	0.808	0.721-0.878	20.1	85.71	65.59
T4LAVmin	0.947	0.886-0.981	21.2	78.57	94.62
T3LAVprep	0.753	0.660- 0.831	30.1	50.00	97.85
T4LAVprep	0.899	0.826-0.949	24.4	100	66.67
T4cTnI	0.806	0.718-0.876	0.024	92.86	56.99
T4Pro-BNP	0.793	0.704-0.866	100.6	100	53.76

cTnI: Cardiac troponin I; Pro-BNP: Pro-brain natriuretic peptide; LAVmin: Minimum left atrial volume; LAVprep: Left atrial volume before the start of the P wave.