Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women's College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.
J Clin Oncol. 2018 Oct 20;36(30):2980-2987. doi: 10.1200/JCO.2018.77.9736. Epub 2018 May 23.
To assess prechemotherapy cardiac imaging practices in relation to patients' heart failure (HF) risk.
We performed a population-based retrospective cohort study of women receiving chemotherapy for early-stage breast cancer in Ontario between 2007 and 2012. We surveyed for baseline cardiac imaging 6 months before chemotherapy or within 30 days thereafter. The proportion of patients who underwent imaging and cumulative incidence of major adverse cardiac event (MACE) rates was determined based on chemotherapy regimen and HF risk factors. Logistic regression was used to assess predictors of pretreatment cardiac imaging.
We studied 18,444 women who had been treated with chemotherapy (median age, 55 years). There was near-universal imaging of women treated with trastuzumab-containing regimens, including those without additional HF risk factors. Women who received anthracyclines without trastuzumab underwent imaging more frequently if they had additional HF risk factors (73.3% 62.6%; < .001). The 5-year incidence of MACE was two to six times higher in patients with HF risk factors across all treatment regimens. Patients with HF risk factors who received anthracyclines without trastuzumab had a higher 5-year incidence of MACE (4.5%) than patients without HF risk factors who received trastuzumab without anthracyclines (2.6%). However, cardiac imaging was less frequent in the former group (73.3% 93.6%; < .001). Logistic regression indicated that most variation in baseline imaging was related to chemotherapy, followed by physician-level factors. The odds of imaging were doubled with female physicians. Patient-specific factors, including HF risk factors, made minimal contribution to variation in imaging.
Baseline cardiac imaging was driven by chemotherapy regimen rather than HF risk. This risk-imaging mismatch is an impetus to reconsider current cardiac imaging practices in patients who receive chemotherapy for breast cancer.
评估化疗前心脏影像学检查与心力衰竭（HF）风险患者的相关性。
我们对 2007 年至 2012 年期间在安大略省接受化疗的早期乳腺癌女性患者进行了一项基于人群的回顾性队列研究。我们在化疗前 6 个月或之后 30 天内调查了基线心脏影像学检查情况。根据化疗方案和 HF 危险因素，确定了进行影像学检查的患者比例和主要不良心脏事件（MACE）发生率的累积发生率。Logistic 回归用于评估预处理心脏影像学检查的预测因素。
我们研究了 18444 名接受过化疗的女性（中位年龄 55 岁）。接受曲妥珠单抗联合化疗方案的女性几乎都进行了影像学检查，包括无其他 HF 危险因素的女性。未接受曲妥珠单抗但接受蒽环类药物化疗的女性，如果有其他 HF 危险因素，则更频繁地进行影像学检查（73.3% 比 62.6%；<0.001）。在所有治疗方案中，有 HF 危险因素的患者的 MACE 发生率在 5 年内是没有 HF 危险因素的患者的 2 至 6 倍。未接受曲妥珠单抗但接受蒽环类药物化疗且有 HF 危险因素的患者 5 年 MACE 发生率（4.5%）高于无 HF 危险因素且未接受蒽环类药物化疗的患者（2.6%）。然而，前者进行心脏影像学检查的频率较低（73.3% 比 93.6%；<0.001）。Logistic 回归表明，基线影像学检查的大部分差异与化疗有关，其次是医生层面的因素。女性医生的检查几率增加了一倍。患者特定因素，包括 HF 危险因素，对影像学检查的差异贡献最小。
基线心脏影像学检查主要受化疗方案驱动，而非 HF 风险。这种风险-影像学不匹配促使我们重新考虑接受乳腺癌化疗的患者目前的心脏影像学检查实践。
