Grover S, Lou P W, Bradbrook C, Cheong K, Kotasek D, Leong D P, Koczwara B, Selvanayagam J B
Cardiology Department, Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders Cardiac Cardiovascular Magnetic Resonance Department, Flinders Medical Centre, Adelaide, South Australia, Australia; Health Sciences, Flinders University, Adelaide, South Australia, Australia; Heart Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Intern Med J. 2015 Feb;45(2):140-7. doi: 10.1111/imj.12645.
Anthracyclines and trastuzumab are well recognised to cause cardiac toxicity. Further to their effects on left ventricular (LV) function, anthracyclines in particular are considered to cause negative arterial remodelling. Whether these changes reverse is unknown. In addition, whether trastuzumab causes specific effects on arterial remodelling is yet undetermined.
Patients receiving these agents for treatment of breast cancer and healthy volunteers prospectively underwent clinical evaluation and cardiovascular magnetic resonance (CMR) imaging at baseline, 1, 4 and 14 months post-therapy, including functional assessment, measurement of aortic pulse wave velocity (PWV) using velocity encoded imaging and distensibility at ascending aorta (AA) and proximal descending aorta (PDA).
Twenty-nine patients pretherapy and 12 volunteers demonstrated no differences in PWV, distensibility and LV function. Among cancer subjects, PWV increased acutely, P = 0.002 (4 months), then decreased by 14 months (P < 0.001). In addition, a decrease was observed in distensibility at the AA within 1 (P = 0.001) and 4 months (P < 0.001) of commencing therapy. At the PDA, only significant reduction was observed at 14 month distensibility when compared with baseline, P < 0.001. Patients with anthracycline exposure only had a greater reduction in aortic distensibility in the AA with time, P = 0.005 at 1 month, P < 0.001 at 4 months and P = 0.009 at 14 months.
Acute changes are observed in PWV and distensibility at the AA following contemporary breast cancer chemotherapy and partially reverse a year after therapy is discontinued, with more severe effects seen with anthracyclines.
蒽环类药物和曲妥珠单抗被公认为会引起心脏毒性。除了对左心室（LV）功能的影响外，蒽环类药物尤其被认为会导致动脉重塑不良。这些变化是否会逆转尚不清楚。此外，曲妥珠单抗是否对动脉重塑有特定影响尚未确定。
接受这些药物治疗乳腺癌的患者和健康志愿者在基线、治疗后1个月、4个月和14个月前瞻性地接受了临床评估和心血管磁共振（CMR）成像，包括功能评估、使用速度编码成像测量主动脉脉搏波速度（PWV）以及升主动脉（AA）和近端降主动脉（PDA）的扩张性。
29例治疗前患者和12名志愿者在PWV、扩张性和LV功能方面无差异。在癌症患者中，PWV急性升高，P = 0.002（4个月），然后在14个月时下降（P < 0.001）。此外，在开始治疗后1个月（P = 0.001）和4个月（P < 0.001）观察到AA处的扩张性降低。在PDA处，与基线相比，仅在14个月时扩张性有显著降低，P < 0.001。仅接受蒽环类药物治疗的患者随着时间的推移，AA处主动脉扩张性的降低更大，1个月时P = 0.005，4个月时P < 0.001，14个月时P = 0.009。
当代乳腺癌化疗后观察到AA处的PWV和扩张性出现急性变化，在停药一年后部分逆转，蒽环类药物的影响更严重。
