Di Lisi Daniela, Leggio Giuseppe, Vitale Giuseppe, Arrotti Salvatore, Iacona Rosanna, Inciardi Riccardo Maria, Nobile Domenico, Bonura Francesca, Novo Giuseppina, Russo Antonio, Novo Salvatore
aDepartment of Biomedicine, Internal Medicine and Specialities (DIBIMIS), Division of Cardiology bDivision of Oncology, University Hospital 'P.Giaccone', University of Palermo, Palermo, Italy.
J Cardiovasc Med (Hagerstown). 2016 Apr;17(4):270-5. doi: 10.2459/JCM.0000000000000232.
Chemotherapy cardiotoxicity is an emerging problem and it is very important to prevent cardiac dysfunction caused by anticancer drugs. The aim of this study was to assess the alterations of the cardiac function induced by chemotherapy in a follow-up of 2 years and to evaluate the cardioprotective role of angiotensin-converting enzyme inhibitors (ACEIs) in the prevention of cardiac dysfunction.
A prospective study was carried out using patients with breast cancer (85 women; median age 57 ± 12 years) and other inclusion and exclusion criteria. On the basis of treatment, patients were divided into six groups: fluorouracil-epirubicincyclophosphamide, FEC (group A); FEC and trastuzumab (B); trastuzumab (C); FEC and taxotere (D); FEC, paclitaxel and trastuzumab (E); and chemotherapy and cardioprotective drugs (F). Cardiological evaluation including electrocardiogram and conventional echocardiogram with tissue Doppler imaging (TDI) was carried out at T0 (before starting chemotherapy), T1 (after 6 months from the start of chemotherapy) and T2 (2 years after the end of chemotherapy).
Significant changes in the TDI parameters of systolic and diastolic function were observed at T1 and T2 in all patients. A significant reduction of left ventricular ejection fraction (LVEF) was observed only at T2. In the patients treated with ACEI (F), these changes were less significant than in other groups and they do not have significant changes in the indices of diastolic function.
TDI is more sensitive than conventional echocardiogram in the early diagnosis of cardiac dysfunction and ACEIs seem to have an important role in the prevention of cardiotoxicity.
化疗心脏毒性是一个新出现的问题，预防抗癌药物引起的心脏功能障碍非常重要。本研究的目的是在2年的随访中评估化疗引起的心脏功能改变，并评估血管紧张素转换酶抑制剂（ACEI）在预防心脏功能障碍中的心脏保护作用。
对符合纳入和排除标准的乳腺癌患者（85名女性；中位年龄57±12岁）进行了一项前瞻性研究。根据治疗方法，患者被分为六组：氟尿嘧啶-表柔比星-环磷酰胺（FEC）组（A组）；FEC联合曲妥珠单抗组（B组）；曲妥珠单抗组（C组）；FEC联合多西他赛组（D组）；FEC、紫杉醇联合曲妥珠单抗组（E组）；化疗联合心脏保护药物组（F组）。在T0（化疗开始前）、T1（化疗开始后6个月）和T2（化疗结束后2年）进行包括心电图和带有组织多普勒成像（TDI）的传统超声心动图在内的心脏评估。
所有患者在T1和T2时观察到收缩和舒张功能的TDI参数有显著变化。仅在T2时观察到左心室射血分数（LVEF）显著降低。在接受ACEI治疗的患者（F组）中，这些变化比其他组不那么显著，并且舒张功能指标没有显著变化。
TDI在心脏功能障碍的早期诊断中比传统超声心动图更敏感，并且ACEI似乎在预防心脏毒性方面具有重要作用。
