Department of Medicine, Division of Hematology and Oncology, Louisiana State University Health Science Center-Shreveport, Shreveport, Louisiana.
Department of Medicine, Division of Cardiology, Louisiana State University Health Science Center-Shreveport, Shreveport, Louisiana.
Breast J. 2019 Jan;25(1):62-68. doi: 10.1111/tbj.13182. Epub 2018 Dec 27.
Anthracycline-based chemotherapy is widely used in the management of breast cancer. Despite the lack of clinical evidence, obtaining prechemotherapy left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition scan is a widely adopted practice throughout the world. We present here the results of a retrospective analysis of breast cancer patients who had LVEF measurements in anticipation of an anthracycline chemotherapy to determine whether predefined cardiac risk factors predicted for poor cardiac function. Retrospective data were analyzed from 482 female breast cancer patients in whom LVEF was measured before starting anthracycline-based chemotherapy. Baseline demographics and multiple risk factors associated with congestive heart failure were collected. Twenty-six possible risk factors for CHF were defined, and the frequency of finding an abnormal LVEF as a function of total risk factors was assessed. Statistical tests include chi-squared and logistic regression analysis. The median age of the study population was 52 years. The original chemotherapy plan was changed in 7 patients (1.45%) based on LVEF findings, all of which had asymptomatic LV dysfunction (LVEF ranging 40%-50%). In 32 patients, despite normal LVEF results, anthracyclines were omitted secondary to prior cardiac issues. In 17 patients where LVEF was reported normal, anthracyclines were skipped based on patient's preference, tumor characteristics, or upstaging of the cancer based on imaging studies. No patient with ≤2 risk factors had an abnormal LVEF (N = 350). The probability of finding an abnormal LVEF in patients without any cardiac risk factors is extremely rare. Skipping baseline LVEF assessment may be an option in some patients with no cardiac risk factors undergoing anthracycline-based chemotherapy.
蒽环类药物化疗广泛用于乳腺癌的治疗。尽管缺乏临床证据，但在全世界范围内，通过超声心动图或多门采集扫描获得化疗前左心室射血分数（LVEF）仍然是一种广泛采用的做法。我们在此介绍了对接受蒽环类化疗的乳腺癌患者进行 LVEF 测量的回顾性分析结果，以确定预先确定的心脏危险因素是否预测心脏功能不良。从 482 名接受蒽环类药物化疗的女性乳腺癌患者中分析了回顾性数据，这些患者在开始蒽环类药物化疗前测量了 LVEF。收集了基线人口统计学数据和与充血性心力衰竭相关的多种危险因素。定义了 26 种可能导致 CHF 的危险因素，并评估了异常 LVEF 与总危险因素的关系。统计检验包括卡方检验和逻辑回归分析。研究人群的中位年龄为 52 岁。根据 LVEF 结果，有 7 名患者（1.45%）改变了最初的化疗计划，这些患者均存在无症状左心室功能障碍（LVEF 范围为 40%-50%）。尽管 LVEF 结果正常，但由于先前存在心脏问题，仍有 32 名患者放弃了蒽环类药物。在 17 名报告 LVEF 正常的患者中，由于患者的偏好、肿瘤特征或基于影像学研究的癌症分期升级，跳过了蒽环类药物。在≤2 个危险因素的患者中，没有一个患者的 LVEF 异常（N=350）。无任何心脏危险因素的患者出现异常 LVEF 的概率极小。在某些没有心脏危险因素的接受蒽环类药物化疗的患者中，跳过基线 LVEF 评估可能是一种选择。
