Charbonnel Clément, Convers-Domart Raphaele, Rigaudeau Sophie, Taksin Anne Laure, Baron Nicolas, Lambert Juliette, Ghez Stéphanie, Georges Jean-Louis, Farhat Hassan, Lambert Jérôme, Rousselot Philippe, Livarek Bernard
Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France.
Eur Heart J Cardiovasc Imaging. 2017 Apr 1;18(4):392-401. doi: 10.1093/ehjci/jew223.
We sought to assess whether global longitudinal strain (GLS) measured early during treatment with anthracyclines (at a cumulative dose of 150 mg/m2) can predict subsequent alterations in left ventricular ejection fraction.
Eighty-six patients with Hodgkin's disease, non-Hodgkin's lymphoma, or acute leukaemia and receiving anthracyclines were prospectively included. Patients underwent complete echocardiography on four occasions: baseline (V1); after reaching a cumulative dose of 150 mg/m2 (V2); end of treatment (V3); and 1 year follow-up (V4). Six patients developed cardiotoxicity, defined as a decrease in left ventricular ejection fraction of >10 percentage points, to a value <53%, at V4. GLS measured at V1 and V2 was significantly lower in the cardiotoxicity group vs. the controls (P = 0.042 and P = 0.01, respectively). Compared with GLS at V1, GLS obtained at V2 provided incremental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver-operating-characteristic curve, 0.82). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95% confidence interval 33-100) and 97% (95% confidence interval 94-100), respectively.
GLS greater than -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is an independent predictor of future anthracycline-induced cardiotoxicity. These findings should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.
我们试图评估在蒽环类药物治疗早期（累积剂量达150mg/m²时）测量的整体纵向应变（GLS）是否能够预测随后左心室射血分数的变化。
前瞻性纳入了86例患有霍奇金病、非霍奇金淋巴瘤或急性白血病且正在接受蒽环类药物治疗的患者。患者在四个时间点接受完整的超声心动图检查：基线（V1）；累积剂量达到150mg/m²后（V2）；治疗结束时（V3）；以及1年随访时（V4）。6例患者发生心脏毒性，定义为在V4时左心室射血分数下降超过10个百分点，降至<53%。与对照组相比，心脏毒性组在V1和V2时测量的GLS显著更低（分别为P = 0.042和P = 0.01）。与V1时的GLS相比，V2时获得的GLS提供了额外的预测信息，并且似乎是心脏毒性的最强预测指标（受试者操作特征曲线下面积为0.82）。对于V2时测量的GLS，当阈值为-17.45%时，检测心脏毒性的敏感性和特异性分别为67%（95%置信区间33 - 100）和97%（95%置信区间94 - 100）。
在150mg/m²蒽环类药物治疗后获得的GLS大于-17.45%是未来蒽环类药物诱导的心脏毒性的独立预测指标。这些发现应鼓励医生在蒽环类药物治疗期间更早地进行超声心动图检查。
