Boczar Kevin Emery, Aseyev Olexiy, Sulpher Jeffrey, Johnson Christopher, Burwash Ian G, Turek Michele, Dent Susan, Dwivedi Girish
Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Department of Medicine (Oncology), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Echo Res Pract. 2016 Sep;3(3):79-84. doi: 10.1530/ERP-16-0020. Epub 2016 Jul 25.
Cardiotoxicity from anthracycline-based chemotherapy is an important cause of early and late morbidity and mortality in breast cancer patients. Left ventricular (LV) function is assessed for patients receiving anthracycline-based chemotherapy to identify cardiotoxicity. However, animal studies suggest that right ventricular (RV) function may be a more sensitive measure to detect LV dysfunction. The purpose of this pilot study was to determine if breast cancer patients undergoing anthracycline-based chemotherapy experience RV dysfunction.
Forty-nine breast cancer patients undergoing anthracycline-based chemotherapy at the Ottawa Hospital between November 2007 and March 2013 and who had 2 echocardiograms performed at least 3months apart were retrospectively identified. Right atrial area (RAA), right ventricular fractional area change (RV FAC) and RV longitudinal strain of the free wall (RV LSFW) were evaluated according to the American Society of Echocardiography guidelines.
The majority (48/49) of patients were females with an average age of 53.4 (95% CI: 50.1-56.7years). From baseline to follow-up study, average LV ejection fraction (LVEF) decreased from 62.22 (95% CI: 59.1-65.4) to 57.4% (95% CI: 54.0-60.9) (P=0.04). During the same time period, the mean RAA increased from 12.1cm(2) (95% CI: 11.1-13.0cm(2)) to 13.8cm(2) (95% CI: 12.7-14.9cm(2)) (P=0.02), mean RV FAC decreased (P=0.01) from 48.3% (95% CI: 44.8-51.74) to 42.1% (95% CI: 38.5-45.6%), and mean RV LSFW worsened from -16.2% (95% CI: -18.1 to -14.4%) to -13.81% (95% CI: -15.1 to -12.5%) (P=0.04).
This study demonstrates that breast cancer patients receiving anthracycline-based chemotherapy experience adverse effects on both right atrial size and RV function. Further studies are required to determine the impact of these adverse effects on right heart function and whether this represents an earlier marker of cardiotoxicity.
基于蒽环类药物的化疗所致心脏毒性是乳腺癌患者早期及晚期发病和死亡的重要原因。对于接受基于蒽环类药物化疗的患者，需评估左心室（LV）功能以识别心脏毒性。然而，动物研究表明右心室（RV）功能可能是检测左心室功能障碍更敏感的指标。本初步研究的目的是确定接受基于蒽环类药物化疗的乳腺癌患者是否会出现右心室功能障碍。
回顾性纳入2007年11月至2013年3月在渥太华医院接受基于蒽环类药物化疗且至少间隔3个月进行了2次超声心动图检查的49例乳腺癌患者。根据美国超声心动图学会指南评估右心房面积（RAA）、右心室面积变化分数（RV FAC）和右心室游离壁纵向应变（RV LSFW）。
大多数（48/49）患者为女性，平均年龄53.4岁（95%可信区间：50.1 - 56.7岁）。从基线到随访研究，平均左心室射血分数（LVEF）从62.22%（95%可信区间：59.1 - 65.4%）降至57.4%（95%可信区间：54.0 - 60.9%）（P = 0.04）。在同一时期，平均RAA从12.1cm²（95%可信区间：11.1 - 13.0cm²）增加至13.8cm²（95%可信区间：12.7 - 14.9cm²）（P = 0.02），平均RV FAC从48.3%（95%可信区间：44.8 - 51.74%）降至42.1%（95%可信区间：38.5 - 45.6%）（P = 0.01），平均RV LSFW从 - 16.2%（95%可信区间： - 18.1至 - 14.4%）恶化为 - 13.81%（95%可信区间： - 15.1至 - 12.5%）（P = 0.04）。
本研究表明，接受基于蒽环类药物化疗的乳腺癌患者右心房大小和右心室功能均受到不利影响。需要进一步研究以确定这些不利影响对右心功能的影响，以及这是否代表心脏毒性的早期标志物。
Zotero 插件