Pediatric Oncology, Princess Maxima Center, Utrecht, The Netherlands.
Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.
Open Heart. 2021 Apr;8(1). doi: 10.1136/openhrt-2020-001506.
Over the past decades, prognosis of patients with cancer has strongly improved and the number of cancer survivors is rapidly growing. Despite this success, cancer treatment is associated with development of serious cardiovascular diseases including left ventricular (LV) systolic dysfunction, heart failure, valvular disease, myocardial infarction, arrhythmias or pericardial diseases. Serial non-invasive cardiac imaging is an important tool to detect early signs of cardiotoxicity, to allow for timely intervention and provide optimal circumstances for long-term prognosis. Currently, echocardiographic imaging is the method of choice for the evaluation of myocardial function during and after cancer therapy. However, 2D echocardiography may fail to detect subtle changes in myocardial function, potentially resulting in a significant delay of therapeutic intervention to impede advanced cardiac disease states with more overt systolic dysfunction. Strain imaging is a promising method for early detection of myocardial dysfunction and may predict future changes in LV ejection fraction. The use of three-dimensional echocardiography may overcome the limitations of 2D echocardiography with more precise and reproducible measurements of LV performance. Cardiac MRI is the gold standard for volumetric assessment and can also be used to perform myocardial tissue characterisation. Visualisation of oedema and fibrosis may provide insights into the degree and disease course of cardiotoxicity and underlying pathophysiological mechanisms. There is growing body of literature regarding the promising role of these advanced imaging modalities in early detection of cardiotoxicity. With this overview paper, new insights and recent results in literature regarding echocardiographic and cardiac magnetic resonance imaging of cancer therapy-related cardiac dysfunction in post-cancer therapy adults will be highlighted.
在过去的几十年中，癌症患者的预后得到了显著改善，癌症幸存者的数量也在迅速增加。尽管取得了这一成功，但癌症治疗与严重心血管疾病的发展相关，包括左心室（LV）收缩功能障碍、心力衰竭、瓣膜疾病、心肌梗死、心律失常或心包疾病。连续的非侵入性心脏成像检查是检测心脏毒性早期迹象的重要工具，可及时进行干预，并为长期预后提供最佳条件。目前，超声心动图成像仍是评估癌症治疗期间和治疗后心肌功能的首选方法。然而，二维超声心动图可能无法检测到心肌功能的细微变化，这可能导致治疗干预的显著延迟，从而阻碍更明显的收缩功能障碍的晚期心脏疾病状态。应变成像技术是早期检测心肌功能障碍的一种很有前途的方法，它可能预测 LV 射血分数的未来变化。三维超声心动图的使用可能会克服二维超声心动图的局限性，从而更精确和可重复地测量 LV 性能。心脏磁共振成像（Cardiac MRI）是容积评估的金标准，也可用于进行心肌组织特征分析。水肿和纤维化的可视化可深入了解心脏毒性的程度和疾病进程以及潜在的病理生理机制。关于这些先进成像方式在早期检测心脏毒性方面的作用，有越来越多的文献报道。通过本文概述，将重点介绍癌症治疗相关心脏功能障碍的超声心动图和心脏磁共振成像方面的新见解和最新文献结果。
