Armenian Saro H, Hudson Melissa M, Mulder Renee L, Chen Ming Hui, Constine Louis S, Dwyer Mary, Nathan Paul C, Tissing Wim J E, Shankar Sadhna, Sieswerda Elske, Skinner Rod, Steinberger Julia, van Dalen Elvira C, van der Pal Helena, Wallace W Hamish, Levitt Gill, Kremer Leontien C M
Department of Population Sciences, City of Hope, Duarte, USA.
Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Lancet Oncol. 2015 Mar;16(3):e123-36. doi: 10.1016/S1470-2045(14)70409-7.
Survivors of childhood cancer treated with anthracycline chemotherapy or chest radiation are at an increased risk of developing congestive heart failure. In this population, congestive heart failure is well recognised as a progressive disorder, with a variable period of asymptomatic cardiomyopathy that precedes signs and symptoms. As a result, several clinical practice guidelines have been developed independently to help with detection and treatment of asymptomatic cardiomyopathy. These guidelines differ with regards to definitions of at-risk populations, surveillance modality and frequency, and recommendations for interventions. Differences between these guidelines could hinder the effective implementation of these recommendations. We report on the results of an international collaboration to harmonise existing cardiomyopathy surveillance recommendations using an evidence-based approach that relied on standardised definitions for outcomes of interest and transparent presentation of the quality of the evidence. The resultant recommendations were graded according to the quality of the evidence and the potential benefit gained from early detection and intervention.
接受蒽环类化疗或胸部放疗的儿童癌症幸存者发生充血性心力衰竭的风险增加。在这一人群中，充血性心力衰竭被公认为是一种进行性疾病，在出现体征和症状之前有一段无症状心肌病的可变时期。因此，已经独立制定了几项临床实践指南，以帮助检测和治疗无症状心肌病。这些指南在高危人群的定义、监测方式和频率以及干预建议方面存在差异。这些指南之间的差异可能会阻碍这些建议的有效实施。我们报告了一项国际合作的结果，该合作采用基于证据的方法来协调现有的心肌病监测建议，该方法依赖于对感兴趣的结果进行标准化定义，并透明地展示证据质量。由此产生的建议根据证据质量以及早期检测和干预所获得的潜在益处进行分级。
