Cardiology Unit, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
J Am Coll Cardiol. 2010 Jan 19;55(3):213-20. doi: 10.1016/j.jacc.2009.03.095.
The purpose of this study was to evaluate the clinical relevance of anthracycline-induced cardiomyopathy (AC-CMP) and its response to heart failure (HF) therapy.
The natural history of AC-CMP, as well as its response to modern HF therapy, remains poorly defined. Hence, evidence-based recommendations for management of this form of cardiomyopathy are still lacking.
We included in the study 201 consecutive patients with a left ventricular ejection fraction (LVEF) <or=45% due to AC-CMP. Enalapril and, when possible, carvedilol were promptly initiated after detection of LVEF impairment. LVEF was measured at enrollment, every month for the first 3 months, every 3 months during the first 2 following years, and every 6 months afterward (mean follow-up 36 +/- 27 months). Patients were considered responders, partial responders, or nonresponders according to complete, partial, or no recovery in LVEF, respectively. Major adverse cardiac events during follow-up were also evaluated.
Eighty-five patients (42%) were responders; 26 patients (13%) were partial responders, and 90 patients (45%) were nonresponders. The percentage of responders progressively decreased as the time from the end of chemotherapy to the start of HF treatment increased; no complete recovery of LVEF was observed after 6 months. Responders showed a lower rate of cumulative cardiac events than partial and nonresponders (5%, 31%, and 29%, respectively; p < 0.001).
In cancer patients developing AC-CMP, LVEF recovery and cardiac event reduction may be achieved when cardiac dysfunction is detected early and a modern HF treatment is promptly initiated.
本研究旨在评估蒽环类药物诱导性心肌病（AC-CMP）的临床相关性及其对心力衰竭（HF）治疗的反应。
AC-CMP 的自然病史及其对现代 HF 治疗的反应仍未得到充分定义。因此，对于这种心肌病的管理，仍然缺乏循证推荐。
我们纳入了 201 例因 AC-CMP 导致左心室射血分数（LVEF）<or=45%的连续患者。在检测到 LVEF 受损后，立即启用依那普利和（如果可能的话）卡维地洛。在入组时、前 3 个月每月、接下来的 2 年每 3 个月以及之后每 6 个月测量 LVEF（平均随访 36 +/- 27 个月）。根据 LVEF 的完全、部分或无恢复情况，患者分别被认为是应答者、部分应答者或无应答者。还评估了随访期间的主要不良心脏事件。
85 例患者（42%）为应答者；26 例患者（13%）为部分应答者，90 例患者（45%）为无应答者。应答者的比例随着从化疗结束到开始 HF 治疗的时间增加而逐渐降低；6 个月后未观察到 LVEF 的完全恢复。与部分和无应答者相比，应答者的累积心脏事件发生率较低（分别为 5%、31%和 29%；p < 0.001）。
在发生 AC-CMP 的癌症患者中，当心脏功能障碍早期检测到并且及时启动现代 HF 治疗时，可能会实现 LVEF 恢复和减少心脏事件。
