*Division of Cardiology, Department of Medicine, Augusta University/University of Georgia Medical Partnership, Athens, GA †Department of Radiology, Weill Cornell Medicine, New York, NY ‡Department of Diagnostic Imaging and Therapeutics, University of Connecticut School of Medicine §Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut School of Medicine, Farmington, CT ∥Division of Cardiology, UFCSPA (Universidade Federal de Ciências da Saúde de Porto Alegre), Porto Alegre, Brasil ¶Division of Cardiology, Medical University of South Carolina, Charleston, SC.
J Thorac Imaging. 2017 Nov;32(6):365-369. doi: 10.1097/RTI.0000000000000285.
The aim of this study was to assess the left ventricular (LV) remodeling response to chemotherapy in low-cardiac-risk women with newly diagnosed nonmetastatic breast cancer. Cardiotoxic effects of chemotherapy are an increasing concern. To effectively interpret cardiac imaging studies performed for screening purposes in patients undergoing cancer therapy it is necessary to understand the normal changes in structure and function that may occur.
Twenty women without preexisting cardiovascular disease, of a mean age of 50 years, newly diagnosed with nonmetastatic breast cancer and treated with anthracycline or trastuzumab, were prospectively enrolled and evaluated at four time points (at baseline, during chemotherapy, 2 weeks after chemotherapy, and 6 months after chemotherapy) using cardiac magnetic resonance imaging, blood samples, and a clinical questionnaire.
Over a 6-month period, the left ventricular ejection fraction (%) decreased (64.15±5.30 to 60.41±5.77, P<0.002) and the LV end-diastolic (mm) and end-systolic (mm) volumes increased (124.73±20.25 to 132.21±19.33, P<0.04 and 45.16±11.88 to 52.57±11.65, P<0.00, respectively). The LV mass (g) did not change (73.06±11.51 to 69.21±15.3, P=0.08), but the LV mass to LVEDV ratio (g/mm) decreased (0.594±0.098 to 0.530±0.124, P<0.04).
In low-cardiac-risk women with nonmetastatic breast cancer, the increased LV volume and a mildly decreased left ventricular ejection fraction during and after chemotherapy do not seem to be associated with laboratory or clinical evidence of increased risk for heart failure.
本研究旨在评估低心脏风险的新诊断为非转移性乳腺癌女性接受化疗后的左心室（LV）重构反应。化疗的心脏毒性作用越来越受到关注。为了有效地解释癌症治疗患者进行筛查目的的心脏成像研究，有必要了解可能发生的结构和功能的正常变化。
20 名无先前心血管疾病的女性，平均年龄 50 岁，新诊断为非转移性乳腺癌，接受蒽环类或曲妥珠单抗治疗，前瞻性入组，并在四个时间点（基线时、化疗期间、化疗后 2 周和化疗后 6 个月）使用心脏磁共振成像、血液样本和临床问卷进行评估。
在 6 个月的时间里，左心室射血分数（%）下降（64.15±5.30 至 60.41±5.77，P<0.002），左心室舒张末期（mm）和收缩末期（mm）容积增加（124.73±20.25 至 132.21±19.33，P<0.04 和 45.16±11.88 至 52.57±11.65，P<0.00，分别）。左心室质量（g）没有变化（73.06±11.51 至 69.21±15.3，P=0.08），但左心室质量与左心室舒张末期容积比（g/mm）下降（0.594±0.098 至 0.530±0.124，P<0.04）。
在非转移性乳腺癌的低心脏风险女性中，化疗期间和化疗后 LV 容积增加和轻度左心室射血分数下降似乎与心力衰竭风险增加的实验室或临床证据无关。
