Berliner Dominik, Beutel Gernot, Bauersachs Johann
Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Dept. of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
Herz. 2020 Nov;45(7):637-644. doi: 10.1007/s00059-020-04957-5.
As a result of better treatment options for malignant cancer, the cardiovascular side effects of such therapies have increasingly come into focus in recent years. The new cardiological subspecialty of oncocardiology is developing strategies to prevent and/or detect those effects early in order to treat them in a timely and adequate manner. The diagnosis of cardiotoxic effects is based mainly on imaging and specific biomarkers. Echocardiography has become the main imaging technique due to its wide availability. In addition to quantitative determination of left ventricular function using two-dimensional methods, three-dimensional methods offer better precision and less variability in the detection of cardiac dysfunction. Furthermore, the analysis of the global longitudinal strain (GLS) reveals even subtle changes in left ventricular function and thus detects very early damage before left ventricular ejection fraction drops. Various biomarkers have been tested recently for their potential to detect cardiotoxicity. Cardiac troponins are currently the best investigated biomarkers and certainly have the highest impact. Due to contradicting results, the importance of natriuretic peptides has not yet been conclusively clarified. Results for myeloperoxidase are promising, as are the results for circulating microRNAs, which still mainly derive from experimental data. In this context, further studies still need to show the value of these in everyday clinical practice.
由于恶性肿瘤的治疗选择有所改善，近年来此类疗法的心血管副作用日益受到关注。肿瘤心脏病学这一新兴的心脏病学亚专业正在制定策略，以便早期预防和/或检测这些副作用，从而及时、充分地进行治疗。心脏毒性作用的诊断主要基于影像学检查和特定的生物标志物。超声心动图因其广泛应用而成为主要的影像学技术。除了使用二维方法定量测定左心室功能外，三维方法在检测心脏功能障碍方面具有更高的精度和更小的变异性。此外，整体纵向应变（GLS）分析能够揭示左心室功能的细微变化，从而在左心室射血分数下降之前检测到非常早期的损伤。最近对各种生物标志物检测心脏毒性的潜力进行了测试。心肌肌钙蛋白是目前研究最多的生物标志物，其影响也最大。由于结果相互矛盾，利钠肽的重要性尚未得到最终明确。髓过氧化物酶的结果很有前景，循环微小RNA的结果也是如此，不过这些结果目前仍主要来自实验数据。在这种情况下，进一步的研究仍需证明这些在日常临床实践中的价值。
