Markman Timothy M, Ruble Kathryn, Loeb David, Chen Allen, Zhang Yiyi, Beasley Gary S, Thompson W Reid, Nazarian Saman
Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26556. Epub 2017 Apr 28.
Anthracycline use is limited by cardiotoxicity, including arrhythmias and left ventricular (LV) dysfunction. We aim to characterize the association between electrophysiological changes and LV dysfunction.
A retrospective chart review was conducted, including all 147 pediatric cancer survivors at our institution over 18 years of age and treated with an anthracycline. One hundred thirty-four patients who had at least one electrocardiogram (ECG) and echocardiogram were analyzed. The association between dysfunction and baseline characteristics, treatment history, and electrocardigraphic parameters were analyzed using multivariable logistic regression. Additionally, a longitudinal generalized estimating equation (GEE) model was used to examine the temporal association between repeated measure corrected QT (QTc) intervals and subsequent LV function.
In our population, 24% of patients had LV dysfunction. The initial posttreatment QTc interval was longer in patients with LV dysfunction (438 ± 35 vs. 420 ± 20 msec, P = 0.002). In logistic regression analysis, QTc interval (P < 0.001) and cumulative radiation dose (P = 0.027) were associated with LV dysfunction. On ECGs performed prior to evidence of LV dysfunction, the QTc was longer than on ECGs preceding a normal echocardiogram (451 ± 32 msec vs. 423 ± 25 msec, P < 0.001). Mean time from QTc ≥ 450 msec to evidence of LV dysfunction was 1.8 ± 2.9 years. In the longitudinal GEE model, QTc prolongation was associated with subsequent decreased fractional shortening.
Among adult survivors of pediatric cancer treated with anthracyclines, prolongation of the QTc interval was associated with subsequent LV dysfunction.
蒽环类药物的使用受到心脏毒性的限制，包括心律失常和左心室（LV）功能障碍。我们旨在描述电生理变化与左心室功能障碍之间的关联。
进行了一项回顾性病历审查，纳入了我院所有18岁以上接受蒽环类药物治疗的147名儿科癌症幸存者。分析了134名至少有一份心电图（ECG）和超声心动图的患者。使用多变量逻辑回归分析功能障碍与基线特征、治疗史和心电图参数之间的关联。此外，使用纵向广义估计方程（GEE）模型来检验重复测量校正QT（QTc）间期与随后左心室功能之间的时间关联。
在我们的研究人群中，24%的患者存在左心室功能障碍。左心室功能障碍患者的初始治疗后QTc间期更长（438±35 vs. 420±20毫秒，P = 0.002）。在逻辑回归分析中，QTc间期（P < 0.001）和累积辐射剂量（P = 0.027）与左心室功能障碍相关。在出现左心室功能障碍证据之前进行的心电图上，QTc比正常超声心动图之前的心电图更长（451±32毫秒 vs. 423±25毫秒，P < 0.001）。从QTc≥450毫秒到出现左心室功能障碍的平均时间为1.8±2.9年。在纵向GEE模型中，QTc延长与随后的缩短分数降低相关。
在接受蒽环类药物治疗的儿科癌症成年幸存者中，QTc间期延长与随后的左心室功能障碍相关。
