Kamphuis Janine A M, Linschoten Marijke, Cramer Maarten J, Doevendans Pieter A, Asselbergs Folkert W, Teske Arco J
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, E03.511, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Netherlands Heart Institute, Utrecht, The Netherlands.
Cardiooncology. 2020 Oct 13;6:23. doi: 10.1186/s40959-020-00079-3. eCollection 2020.
Anthracycline-induced cardiac dysfunction (ACD) is a notorious side effect of anticancer treatment. It has been described as a phenomenon of a continuous progressive decline of cardiac function, eventually leading to dilated cardiomyopathy (DCM). This progressive nature suggests that patients with a delayed ACD diagnosis have greater compromise of cardiac function and more adverse remodeling, with a poor response to heart failure (HF) treatment. This study aimed to delineate the impact of a delayed ACD diagnosis on echocardiographic characteristics and response to HF treatment.
From the population of our cardio-oncology outpatient clinic, 92 ACD patients were included in this study (age 51.6 ± 16.2 years, median cumulative anthracycline dose 329 [200-329] mg/m), and a median follow-up of 25.0 [9.6-37.2] months after ACD diagnosis. Median time to ACD diagnosis for patients diagnosed early (< 1 year) and late (> 1 year) was 4.0 vs. 47.7 months respectively. There were no echocardiographic differences between patients diagnosed early vs. late (LVEF 43.6 ± 4.9% vs. 43.0 ± 6.2% and iEDV 63.6 vs. 62.9 mL/m). Eighty-three percent of patients presented with mild LV dysfunction and in 79% the LV was not dilated. Patients diagnosed early were more likely to have (partial) recovery of cardiac function upon HF treatment initiation ( = 0.015).
In the setting of a cardio-oncology outpatient clinic, patients with ACD presented with a hypokinetic non-dilated cardiomyopathy, rather than typical DCM. Timing of ACD diagnosis did not impact HF disease severity. However, in patients receiving an early diagnosis, cardiac function was more likely to recover upon HF treatment.
蒽环类药物诱导的心脏功能障碍（ACD）是抗癌治疗中一种广为人知的副作用。它被描述为心脏功能持续渐进性下降的现象，最终导致扩张型心肌病（DCM）。这种渐进性表明，ACD诊断延迟的患者心脏功能受损更大，心脏重塑更严重，对心力衰竭（HF）治疗反应不佳。本研究旨在探讨ACD诊断延迟对超声心动图特征及HF治疗反应的影响。
从我们心脏肿瘤门诊患者中，纳入92例ACD患者（年龄51.6±16.2岁，蒽环类药物累积剂量中位数为329[200 - 329]mg/m²），ACD诊断后中位随访时间为25.0[9.6 - 37.2]个月。早期（<1年）和晚期（>1年）诊断的患者，ACD诊断的中位时间分别为4.0个月和47.7个月。早期和晚期诊断的患者在超声心动图上无差异（左心室射血分数[LVEF]分别为43.6±4.9%和43.0±6.2%，舒张末期容积指数[iEDV]分别为63.6和62.9 mL/m²）。83%的患者表现为轻度左心室功能障碍，79%的患者左心室未扩张。早期诊断的患者在开始HF治疗后更有可能出现心脏功能（部分）恢复（P = 0.015）。
在心脏肿瘤门诊环境中，ACD患者表现为运动减弱的非扩张型心肌病，而非典型的DCM。ACD诊断时间不影响HF疾病严重程度。然而，早期诊断的患者在接受HF治疗后心脏功能更有可能恢复。
