Galderisi Maurizio, Esposito Roberta, Sorrentino Regina, Mura Lucia La, Santoro Ciro, Tufano Antonella
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
J Cardiovasc Echogr. 2020 Apr;30(Suppl 1):S33-S37. doi: 10.4103/jcecho.jcecho_8_19. Epub 2020 Apr 10.
Nonvalvular atrial fibrillation (AF) is a relatively frequent arrhythmia in cancer patients; it is possibly due to direct effect of cancer or consequence of cancer therapies. AF creates important problems for both therapeutic management and prognosis in cancer patients. The anticoagulation of cancer patients presenting AF is a main issue because of the difficult balance between thromboembolic and bleeding risks, both elevated in this clinical setting. A comprehensive echo Doppler examination is mandatory to identify the eventual sources of emboli in left atrial (LA) cavity, mainly the transesophageal echocardiography (TEE), but also to predict the subsequent development of heart failure. This evaluation is particularly important to graduate anticoagulation and to prevent and manage symptoms/signs of heart failure. The performance of a TEE precardioversion is highly encouraged to detect possible thrombi in LA appendage. A careful assessment of LA size (LA volume index) and function (LA emptying fraction and/or LA strain) should always be planned to predict the possible recurrence of AF paroxysmal episodes. This is in fact a key action, not only from the cardiologic point of view but also for the oncologic perspectives in individual situations. Patients with larger left atrium and more impaired LA function should be addressed toward a less aggressive cancer treatment, with drugs which are not associated or are poorly related with the risk of AF development. A correct and comprehensive echocardiographic assessment could even induce the oncologist to change the cancer management balancing the oncologic and the cardiac risk.
非瓣膜性心房颤动（AF）在癌症患者中是一种相对常见的心律失常；这可能是由于癌症的直接影响或癌症治疗的后果。AF给癌症患者的治疗管理和预后都带来了重要问题。由于在这种临床情况下血栓栓塞风险和出血风险都升高，且难以平衡，因此癌症合并AF患者的抗凝治疗是一个主要问题。必须进行全面的超声心动图检查，以确定左心房（LA）腔内栓子的最终来源，主要是经食管超声心动图（TEE），同时也用于预测心力衰竭的后续发展。这种评估对于调整抗凝治疗以及预防和管理心力衰竭的症状/体征尤为重要。强烈建议在心脏复律前进行TEE检查，以检测左心耳可能存在的血栓。应始终计划仔细评估LA大小（LA容积指数）和功能（LA排空分数和/或LA应变），以预测AF阵发性发作的可能复发。事实上，这不仅从心脏病学角度来看是一项关键措施，从个体情况下的肿瘤学角度来看也是如此。左心房较大且LA功能受损更严重的患者，应采用与AF发生风险无关或相关性较小的药物，进行不太积极的癌症治疗。正确而全面的超声心动图评估甚至可能促使肿瘤学家在权衡肿瘤学和心脏风险后改变癌症治疗方案。
