Elbl L, Vasova I, Tomaskova I, Jedlicka F, Navratil M, Pospisil Z, Vorlicek J
Department of Cardiology, Faculty Hospital Brno-Bohunice, 62500 Brno, Czech Republic.
Neoplasma. 2006;53(2):174-81.
Authors conducted a one-year prospective study to determine whether CHOP regimen (cyclophosphamide, doxorubicin, vincristin, and prednisone), used in the treatment of aggressive non-Hodgkin s lymphoma, is associated with the presence of an early impairment of cardiac function. Forty seven patients were prospectively examined (27 male and 20 female) aged 49+/-14 years who were treated with CHOP regimen. Rest echocardiography was performed at baseline and one-year control. Cardiopulmonary exercise test was carried out at one-year control examination. The ejection fraction (EF), parameters of diastolic function, myocardial performance index (MPI), and pVO2 were used as parameters of cardiopulmonary performance. The cumulative dose (CD) of doxorubicin was 277+/-56 (300 mg/m(2)) was given. The baseline EF 64+/-5% (64%) decreased to 58+/-7% (57%) at the one-year control (p<0.0001). 23% of patients exhibited a drop in EF >10% during the follow-up. 43% revealed a pathologically increased value of MPI >0.55, and 47% impaired diastolic function compared to the baseline values, respectively. 21% of patients exhibited a decrease of pVO(2) < 20 ml/kg/min, and 17% pVO(2) < 80% of the reference value, respectively. None of the patients developed signs of heart failure. The Doppler parameters of both diastolic and global LV function were the most affected measures and significantly influenced the cardiopulmonary performance. Multivariate analysis showed that CD > or =300 mg/m(2) (OR=8.08; p<0.05) and the presence of risk factors (OR=9.48; p<0.008) are the best predictors of cardiotoxicity. The results show that subclinical cardiac impairment was frequent in patients receiving the CHOP regimen with safe cumulative doses of doxorubicin. The value of described changes for the development of heart failure has to be assessed during the prospective follow-up.
作者开展了一项为期一年的前瞻性研究，以确定用于治疗侵袭性非霍奇金淋巴瘤的CHOP方案（环磷酰胺、阿霉素、长春新碱和泼尼松）是否与早期心功能损害有关。对47例接受CHOP方案治疗的患者（27例男性和20例女性）进行了前瞻性检查，患者年龄为49±14岁。在基线期和一年后复查时进行静息超声心动图检查。在一年后复查时进行心肺运动试验。射血分数（EF）、舒张功能参数、心肌性能指数（MPI）和峰值摄氧量（pVO2）用作心肺功能参数。阿霉素的累积剂量（CD）为277±56（300mg/m²）。基线期EF为64±5%（64%），在一年后复查时降至58±7%（57%）（p<0.0001）。23%的患者在随访期间EF下降>10%。43%的患者MPI病理值升高>0.55，47%的患者舒张功能与基线值相比受损。21%的患者pVO2下降<20ml/kg/min，17%的患者pVO2<参考值的80%。所有患者均未出现心力衰竭迹象。舒张期和左心室整体功能的多普勒参数是受影响最大的指标，并显著影响心肺功能。多因素分析表明，CD≥300mg/m²（OR=8.08；p<0.05）和存在危险因素（OR=9.48；p<0.008）是心脏毒性的最佳预测指标。结果表明，接受CHOP方案且阿霉素累积剂量安全的患者中，亚临床心脏损害很常见。在未来的随访中必须评估所描述的这些变化对心力衰竭发展的价值。
