Allen J, Thomson J D, Lewis I J, Gibbs J L
Department of Paediatric Cardiology, Yorkshire Heart Centre, E Floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
Heart. 2001 Apr;85(4):430-2. doi: 10.1136/heart.85.4.430.
To investigate the new onset of mitral regurgitation in patients with otherwise normal echocardiograms after anthracycline treatment and to assess its relation to other selected indicators of myocardial damage.
Prospective echocardiographic and electrocardiographic study.
Tertiary paediatric cardiac referral centre.
305 patients, aged 2-33 years (median 14 years), treated with cumulative anthracycline doses of between 150-450 mg/m(2) (median 180 mg/m(2)) for childhood malignancy.
Colour flow Doppler detection of mitral regurgitation and its relation to changes in echocardiographic indices of left ventricular function (systolic and diastolic dimensions, fractional shortening) and to changes in the 12 lead ECG; and the prevalence of mitral regurgitation in the anthracycline treated patients in comparison with previously studied normal volunteers of similar age.
34 patients (11.6%) developed ultrasound detectable mitral regurgitation, which was not apparent clinically, during or after anthracycline treatment, compared with only 1.8% of a normal population of similar age (p < 0.0001). Nine of the 34 also developed non-specific T wave abnormalities. All 34 patients had normal systolic function at the time of initial detection of mitral regurgitation, but four later developed impaired left ventricular function (5, 11, 20, and 27 months after the first detection of mitral regurgitation).
Mitral regurgitation occurs much more often in patients treated with anthracyclines than in the normal population. Echocardiographic detection of new mitral regurgitation with or without ECG abnormalities may be an early predictor of anthracycline cardiomyopathy.
研究接受蒽环类药物治疗后超声心动图检查其他方面正常的患者中新发二尖瓣反流情况，并评估其与其他选定的心肌损伤指标之间的关系。
前瞻性超声心动图和心电图研究。
三级儿科心脏转诊中心。
305例年龄在2至33岁（中位数14岁）的患者，因儿童恶性肿瘤接受了累积剂量为150 - 450 mg/m²（中位数180 mg/m²）的蒽环类药物治疗。
彩色多普勒血流检测二尖瓣反流及其与左心室功能超声心动图指标（收缩期和舒张期尺寸、缩短分数）变化以及12导联心电图变化的关系；与先前研究的年龄相似的正常志愿者相比，蒽环类药物治疗患者中二尖瓣反流的患病率。
34例患者（11.6%）在蒽环类药物治疗期间或之后出现超声可检测到的二尖瓣反流，临床上不明显，而年龄相似的正常人群中这一比例仅为1.8%（p < 0.0001）。34例患者中有9例还出现了非特异性T波异常。所有34例患者在首次检测到二尖瓣反流时收缩功能正常，但其中4例后来出现左心室功能受损（在首次检测到二尖瓣反流后5、11、20和27个月）。
接受蒽环类药物治疗的患者中二尖瓣反流的发生率远高于正常人群。超声心动图检测到新发二尖瓣反流伴或不伴心电图异常可能是蒽环类药物性心肌病的早期预测指标。
