Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey,
Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey.
Oncol Res Treat. 2019;42(7-8):375-381. doi: 10.1159/000500439. Epub 2019 May 27.
It is known that chemotherapeutic agents cause myocardial cell damage leading to left ventricular dysfunction and heart failure. Fragmented QRS is an indication of fibrosis developing as a result of myocardial cell damage. The aim of this study is to assess whether there is a relationship between the chemotherapeutic treatment and the development of the fragmented QRS complex in electrocardiography (ECG).
Among 130 patients who were diagnosed with non-Hodgkin lymphoma and received an R-CHOP treatment regimen, the potential emergence of fragmented QRS on ECG as well as the changes in the left ventricular ejection fraction (LVEF) (on transthoracic echocardiography) in response to various chemotherapeutic regimens were sought.
New development of a fragmented QRS pattern was observed in 53 of the 130 patients (40.8%). These patients were found to have lower LVEF values along with higher numbers of chemotherapy courses and cumulative doses. In the logistic regression analysis, age (OR = 1.042; 95% CI 1.009-1.076; p = 0.012) and number of courses (OR = 1.848; 95% CI 1.409-2.423; p < 0.001) were found to be the most important predictors of fragmented QRS development. In subjects with a fragmented QRS pattern, there was a significant difference between the initial and repeat LVEF values (p < 0.001). Importantly the emergence of a fragmentation pattern occurred much earlier compared to the drop in LVEF values (10.62 ± 4.04 vs. 15.24 ± 7.49 months).
Development of a fragmented QRS pattern in response to cancer therapy emerges as a new parameter potentially predictive of chemotherapy-induced cardiotoxicity.
已知化疗药物会导致心肌细胞损伤，从而导致左心室功能障碍和心力衰竭。碎裂 QRS 是心肌细胞损伤导致纤维化发展的指标。本研究旨在评估心电图（ECG）中碎裂 QRS 复合物的发展是否与化疗治疗有关。
在 130 名被诊断患有非霍奇金淋巴瘤并接受 R-CHOP 治疗方案的患者中，寻找潜在的 ECG 上出现碎裂 QRS 以及左心室射血分数（LVEF）（经胸超声心动图）的变化与各种化疗方案的关系。
在 130 名患者中，有 53 名（40.8%）出现新的碎裂 QRS 模式。这些患者的 LVEF 值较低，化疗疗程和累积剂量较高。在逻辑回归分析中，年龄（OR = 1.042；95%CI 1.009-1.076；p = 0.012）和疗程数（OR = 1.848；95%CI 1.409-2.423；p < 0.001）被发现是碎裂 QRS 发展的最重要预测因素。在存在碎裂 QRS 模式的患者中，初始 LVEF 值和重复 LVEF 值之间存在显著差异（p < 0.001）。重要的是，碎裂模式的出现早于 LVEF 值的下降（10.62 ± 4.04 与 15.24 ± 7.49 个月）。
癌症治疗引起的碎裂 QRS 模式的发展是一个新的潜在预测化疗引起的心脏毒性的参数。
