Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.
Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
Eur Heart J Cardiovasc Imaging. 2021 Mar 22;22(4):451-458. doi: 10.1093/ehjci/jeaa421.
Left ventricular ejection fraction (LVEF) is standard of care for evaluating chemotherapy-associated cardiotoxicity, although global longitudinal strain (GLS) offers advantages. However, neither change in LVEF or GLS has been associated with short-term symptoms, functional capacity, or long-term heart failure (HF) risk. We sought to determine whether an integrative measure of cardiovascular function (VO2peak) that is strongly associated with HF risk would be more sensitive to cardiac damage induced by cancer treatment than LVEF, GLS, or cardiac biomarkers.
Patients (n = 206, 53 ± 13 years, 35% male) scheduled to commence anti-cancer treatment completed assessment prior to, and within 6 months after therapy. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP), and cardiorespiratory fitness (VO2peak) were measured. LV function was normal prior to treatment (LVEF 61 ± 5%; GLS -19.4 ± 2.1), but VO2peak was only 88 ± 26% of age-predicted. After treatment, VO2peak was reduced by 7 ± 15% (equivalent of 7 years normal ageing, P < 0.0001) and the rates of functional disability (defined as VO2peak ≤ 18 mL/min/kg) almost doubled (15% vs. 26%, P = 0.016). In contrast, small, reductions in LVEF (59 ± 5% vs. 58 ± 5%, P = 0.03) and GLS (-19.4 ± 2.1 vs. -18.9 ± 2.2, P = 0.002) and an increase in troponin levels (4.0 ± 6.9 vs. 26.4 ± 26.2 ng/mL, P < 0.0001) were observed.
Anti-cancer treatment is associated with marked reductions in functional capacity that occur independent of reductions in LVEF and GLS. The assessment of VO2peak prior to, and following treatment may be a more sensitive means of identifying patients at increased risk of HF.
左心室射血分数（LVEF）是评估化疗相关性心脏毒性的标准，但整体纵向应变（GLS）具有优势。然而，LVEF 或 GLS 的变化均与短期症状、功能能力或长期心力衰竭（HF）风险无关。我们试图确定心血管功能的综合指标（VO2peak）是否比 LVEF、GLS 或心脏生物标志物更能敏感地检测到癌症治疗引起的心脏损伤，该指标与 HF 风险密切相关。
计划开始抗癌治疗的 206 例患者（53±13 岁，35%为男性）在治疗前和治疗后 6 个月内完成评估。测量了左心室功能（LVEF、GLS）、心脏生物标志物（肌钙蛋白和 BNP）和心肺功能（VO2peak）的变化。治疗前 LV 功能正常（LVEF 61±5%；GLS-19.4±2.1），但 VO2peak 仅为年龄预测值的 88±26%。治疗后，VO2peak 降低了 7±15%（相当于 7 年正常老化，P<0.0001），功能障碍的发生率几乎翻了一番（15%对 26%，P=0.016）。相比之下，LVEF （59±5%对 58±5%，P=0.03）和 GLS （-19.4±2.1 对-18.9±2.2，P=0.002）的轻微降低以及肌钙蛋白水平的升高（4.0±6.9 对 26.4±26.2ng/ml，P<0.0001）。
抗癌治疗与功能能力的显著降低有关，而 LVEF 和 GLS 的降低则无关。在治疗前和治疗后评估 VO2peak 可能是一种更敏感的方法，可识别 HF 风险增加的患者。
