Fei Hong-Wen, Ali Mohammed T, Tan Timothy C, Cheng Kai-Hung, Salama Laura, Hua Lanqi, Zeng Xin, Halpern Elkan F, Taghian Alphonse, MacDonald Shannon M, Scherrer-Crosbie Marielle
Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Adult Echocardiography, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
Echocardiography. 2016 Apr;33(4):519-26. doi: 10.1111/echo.13168. Epub 2016 Mar 16.
The combination of anthracyclines (AC) and trastuzumab (TRZ) is highly effective in patients with aggressive HER-2 + breast cancer, but has a significant risk of cardiotoxicity (CT). Trastuzumab-induced CT may be reversible. The aim of this study was to identify echocardiographic parameters associated with recovery of left ventricular ejection fraction (LVEF) in patients who developed CT after AC and TRZ treatment.
Women with newly diagnosed breast cancer treated with AC followed by TRZ and monitored with serial echocardiograms were retrospectively studied. Left ventricular end-diastolic and systolic volumes, LVEF, and global longitudinal strain (GLS) were examined. Development and reversibility of CT were defined based on changes in LVEF according to the 2014 ASE/EACVI recommendations. Cox analysis was used to determine the association of echocardiographic variables with the subsequent development and reversibility of CT. Ninety-five patients underwent 5 echocardiograms or more in a 17-month (13-28 months) follow-up period. Nineteen patients (20%) developed CT. Left ventricular volumes, LVEF, and GLS measured after AC completion identified the subsequent development of CT. Of the 19 patients with CT, the LVEF partially or fully recovered in 13 (68%). GLS at the time of CT diagnosis was associated with subsequent recovery of LVEF (P = 0.004).
In patients with breast cancer treated with AC and TRZ who develop CT, GLS at the time of CT diagnosis is associated with subsequent recovery of LVEF and may be useful for risk stratification and to guide treatment.
蒽环类药物（AC）与曲妥珠单抗（TRZ）联合使用对侵袭性HER-2+乳腺癌患者疗效显著，但有显著的心脏毒性（CT）风险。曲妥珠单抗所致的CT可能是可逆的。本研究旨在确定接受AC和TRZ治疗后发生CT的患者左心室射血分数（LVEF）恢复相关的超声心动图参数。
对新诊断的乳腺癌女性患者进行回顾性研究，这些患者先接受AC治疗，随后接受TRZ治疗，并通过系列超声心动图进行监测。检查左心室舒张末期和收缩末期容积、LVEF和整体纵向应变（GLS）。根据2014年美国超声心动图学会/欧洲心血管影像学会的建议，基于LVEF的变化定义CT的发生和可逆性。采用Cox分析确定超声心动图变量与CT后续发生及可逆性之间的关联。95例患者在17个月（13 - 28个月）的随访期内接受了5次或更多次超声心动图检查。19例患者（20%）发生CT。AC治疗完成后测量的左心室容积、LVEF和GLS可确定CT的后续发生情况。在19例发生CT的患者中，13例（68%）的LVEF部分或完全恢复。CT诊断时的GLS与LVEF的后续恢复相关（P = 0.004）。
在接受AC和TRZ治疗且发生CT的乳腺癌患者中，CT诊断时的GLS与LVEF的后续恢复相关，可能有助于风险分层和指导治疗。
