Department of Pharmacology and Toxicology, College of Pharmacy, Tanta University, Tanta, Egypt.
J Card Fail. 2012 Aug;18(8):607-13. doi: 10.1016/j.cardfail.2012.06.416.
Adriamycin (ADR) is a potent chemotherapeutic agent widely used in the treatment of childhood acute lymphoblastic leukemia (ALL); its clinical use is limited owing to its marked cardiotoxicity. The present study investigated the possible protective role of carvedilol on ADR-induced left ventricular dysfunction in children with ALL.
Fifty children with newly diagnosed ALL were included in this study. They were divided into 2 equal groups: 1) ADR; and 2) ADR + carvedilol. Patients were evaluated with conventional 2-dimensional echocardiographic examination (2D), pulsed tissue Doppler (PTD), and 2-dimensional longitudinal strain echocardiography (2DS) before and after therapy. Plasma lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and troponin I levels were also determined before and after therapy. ADR treatment reduced left ventricular systolic dysfunction as assessed by a significant decrease in fractional shortening (FS) (2D) and global peak-systolic strain (GPSS; 2DS). In addition, ADR treatment significantly increased plasma troponin I and LDH. Pretreatment of ADR-treated patients with carvedilol resulted in a significant increase in FS (2D) and GPSS (2DS). Furthermore, carvedilol pretreatment inhibited ADR-induced increase in plasma troponin I and LDH.
These results suggested a protective role of carvedilol against ADR-induced cardiotoxicity.
阿霉素（ADR）是一种广泛用于治疗儿童急性淋巴细胞白血病（ALL）的有效化疗药物；但其临床应用受到其明显的心脏毒性的限制。本研究探讨了卡维地洛对儿童 ALL 患者 ADR 诱导的左心室功能障碍的可能保护作用。
本研究纳入了 50 例新诊断为 ALL 的儿童。他们被分为两组：1）ADR 组；2）ADR+卡维地洛组。在治疗前后，患者接受了常规二维超声心动图检查（2D）、脉冲组织多普勒（PTD）和二维纵向应变超声心动图（2DS）评估。在治疗前后还测定了血浆乳酸脱氢酶（LDH）、肌酸磷酸激酶（CPK）和肌钙蛋白 I 水平。ADR 治疗导致左心室收缩功能障碍，表现为节段缩短分数（FS）（2D）和整体收缩期峰值应变（GPSS；2DS）显著降低。此外，ADR 治疗显著增加了血浆肌钙蛋白 I 和 LDH。ADR 治疗患者预先给予卡维地洛治疗可显著增加 FS（2D）和 GPSS（2DS）。此外，卡维地洛预处理抑制了 ADR 诱导的血浆肌钙蛋白 I 和 LDH 的增加。
这些结果表明卡维地洛对 ADR 诱导的心脏毒性具有保护作用。
