School of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Hematol Oncol. 2011 Sep;29(3):124-30. doi: 10.1002/hon.967. Epub 2010 Sep 22.
Cardiotoxicity has been feared as a potential side effect of imatinib therapy. Studies with short-term follow-up failed to identify an excess of cardiac events, but longer-term observations are needed to more definitely exclude this adverse effect. This study was designed to assess the cardiac effects of imatinib in patients under long-term treatment. We included 90 chronic myeloid leukaemia (CML) patients under imatinib therapy for a median treatment time of 3.3 years (mean age 48.9 ± 15.1 years). Patients underwent clinical evaluation, electrocardiography, echocardiography (two-dimensional, colour flow, tissue Doppler and strain imaging), brain natiuretic peptide (BNP) and troponin I measurements. Twenty healthy volunteers were included as a control group for strain measurements. The mean ejection fraction was 68 ± 7% and the median BNP level was 9.6 pg/ml (interquartile range [IQR] 5.7-17.0 pg/ml). Two patients had either an elevated BNP or a depressed ejection fraction (2.2%; 90%CI 0.9-6.8%). Most of troponin I measurements were lower than the detection limit, except for two patients. Longitudinal strain was similar to measurements in healthy controls. A weak relation was observed between log BNP and imatinib treatment duration and dose. There was no relation between these variables and left ventricle ejection fraction. In conclusion, matinib-related cardiotoxicity is an uncommon event in CML patients, even during long-term treatment. Therefore, its use should not be cause of great concern, and the usefulness of regular cardiac monitoring all patients while on imatinib therapy is questionable.
心脏毒性一直被视为伊马替尼治疗的潜在副作用。短期随访研究未能发现心脏事件的增加，但需要更长时间的观察才能更明确地排除这种不良反应。本研究旨在评估长期接受伊马替尼治疗的患者的心脏效应。我们纳入了 90 名接受伊马替尼治疗的慢性髓系白血病（CML）患者，中位治疗时间为 3.3 年（平均年龄 48.9±15.1 岁）。患者接受了临床评估、心电图、超声心动图（二维、彩色血流、组织多普勒和应变成像）、脑钠肽（BNP）和肌钙蛋白 I 测量。纳入 20 名健康志愿者作为应变测量的对照组。平均射血分数为 68±7%，中位 BNP 水平为 9.6pg/ml（四分位距[IQR] 5.7-17.0pg/ml）。有 2 名患者 BNP 升高或射血分数降低（2.2%；90%CI 0.9-6.8%）。除 2 名患者外，大多数肌钙蛋白 I 测量值低于检测限。纵向应变与健康对照组的测量值相似。观察到 BNP 的对数与伊马替尼治疗持续时间和剂量之间存在弱相关。这些变量与左心室射血分数之间没有关系。总之，在 CML 患者中，伊马替尼相关的心脏毒性是一种罕见事件，即使在长期治疗中也是如此。因此，它的使用不应引起极大关注，而且在伊马替尼治疗期间对所有患者进行常规心脏监测的有效性是值得怀疑的。
