Di Lisi D, Bonura F, Macaione F, Cuttitta F, Peritore A, Meschisi M, Novo G, D'Alessandro N, Novo S
Division of Cardiology, Post-Graduate School of Cardiovascular Diseases, Department of Internal Medicine, Cardiovascular and Nephro-Urological Disease, University of Palermo, Italy.
Minerva Cardioangiol. 2011 Aug;59(4):301-8.
The cardiotoxicity of anticancer drugs is an emerging problem and only an identification of the early signs of cardiotoxicity by conventional echocardiography and not (tissue Doppler imaging, TDI), will limit and contain the long-term cardiotoxicity effects. The aim of this study was to identify, through conventional echocardiography and TDI, parameters to use as early "signs" of cardiotoxicity.
A prospective study was performed using patients with breast cancer (72 women, median age 57 ± 12) treated with anticancer drugs (adjuvant chemotherapy). All patients underwent a careful cardiological evaluation before starting treatment (T0) and during follow-up at 3 months (T1), 6 months (T2) and 1 year (T3). Electrocardiography and echocardiography were performed in all patients in these times. Echocardiography evaluation considered the following parameters: systolic and diastolic diameters and volumes, LVEF, MAPSE, TAPSE, E/A TDI (Em, Am, Sm, IVCT, IVRT, ET, TEI index). On the basis of chemotherapy treatment, patients were divided into 5 groups: A=FEC (fluorouracil, epirubicin, cyclophosphamide), B=FEC+trastuzumab, C=trastuzumab, D=FEC+taxotere, E=FEC+taxolo+trastuzumab.
A significant reduction in the echo parameters of TDI was observed. TDI appears to offer important advantages over traditional techniques in revealing the presence of early signs of cardiotoxicity.
The TDI should be utilized to complement conventional echocardiography in the assessment of cardiotoxicity.
抗癌药物的心脏毒性是一个新出现的问题，仅通过传统超声心动图而非组织多普勒成像（TDI）来识别心脏毒性的早期迹象，将限制并控制长期心脏毒性效应。本研究的目的是通过传统超声心动图和TDI来识别可作为心脏毒性早期“迹象”的参数。
对接受抗癌药物（辅助化疗）治疗的乳腺癌患者（72名女性，中位年龄57±12岁）进行了一项前瞻性研究。所有患者在开始治疗前（T0）以及随访的3个月（T1）、6个月（T2）和1年（T3）时均接受了仔细的心脏评估。在这些时间点对所有患者进行心电图和超声心动图检查。超声心动图评估考虑以下参数：收缩期和舒张期直径及容积、左心室射血分数（LVEF）、心肌运动幅度（MAPSE）、三尖瓣环平面收缩期位移（TAPSE）、TDI的E/A（Em、Am、Sm、等容收缩时间（IVCT）、等容舒张时间（IVRT）、射血时间（ET）、心肌性能指数（TEI指数））。根据化疗方案，患者被分为5组：A = FEC（氟尿嘧啶、表柔比星、环磷酰胺），B = FEC + 曲妥珠单抗，C = 曲妥珠单抗，D = FEC + 多西他赛，E = FEC + 紫杉醇 + 曲妥珠单抗。
观察到TDI的超声参数有显著降低。在揭示心脏毒性早期迹象方面，TDI似乎比传统技术具有重要优势。
在评估心脏毒性时，应利用TDI来补充传统超声心动图。
