Sueta Daisuke, Usuku Hiroki, Kinoshita Yui, Tsujita Kenichi
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Department of Molecular Laboratory, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Eur Heart J Case Rep. 2020 Nov 12;4(6):1-5. doi: 10.1093/ehjcr/ytaa355. eCollection 2020 Dec.
The onset prevention and early diagnosis in cardiotoxicity due to cancer chemotherapy are important, and it is important to detect cardiac dysfunction at an early stage and start treatment to enhance the therapeutic effect.
A 31-year-old female with breast cancer received chemotherapy with epirubicin (400 mg/m) and cyclophosphamide followed by docetaxel. Two months after the initiation of her chemotherapy, the left ventricular (LV) ejection fraction (LVEF) determined by echocardiography fell to 41.2%, and she was diagnosed with cancer therapy-related cardiac dysfunction (CTRCD). Three months after the initiation of cancer treatment, the peak velocity of late diastolic transmitral Doppler flow (A wave) became undetectable. Peak longitudinal strain (LS) and peak LS rate, which reflect left atrium (LA) reservoir function, gradually declined like the LVEF and LV-global LS (GLS). Seven months after the initiation of cancer treatment, she was diagnosed with acute decompensated heart failure. The changes in peak LS and peak LS at the onset were greater than those in LVEF and LV-GLS.
This is a case report suggesting that LA reservoir function might be a more sensitive indicator than LVEF or LV-GLS in detecting CTRCD and that LA booster function might be the earliest. Left atrium reservoir function might be a more sensitive than conventional LV pump function and optimal indicator in CTRCD.
癌症化疗所致心脏毒性的发病预防和早期诊断至关重要，早期检测心脏功能障碍并开始治疗以提高治疗效果很重要。
一名31岁乳腺癌女性接受了表柔比星（400mg/m²）和环磷酰胺化疗，随后使用多西他赛。化疗开始两个月后，超声心动图测定的左心室（LV）射血分数（LVEF）降至41.2%，她被诊断为癌症治疗相关心脏功能障碍（CTRCD）。癌症治疗开始三个月后，舒张晚期二尖瓣血流峰值速度（A波）无法检测到。反映左心房（LA）储备功能的峰值纵向应变（LS）和峰值LS率，像LVEF和左心室整体LS（GLS）一样逐渐下降。癌症治疗开始七个月后，她被诊断为急性失代偿性心力衰竭。发病时峰值LS和峰值LS的变化大于LVEF和左心室GLS的变化。
本病例报告提示，在检测CTRCD方面，左心房储备功能可能比LVEF或左心室GLS更敏感，且左心房增强功能可能是最早出现变化的。在CTRCD中，左心房储备功能可能比传统的左心室泵功能更敏感且是最佳指标。
