Conyers Rachel, Costello Ben, La Gerche Andre, Tripaydonis Anne, Burns Charlotte, Ludlow Louise, Lange Peter, Ekert Paul, Mechinaud Francoise, Cheung Michael, Martin Michelle, Elliot David
Children's Cancer Centre, The Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
The Baker IDI Institute, The Alfred Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2017 Oct;47(10):1166-1172. doi: 10.1111/imj.13481.
It has long been established that cardiotoxicity occurs as a result of exposure to certain chemotherapeutics, particularly anthracyclines. Historically, clinicians equate cardiotoxicity with a poor prognosis, in a small percentage of patients and deem long-term surveillance as optional. Emerging evidence suggests that anthracycline cardiotoxicity (ACT) is a life-long risk with an incidence approaching 20%.
To elucidate the incidence of anthracycline cardiotoxicity within a current paediatric oncology survivor cohort.
Participants were identified through the Haematology-Oncology database at the Royal Children's Hospital, Melbourne. Patients were identified from a retrospective audit of outpatient attendances between January 2008 and December 2015. Patients with a cancer diagnosis exposed to anthracyclines were eligible for the study. Patient demographics and echocardiogram findings were recorded with patients subcategorised according to degree of ACT. More significant ACT defined as fractional shortening (FS) <24% and less significant if FS 24-28% or a decline in baseline ejection fraction of >10%.
Two hundred and eighty-six of a total 481 identified patients were eligible for study inclusion. Twenty patients displayed significant ACT with FS <24%. Ten patients had a FS 24-28% and 25 patients with a decline in ejection fraction from baseline of >10%. Overall, 6.6% demonstrated significant cardiac complications, whilst 19.6 % demonstrated some degree of ACT and decline in myocardial function. When stratified for cumulative anthracycline dose, the incidence of severe cardiac dysfunction was 5.1% (<250 mg/m ) and 25% (>250 mg/m ) CONCLUSION: This study demonstrates, in keeping with modern literature, the higher incidence of anthracycline associated cardiac toxicity and a need for better surveillance and follow up.
长期以来已明确，接触某些化疗药物，尤其是蒽环类药物会导致心脏毒性。从历史上看，临床医生认为心脏毒性在一小部分患者中预示着预后不良，并将长期监测视为可选项。新出现的证据表明，蒽环类药物心脏毒性（ACT）是一种终身风险，发病率接近20%。
阐明当前儿科肿瘤幸存者队列中蒽环类药物心脏毒性的发生率。
通过墨尔本皇家儿童医院的血液肿瘤数据库确定参与者。从对2008年1月至2015年12月门诊就诊情况的回顾性审计中识别患者。确诊患有癌症且接触过蒽环类药物的患者符合研究条件。记录患者人口统计学资料和超声心动图检查结果，并根据ACT程度对患者进行分类。更严重的ACT定义为缩短分数（FS）<24%，若FS为24 - 28%或基线射血分数下降>10%则为不太严重的ACT。
在总共481名已识别的患者中，有286名符合研究纳入条件。20名患者表现出严重ACT，FS<24%。10名患者的FS为24 - 28%，25名患者的射血分数较基线下降>10%。总体而言，6.6%表现出严重心脏并发症，而19.6%表现出一定程度的ACT和心肌功能下降。按累积蒽环类药物剂量分层时，严重心脏功能障碍的发生率在<250 mg/m²时为5.1%，在>250 mg/m²时为25%。结论：本研究与现代文献一致，表明蒽环类药物相关心脏毒性的发生率较高，需要更好的监测和随访。
