Rosa Gian Marco, Gigli Lorenzo, Tagliasacchi Maria Isabella, Di Iorio Cecilia, Carbone Federico, Nencioni Alessio, Montecucco Fabrizio, Brunelli Claudio
Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland.
Eur J Clin Invest. 2016 Mar;46(3):264-84. doi: 10.1111/eci.12589. Epub 2016 Jan 21.
Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques.
This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography.
Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal.
Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.
抗癌治疗显著改善了患者的预后，但不幸的是可能会受到心脏毒性的阻碍。已报道了心力衰竭的有症状和无症状临床形式，其可能是可逆的或不可逆的。本综述的目的是概述与心脏毒性相关的抗肿瘤药物以及现有的诊断技术。
本叙述性综述基于截至2015年11月来自MEDLINE和PUBMED的资料。我们查阅了抗肿瘤药物与心脏毒性，以及与超声心动图、肌钙蛋白、心脏磁共振和正电子发射断层扫描相关的术语。
据报道，蒽环类药物、单克隆抗体、氟嘧啶、紫杉烷、烷化剂、长春花生物碱可诱发心脏毒性的不同临床表现。胸部放疗也与各种形式的心脏损伤有关，这些损伤与其他病因的心脏病患者中发现的损伤难以区分，甚至可能在放疗后数年出现。在诊断技术中，超声心动图是一种无创、经济有效且广泛可用的成像工具。核成像和心脏磁共振可被使用，但不太广泛可用且操作更困难。最后，一些生物标志物，如肌钙蛋白，可用于评估心脏损伤，但确定肌钙蛋白评估的最佳时机仍不明确，确定阳性的临界值仍是一个重要目标。
抗癌治疗的心脏毒性与心力衰竭的发生有关。新型诊断工具可能有助于早期识别不可逆形式的心脏病。
