Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., PO Box 19024, Mailstop M4-C308, Seattle, WA 98109, USA.
Cardiovasc Res. 2019 Apr 15;115(5):922-934. doi: 10.1093/cvr/cvz031.
With 5-year survival of children with cancer exceeding 80% in developed countries, premature cardiovascular disease is now a major cause of early morbidity and mortality. In addition to the acute and chronic cardiotoxic effects of anthracyclines, related chemotherapeutics, and radiation, a growing number of new molecular targeted agents may also have detrimental effects on the cardiovascular system. Survivors of childhood cancer also may have earlier development of conventional cardiovascular risk factors such as hypertension, dyslipidaemia, and diabetes, which further increase their risk of serious cardiovascular disease. This review will examine the epidemiology of acute and chronic cardiotoxicity relevant to paediatric cancer patients, including genetic risk factors. We will also provide an overview of current screening recommendations, including the evidence regarding both imaging (e.g. echocardiography and magnetic resonance imaging) and blood-based biomarkers. Various primary and secondary prevention strategies will also be discussed, primarily in relation to anthracycline-related cardiomyopathy. Finally, we review the available evidence related to the management of systolic and diastolic dysfunction in paediatric cancer patients and childhood cancer survivors.
在发达国家，儿童癌症患者的 5 年生存率超过 80%，因此，过早发生心血管疾病已成为导致发病和死亡的主要原因。除蒽环类药物、相关化疗药物和放射治疗的急性和慢性心脏毒性作用外，越来越多的新型分子靶向药物也可能对心血管系统产生不良影响。儿童癌症幸存者可能更早出现高血压、血脂异常和糖尿病等传统心血管危险因素，这进一步增加了他们发生严重心血管疾病的风险。本文将探讨与儿科癌症患者相关的急性和慢性心脏毒性的流行病学，包括遗传危险因素。我们还将概述当前的筛查建议，包括关于影像学（如超声心动图和磁共振成像）和基于血液的生物标志物的证据。还将讨论各种一级和二级预防策略，主要与蒽环类相关的心肌病有关。最后，我们回顾了与儿科癌症患者和儿童癌症幸存者的收缩和舒张功能障碍的管理相关的现有证据。
