Thompson Grace E, Wright Phyllis P
Emory University, Atlanta, Georgia.
J Adv Pract Oncol. 2019 May-Jun;10(4):360-366. doi: 10.6004/jadpro.2019.10.4.4. Epub 2019 Mar 1.
As cancer survivorship increases, clinicians need to become educated regarding the long-term effect of cancer treatments. Cancer therapeutics-related cardiac dysfunction (CTRCD) is one such sequela that contributes to significant morbidity and mortality. Unfortunately, screening and management practices regarding CTRCD are inconsistent within guidelines and practice. This review will first look at anthracycline-related cardiac dysfunction occurrence and pathophysiology. Current guidelines for CTRCD screening will be discussed, including the use of 2D echocardiograms along with newer technology such as 3D echocardiography and global systolic longitudinal myocardial strain (GLS) measurements. Biomarkers like serum troponin demonstrate promise as an early indicator of cardiomyocyte injury and a potential means of risk stratification; however, guidelines vary regarding how best to incorporate elevated serum troponin levels into management plans. Growing evidence indicates the clinical need for early detection of CTRCD in order to initiate preventative pharmacologic management and improve patient outcomes.
随着癌症幸存者数量的增加，临床医生需要接受有关癌症治疗长期影响的教育。癌症治疗相关的心脏功能障碍（CTRCD）就是这样一种后遗症，它会导致严重的发病率和死亡率。不幸的是，关于CTRCD的筛查和管理方法在指南和实践中并不一致。本综述将首先探讨蒽环类药物相关心脏功能障碍的发生情况和病理生理学。将讨论CTRCD筛查的现行指南，包括二维超声心动图的使用以及诸如三维超声心动图和整体收缩期纵向心肌应变（GLS）测量等新技术。血清肌钙蛋白等生物标志物有望作为心肌细胞损伤的早期指标和潜在的风险分层手段；然而，关于如何最好地将血清肌钙蛋白水平升高纳入管理计划，各指南存在差异。越来越多的证据表明，临床上需要早期检测CTRCD，以便启动预防性药物治疗并改善患者预后。
