Shigemitsu Sachie, Takahashi Ken, Yazaki Kana, Kobayashi Maki, Yamada Mariko, Akimoto Katsumi, Tamaichi Hiroyuki, Fujimura Junya, Saito Masahiro, Nii Masaki, Itatani Keiichi, Shimizu Toshiaki
Department of Pediatrics, Faculty of Medicine, Juntendo University, 3-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Pediatrics, Kawasaki Kyodo Hospital, 2-1-5 Sakuramoto, Kawasaki-ku, Kawasaki-city, Kanagawa, 210-0833, Japan.
Heart Vessels. 2019 Jun;34(6):992-1001. doi: 10.1007/s00380-018-01332-7. Epub 2019 Jan 23.
Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in survivors of childhood cancer. The intraventricular pressure gradient (IVPG) of the left ventricle (LV) is the suction force of blood from the left atrium to the LV apex during early diastole and is a sensitive indicator of diastolic function. We assessed IVPG as a new indicator of the cardiac dysfunction in survivors of childhood cancer after anthracycline therapy. We performed a prospective echocardiographic study on 40 survivors of childhood cancer aged 6-26 years who received anthracycline therapy (group A) and 53 similar-age normal controls (group N). The subjects were divided into the younger groups, N1 and A1 (age < 16 years); older groups, N2 and A2 (age ≥ 16 years). IVPG was calculated using color M-mode Doppler imaging of the mitral inflow using Euler's equation. Total IVPG was divided into the basal and mid-to-apical IVPG to demonstrate more clearly the mechanisms of the LV diastolic suction force. The total anthracycline dose was 16.2-600.0 mg/m (median 143.5 mg/m). Total IVPG significantly decreased in group A2 compared with that in group N2 (0.39 ± 0.07 vs. 0.29 ± 0.11 mmHg/cm; p = 0.010). The mid-to-apical IVPG significantly decreased in groups A1 and A2 compared with that in groups N1 and N2, respectively (N1 vs. A1: 0.20 ± 0.05 vs. 0.16 ± 0.05 mmHg/cm, p = 0.036; N2 vs. A2: 0.21 ± 0.06 vs. 0.14 ± 0.06 mmHg/cm, p = 0.001). Basal IVPG, E wave, and E/e' were not significantly different between patients and normal controls. The total and mid-to-apical IVPG, especially mid-to-apical IVPG, could be sensitive new indicators in survivors of childhood cancer after anthracycline therapy.
蒽环类化疗药物导致的心脏毒性引起的心脏功能障碍是儿童癌症幸存者发病和死亡的主要原因。左心室内压力梯度(IVPG)是舒张早期血液从左心房抽吸至左心室心尖的吸力,是舒张功能的敏感指标。我们评估IVPG作为蒽环类药物治疗后儿童癌症幸存者心脏功能障碍的新指标。我们对40名接受蒽环类药物治疗的6 - 26岁儿童癌症幸存者(A组)和53名年龄相仿的正常对照者(N组)进行了前瞻性超声心动图研究。受试者分为较年轻组,N1和A1(年龄<16岁);较年长组,N2和A2(年龄≥16岁)。使用二尖瓣流入的彩色M型多普勒成像并依据欧拉方程计算IVPG。将总IVPG分为基部IVPG和中至心尖部IVPG,以更清楚地展示左心室舒张期吸力的机制。蒽环类药物的总剂量为16.2 - 600.0mg/m²(中位值143.5mg/m²)。与N2组相比,A2组的总IVPG显著降低(0.39±0.07 vs. 0.29±0.11mmHg/cm;p = 0.010)。与N1组和N2组相比,A1组和A2组的中至心尖部IVPG分别显著降低(N1组 vs. A1组:0.20±0.05 vs. 0.16±0.05mmHg/cm,p = 0.036;N2组 vs. A2组:0.21±0.06 vs. 0.14±0.06mmHg/cm,p = 0.001)。患者组和正常对照组之间的基部IVPG、E波和E/e'无显著差异。总IVPG和中至心尖部IVPG,尤其是中至心尖部IVPG,可能是蒽环类药物治疗后儿童癌症幸存者心脏功能障碍的敏感新指标。