Cardiovascular Rehabilitation-Heart Failure Unit Ospedale SS Trinita' Fossano, Italy.
Int J Cardiol. 2011 Apr 14;148(2):194-8. doi: 10.1016/j.ijcard.2009.09.564. Epub 2009 Nov 27.
Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment.
Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled. All patients underwent clinical assessment, radionuclide ventriculography, troponin I and brain natriuretic peptide (BNP) measurements at baseline and one-month (T1), one year (T2) and 2-year (T3) after chemotherapy. Reductions of LVEF ≥ 10% or an overt heart failure were considered cardiovascular events.
53 patients, 52 females and 1 male, age 55.3 years were included and followed at T3. A significant reduction of LVEF was observed (from 62 ± 5.5% to 59.3 ± 8.6%, p=0.04) at T3; BNP increased (from 33.4 ± 41.5 pg/ml to 62.7 ± 94.7 pg/ml, p=0.005) at T1. Troponin I augmented at T1 (from 0.006 ± 0.01 ng/ml to 0.05 ± 0.04 ng/ml, p=0.0001) but normalized at T2 (0.005 ± 0.08 ng/ml; p=0.9). Only baseline BNP was nearly to be significantly correlated with T3 LVEF (p=0.07 HR 0.96-1) at multivariate analysis. In 13/53 patients (32.1%) LVEF showed ≥ 10% reduction at T3 (group A); in 40/53 patients (67.9%) LVEF was unchanged (group B). Patients in group A demonstrated higher baseline plasma BNP (p=0.02) and lower haemoglobin concentration (p=0.007) compared to patients in group B.
LVEF and BNP modified early after anthracycline chemotherapy and LVEF did not recover at T3. In patients who developed left ventricular systolic dysfunction, a subclinical activation of neurohormonal profile was observed.
目的：评估蒽环类药物辅助化疗对早期乳腺癌患者左心室射血分数（LVEF）的影响，并分析化疗对肌钙蛋白 I（cTnI）和神经激素评估的影响。
方法：选择接受手术治疗且适合接受辅助化疗的早期乳腺癌患者。所有患者在基线、化疗后 1 个月（T1）、1 年（T2）和 2 年（T3）时进行临床评估、放射性核素心室造影、cTnI 和脑钠肽（BNP）检测。LVEF 降低≥10%或出现明显心力衰竭时定义为心血管事件。
结果：53 例患者（52 名女性和 1 名男性）入组，年龄 55.3 岁，在 T3 时进行随访。结果显示，T3 时 LVEF 显著降低（从 62±5.5%降至 59.3±8.6%，p=0.04）；T1 时 BNP 升高（从 33.4±41.5 pg/ml 升至 62.7±94.7 pg/ml，p=0.005）。T1 时 cTnI 升高（从 0.006±0.01 ng/ml 升至 0.05±0.04 ng/ml，p=0.0001），但在 T2 时恢复正常（0.005±0.08 ng/ml，p=0.9）。多变量分析显示，仅基线 BNP 与 T3 LVEF 接近显著相关（p=0.07，HR 0.96-1）。在 53 例患者中（32.1%），T3 时 LVEF 下降≥10%（A 组）；40 例（67.9%）患者 LVEF 无变化（B 组）。与 B 组相比，A 组患者的基线血浆 BNP 更高（p=0.02），血红蛋白浓度更低（p=0.007）。
结论：蒽环类药物辅助化疗后早期 LVEF 和 BNP 发生改变，至 T3 时 LVEF 未恢复。在发生左心室收缩功能障碍的患者中，观察到神经激素谱的亚临床激活。
