Bianchi L, Bertocchi C, Felci U, Ferrario G, Giani P, Mariani L, Medolago G, Sarti E
Ospedali Riuniti di Bergamo, Division di Oncologia.
Minerva Med. 1989 Mar;80(3):215-26.
To prevent delayed cardiomyopathy induced by adriamycin and subsequent severe congestive heart failure, a monitoring schedule with noninvasive techniques to measure cardiac performance (CPK-MB, electrocardiographic, systolic time intervals, echocardiography and quantitative radionuclide angiography) has been used. 15 patients, 33 to 65 years old, with metastatic breast carcinoma, previously treated with a polychemotherapy protocol not including adriamycin have been studied. Monitoring at 0 time allowed to exclude one patient with previous asymptomatic cardiomyopathy and to treat patients at risk with cardiovascular pathology, up to reach and even exceed the dosage of 550 mg/m2. Four of the treated patients showed positive findings of cardiomyopathy at different adriamycin dosage levels: 2 asymptomatic dilatative cardiomyopathies, 1 symptomatic and 1 with congestive heart failure remitted with medical therapy. No patient died because of cardiovascular complications. The results obtained show that of all noninvasive techniques used, only quantitative radionuclide angiocardiography allowed, when employed following an adequate monitoring schedule, to detect reliable findings of moderate and reversible cardiomyopathy thus indicating the appropriate time for drug discontinuation.
为预防阿霉素诱导的迟发性心肌病及随后发生的严重充血性心力衰竭，已采用了一种利用无创技术监测心脏功能的方案（肌酸磷酸激酶同工酶MB、心电图、收缩期时间间期、超声心动图和定量放射性核素血管造影）。研究了15例年龄在33至65岁之间的转移性乳腺癌患者，这些患者先前接受过不包括阿霉素的综合化疗方案治疗。在0时进行监测，得以排除1例先前患有无症状心肌病的患者，并对有心血管病变风险的患者进行治疗，直至达到甚至超过550 mg/m²的剂量。4例接受治疗的患者在不同阿霉素剂量水平下出现心肌病阳性表现：2例无症状扩张型心肌病，1例有症状，1例充血性心力衰竭经药物治疗缓解。没有患者因心血管并发症死亡。所获得的结果表明，在所有使用的无创技术中，只有定量放射性核素血管造影在按照适当的监测方案使用时，能够检测到中度和可逆性心肌病的可靠表现，从而表明停药的合适时机。
