Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Int J Cardiol. 2021 Jan 15;323:126-132. doi: 10.1016/j.ijcard.2020.08.019. Epub 2020 Aug 13.
Hypertension is considered an important risk factors for cancer therapeutics-related cardiac dysfunction (CTRCD) as well as heart failure. However, the impact of hypertension and left ventricular (LV) hypertrophy (LVH), which is associated with hypertension, on LV function in patients treated with anthracycline chemotherapy for malignant lymphoma remains uncertain.
We studied 92 patients with malignant lymphoma and with preserved LV ejection fraction (LVEF). Echocardiography was performed before and two-month after anthracycline chemotherapy. CTRCD was defined as the presence of an absolute decrease in LVEF ≥10% to a final value <53%. LVH was defined as concentric hypertrophy, which was determined as relative wall thickness ≥ 0.42 and LV mass index >95 g/m for females and > 115 g/m for males.
Relative decrease in LVEF after anthracycline chemotherapy in patients with hypertension (n = 23) was significantly higher than that in patients without hypertension (n = 69) (-5.8% [-9.4, -1.3]) vs. (-1.1% [-4.1, 2.5]); P = .005). Moreover, the prevalence of CTRCD in patients with hypertension tended to be higher than in those without hypertension (17% vs. 5%, p = .09). A sequential logistic model for predicting CTRCD, based on baseline clinical variables including major clinical risk factors, was improved by the addition of the complication of hypertension (P = .049), and further improved by the addition of the presence of LVH (P = .023).
Hypertension, especially when complicated by LVH, was found to be associated with LV dysfunction after anthracycline chemotherapy in patients with malignant lymphoma and preserved LVEF. Watchful observation or early therapeutic intervention may thus be needed for such patients by the addition of the presence of LVH.
高血压被认为是癌症治疗相关心脏功能障碍（CTRCD）以及心力衰竭的一个重要危险因素。然而，高血压以及与高血压相关的左心室（LV）肥大（LVH）对接受蒽环类化疗治疗恶性淋巴瘤患者的 LV 功能的影响仍不确定。
我们研究了 92 例左心室射血分数（LVEF）正常的恶性淋巴瘤患者。在接受蒽环类化疗前后 2 个月进行超声心动图检查。CTRCD 定义为 LVEF 绝对下降≥10%，最终值<53%。LVH 定义为向心性肥厚，相对室壁厚度≥0.42 和女性 LV 质量指数>95g/m，男性>115g/m。
高血压患者（n=23）接受蒽环类化疗后 LVEF 的相对下降明显高于无高血压患者（n=69）（-5.8%[-9.4, -1.3] vs. -1.1%[-4.1, 2.5]）；P=0.005）。此外，高血压患者的 CTRCD 发生率也高于无高血压患者（17% vs. 5%，p=0.09）。基于包括主要临床危险因素在内的基线临床变量的逐步逻辑模型预测 CTRCD，在加入高血压并发症后（P=0.049），预测能力得到改善，进一步加入 LVH 后（P=0.023），预测能力进一步提高。
高血压，特别是合并 LVH 时，与恶性淋巴瘤患者接受蒽环类化疗后 LV 功能障碍有关。对于此类患者，在 LVH 存在的情况下，可能需要密切观察或早期治疗干预。
