Jannazzo Abigail, Hoffman Janet, Lutz Mark
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI, USA.
Ann Pharmacother. 2008 Jan;42(1):99-104. doi: 10.1345/aph.1K359. Epub 2007 Dec 19.
To review the literature regarding the appropriate monitoring for anthracycline-induced cardiotoxicity.
A MEDLINE search of the literature was performed (1966-August 2007). Search terms included anthracycline, cardiotoxicity, and monitoring. Additional references were identified through bibliographic reviews.
Anthracycline medications are effective in the treatment of many malignancies but their use is limited by their associated cardiotoxicity. The focus of anthracycline-induced cardiotoxicity prevention has been on monitoring cardiac function during treatment; however, a consensus on the most appropriate way to monitor patients is not available. Most guidelines lack specific details on the appropriate methods of cardiac evaluation and schedule. One guideline that does provide specific recommendations on both the method of evaluation and schedule has been criticized for being too restrictive, costly, and lacking in evidentiary support. The literature is insufficient in evaluation of the predictive value of cardiac function monitoring by echocardiography or radionuclide angiography during anthracycline therapy and the future development of cardiotoxicity, the necessity of baseline cardiac function monitoring, the optimal follow-up cardiac evaluation schedule, and the addition of risk stratification to monitoring schemes.
Although guidelines are inadequate to predict and prevent anthracycline-induced cardiotoxicity, until further research is available, following one of the existing guidelines to monitor for this adverse effect is a practical solution.
回顾有关蒽环类药物所致心脏毒性的适当监测的文献。
对文献进行了MEDLINE检索（1966年至2007年8月）。检索词包括蒽环类药物、心脏毒性和监测。通过文献综述确定了其他参考文献。
蒽环类药物在许多恶性肿瘤的治疗中有效，但它们的使用受到其相关心脏毒性的限制。蒽环类药物所致心脏毒性预防的重点一直是在治疗期间监测心脏功能；然而，对于监测患者的最合适方法尚无共识。大多数指南缺乏关于心脏评估的适当方法和时间表的具体细节。一项确实在评估方法和时间表两方面都提供了具体建议的指南因过于严格、成本高昂且缺乏证据支持而受到批评。关于蒽环类药物治疗期间超声心动图或放射性核素血管造影对心脏功能监测的预测价值以及心脏毒性的未来发展、基线心脏功能监测的必要性、最佳的后续心脏评估时间表以及在监测方案中增加风险分层，文献资料不足。
尽管指南不足以预测和预防蒽环类药物所致心脏毒性，但在有进一步研究之前，遵循现有指南之一来监测这种不良反应是一种实际的解决办法。
