Cardinale D, Sandri M T, Martinoni A, Tricca A, Civelli M, Lamantia G, Cinieri S, Martinelli G, Cipolla C M, Fiorentini C
Cardiology Unit, Istituto Europeo di Oncologia, University of Milan, Italy.
J Am Coll Cardiol. 2000 Aug;36(2):517-22. doi: 10.1016/s0735-1097(00)00748-8.
We investigated the role of cardiac troponin I (cTnI) in patients with aggressive malignancies treated with high-dose chemotherapy (HDC).
High dose chemotherapy is potentially limited by cardiac toxicity. Considering the fact that cardiac dysfunction may become clinically evident weeks or months after HDC, the availability of an early marker of myocardial injury, able to predict late ventricular impairment, is a current need.
We measured, in 204 patients (45+/-10 years) affected by cancer resistant to conventional treatment, the cTnI plasma concentration after every single cycle of HDC. According to the cTnI value (< or = or >0.4 ng/ml), patients were divided into a troponin positive (cTnI+, n = 65) and a troponin negative (cTnI-, n = 139) group. All patients underwent echocardiographic examination during the following seven months.
In the cTnI- group, left ventricular ejection fraction (LVEF) progressively decreased after HDC, reaching a maximal reduction after three months; however, myocardial depression was transient and no longer detectable at later follow-up. By contrast, in the cTnI+ group LVEF reduction was more marked and still evident at the end of the follow-up. In cTnI+ patients, a close relationship between the short-term cTnI increment and the greatest LVEF reduction was found (r = -0.87, p<0.0001).
The elevation of cTnI in patients undergoing HDC for aggressive malignancies accurately predicts the development of future LVEF depression. In this setting, cTnI can be considered a sensitive and reliable marker of acute minor myocardial damage with relevant clinical and prognostic implications.
我们研究了心肌肌钙蛋白I（cTnI）在接受大剂量化疗（HDC）的侵袭性恶性肿瘤患者中的作用。
大剂量化疗可能受到心脏毒性的限制。鉴于心脏功能障碍可能在HDC数周或数月后才在临床上显现出来，目前需要一种能够预测晚期心室功能损害的心肌损伤早期标志物。
我们测量了204例（45±10岁）对传统治疗耐药的癌症患者在每一个HDC周期后的cTnI血浆浓度。根据cTnI值（≤或＞0.4 ng/ml），将患者分为肌钙蛋白阳性（cTnI+，n = 65）组和肌钙蛋白阴性（cTnI-，n = 139）组。所有患者在接下来的七个月内接受超声心动图检查。
在cTnI-组中，HDC后左心室射血分数（LVEF）逐渐下降，三个月后降至最大降幅；然而，心肌抑制是短暂的，在后续随访中不再可检测到。相比之下，在cTnI+组中，LVEF的降低更为明显，在随访结束时仍很明显。在cTnI+患者中，发现短期cTnI升高与最大LVEF降低之间存在密切关系（r = -0.87，p<0.0001）。
接受HDC治疗侵袭性恶性肿瘤的患者中cTnI升高准确预测了未来LVEF降低的发生。在这种情况下，cTnI可被视为急性轻度心肌损伤的敏感且可靠标志物，具有相关的临床和预后意义。
