Ayuna Ahmed, Abidin Nik
Salford Royal NHS Foundation Trust, Manchester, UK.
Egypt Heart J. 2020 Sep 11;72(1):59. doi: 10.1186/s43044-020-00090-0.
Anthracycline-induced cardiotoxicity has been classified based on its onset into acute, early, and late. It may have a significant burden on the quality and quantity of life of those exposed to this class of medication. Currently, there are several ongoing debates on the role of different measures in the primary prevention of cardiotoxicity in cancer survivors. Our article aims to focus on the role of neurohormonal blockers in the primary prevention of anthracycline-induced cardiotoxicity, whether it is acute, early, or late onset. PubMed and Google Scholar database were searched for the relevant articles; we reviewed and appraised 15 RCTs, and we found that angiotensin-converting enzyme inhibitors (ACEI) and B-blockers were the most commonly used agents. Angiotensin II receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) were used in a few other trials. The follow-up period was on the range of 1-156 weeks (mode 26 weeks). Left ventricular ejection fraction (LVEF), left ventricular diameters, and diastolic function were assessed by either echocardiogram or occasionally by cardiac magnetic resonance imaging (MRI). The occurrence of myocardial injury was assessed by troponin I. It was obvious that neurohormonal blockers reduced the occurrence of LVEF and myocardial injury in 14/15 RCTs.
Beta-blockers, especially carvedilol and ACEI, especially enalapril, should be considered for the primary prevention of acute- and early-onset cardiotoxicity. ARB and MRA are suitable alternatives when patients are intolerant to ACE-I and B-blockers. We recommend further studies to explore and establish the role of neurohormonal blockers in the primary prevention of the acute-, early-, and late-onset cardiotoxicity.
蒽环类药物引起的心脏毒性根据其发作时间可分为急性、早期和晚期。它可能会对接触这类药物的人的生活质量和数量产生重大负担。目前，关于不同措施在癌症幸存者心脏毒性一级预防中的作用存在一些持续的争论。我们的文章旨在关注神经激素阻滞剂在蒽环类药物引起的心脏毒性一级预防中的作用，无论其是急性、早期还是晚期发作。我们在PubMed和谷歌学术数据库中搜索了相关文章；我们回顾并评估了15项随机对照试验，发现血管紧张素转换酶抑制剂（ACEI）和β受体阻滞剂是最常用的药物。血管紧张素II受体阻滞剂（ARB）和盐皮质激素受体拮抗剂（MRA）在其他一些试验中使用。随访期为1至156周（中位数为26周）。通过超声心动图或偶尔通过心脏磁共振成像（MRI）评估左心室射血分数（LVEF）、左心室直径和舒张功能。通过肌钙蛋白I评估心肌损伤的发生情况。很明显，在15项随机对照试验中的14项中，神经激素阻滞剂减少了LVEF降低和心肌损伤的发生。
β受体阻滞剂，尤其是卡维地洛，以及ACEI，尤其是依那普利，应被考虑用于急性和早期发作心脏毒性的一级预防。当患者对ACEI和β受体阻滞剂不耐受时，ARB和MRA是合适的替代药物。我们建议进一步开展研究，以探索并确定神经激素阻滞剂在急性、早期和晚期发作心脏毒性一级预防中的作用。
