Colombo Alessandro, Cardinale Daniela
Cardiology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Future Cardiol. 2013 Jan;9(1):105-18. doi: 10.2217/fca.12.73.
Cardiotoxicity is a frequent and serious adverse effect of both conventional and novel anticancer treatments, affecting patient survival and quality of life. The current standard for cardiac monitoring during cancer therapy, mainly based on left ventricular ejection fraction assessment, detects myocardial damage only when a functional impairment has already occurred, not allowing for early preventive strategies. Measurement of cardiospecific biomarkers has proven to have higher prognostic value than imaging modalities. In particular, cardiac troponin elevation during chemotherapy allows the identification of patients who are more prone to develop myocardial dysfunction and cardiac events during follow-up. In these patients, the use of an angiotensin-converting enzyme inhibitor such as enalapril has shown to be effective in improving clinical outcome, giving the chance for a cardioprotective strategy in a selected population. Once left ventricular dysfunction occurs, heart failure therapies currently used for other forms of left ventricular dysfunction, particularly angiotensin-converting enzyme inhibitors and β-blockers, seem to be effective. However, their use in cancer patients is still undervalued.
心脏毒性是传统和新型抗癌治疗常见且严重的不良反应，影响患者的生存和生活质量。癌症治疗期间心脏监测的当前标准主要基于左心室射血分数评估，仅在功能损害已经发生时才能检测到心肌损伤，无法采取早期预防策略。心脏特异性生物标志物的测量已被证明比成像方式具有更高的预后价值。特别是化疗期间心肌肌钙蛋白升高可识别出在随访期间更容易发生心肌功能障碍和心脏事件的患者。在这些患者中，使用血管紧张素转换酶抑制剂如依那普利已显示出可有效改善临床结局，为特定人群提供了心脏保护策略的机会。一旦发生左心室功能障碍，目前用于其他形式左心室功能障碍的心力衰竭治疗方法，特别是血管紧张素转换酶抑制剂和β受体阻滞剂，似乎是有效的。然而，它们在癌症患者中的应用仍未得到充分重视。
