Cardinale Daniela, Iacopo Fabiani, Cipolla Carlo Maria
Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy.
Cardiology Division, European Institute of Oncology, IRCCS, Milan, Italy.
Front Cardiovasc Med. 2020 Mar 18;7:26. doi: 10.3389/fcvm.2020.00026. eCollection 2020.
Cardiotoxicity is a feared side effect that may limit the clinical use of anthracyclines. It may indeed affect the quality of life and survival of patients with cancer, regardless of oncological prognosis. This paper provides an overview of anthracycline-induced cardiotoxicity in terms of definition, classification, incidence, risk factors, possible mechanisms, diagnosis, and treatment. We also report effective strategies for preventing cardiotoxicity. In addition, we discuss limiting current approaches, the need for a new classification, and early cardiotoxicity detection and treatment. Probably, anthracycline-induced cardiotoxicity is a continuous phenomenon that starts from myocardial cell injury; it is followed by left ventricular ejection fraction (LVEF) and, if not diagnosed and cured early, progressively leads to symptomatic heart failure. Anthracycline-induced cardiotoxicity can be detected at a preclinical phase. The role of biomarkers, in particular troponins, in identifying subclinical cardiotoxicity and its therapy with angiotensin-converting enzyme inhibitors (mainly enalapril) to prevent LVEF reduction is a recognized and effective strategy. If cardiac dysfunction has already occurred, partial or complete LVEF recovery may still be obtained in case of early detection of cardiotoxicity and prompt heart failure treatment.
心脏毒性是一种令人担忧的副作用，可能会限制蒽环类药物的临床应用。它确实可能影响癌症患者的生活质量和生存率，而与肿瘤预后无关。本文从定义、分类、发病率、危险因素、可能机制、诊断和治疗等方面对蒽环类药物引起的心脏毒性进行了概述。我们还报告了预防心脏毒性的有效策略。此外，我们讨论了当前方法的局限性、新分类的必要性以及早期心脏毒性的检测和治疗。蒽环类药物引起的心脏毒性可能是一种从心肌细胞损伤开始的连续现象；随后是左心室射血分数（LVEF）下降，如果不及早诊断和治疗，会逐渐导致有症状的心衰。蒽环类药物引起的心脏毒性可在临床前阶段检测到。生物标志物，特别是肌钙蛋白，在识别亚临床心脏毒性以及用血管紧张素转换酶抑制剂（主要是依那普利）进行治疗以防止LVEF降低方面的作用是一种公认的有效策略。如果已经发生心脏功能障碍，在早期发现心脏毒性并及时治疗心力衰竭的情况下，仍可能部分或完全恢复LVEF。
