Tadic Marijana, Cuspidi Cesare, Hering Dagmara, Venneri Lucia, Danylenko Oleksandr
Cardiology department, University Clinical Hospital Centre "Dr. Dragisa Misovic", Belgrade, Serbia.
Clinical Research Unit, University of Milan-Bicocca and Italian Institute for Auxology, Meda, Italy.
Clin Cardiol. 2017 Jul;40(7):437-443. doi: 10.1002/clc.22672. Epub 2017 Feb 13.
A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic.
Chemotherapy induces RV structural, functional, and mechanical changes.
We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab."
The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment.
Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.
在过去几十年的研究中发现了大量化疗引起的心血管并发症。这些研究大多聚焦于左心室（LV）重塑。本文旨在全面概述化疗引起右心室（RV）重塑的潜在机制，并总结关于该主题的临床研究。
化疗会引起右心室的结构、功能和力学变化。
我们在PubMed、MEDLINE、Ovid和Embase数据库中检索了1990年1月至2016年9月期间以英文发表的研究，使用了以下关键词：“化疗”、“心脏”、“右心室”、“蒽环类药物”和“曲妥珠单抗”。
现有研究表明，右心室重塑与左心室重塑同时发生，这就是为什么在对接受化疗的患者进行全面心脏评估时，尤其是那些涉及蒽环类药物和曲妥珠单抗的方案中，右心室重塑不应被忽视。调查显示，这些药物会对右心室的结构、功能和力学产生显著影响。这些药物会导致右心室心肌纤维化、右心室扩张、右心室收缩功能下降、舒张功能恶化，最终损害右心室力学（应变）。化疗引起右心室重塑的机制仍不完全清楚，但人们认为化疗对心肌的直接破坏作用、氧化应激、内皮功能障碍以及对肺循环的负面影响可能会显著导致右心室损害。
化疗通过不同的复杂机制导致右心室结构、功能和力学受损。
