使用斑点追踪超声心动图检测儿童癌症患者晚期蒽环类药物所致心脏毒性：一项前瞻性对照横断面研究。
Use of speckle tracking echocardiography to detect late anthracycline-induced cardiotoxicity in childhood cancer: A prospective controlled cross-sectional study.
作者信息
Amedro Pascal, Vincenti Marie, Abassi Hamouda, Lanot Nicolas, De La Villeon Gregoire, Guillaumont Sophie, Gamon Lucie, Mura Thibault, Lopez-Perrin Karine, Haouy Stephany, Sirvent Anne, Cazorla Olivier, Vergely Laurence, Lacampagne Alain, Avesani Martina, Sirvent Nicolas, Saumet Laure
机构信息
Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France.
Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, CHU Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France.
出版信息
Int J Cardiol. 2022 May 1;354:75-83. doi: 10.1016/j.ijcard.2022.02.012. Epub 2022 Feb 12.
BACKGROUND
This study aimed to detect late sub-clinical patterns of cardiac dysfunction using speckle tracking echocardiography (STE) in children with cancer remission more than 12 months after the end of anthracycline treatment.
METHODS
This prospective controlled study enrolled 196 children, 98 of which had been treated with anthracyclines (mean age 10.8 ± 3.6 years; 51% female) and 98 were age- and gender-matched healthy subjects in a 1:1 case-control design. Conventional echocardiographic variables were collected for left ventricle (LV) and right ventricle (RV). STE analyses were performed in the LV longitudinal, radial, and circumferential displacements and in the RV free wall longitudinal displacement. The association between LV global longitudinal strain (GLS) and the main clinical and biological parameters was evaluated.
RESULTS
After a mean time interval of 5.1 ± 3.2 years since the end of chemotherapy (mean cumulative anthracycline dose of 192 ± 96 mg/m), conventional echocardiographic measures were normal. GLS was significantly decreased in the anthracycline group (-19.1% vs. -21.5%, P < 0.0001), with a higher proportion of children with abnormal values (Z-score < -2 in 18.6% vs. 1.0%, P < 0.0001). No association was found between GLS and clinical or biological parameters. Circumferential strain was significantly worse in the anthracycline group (-16.8% vs. -19.4%, P < 0.0001), and radial strain significantly better (+51.4% vs. +35.9%, P < 0.0001). RV conventional echocardiography and STE parameters were normal and not different between anthracycline and control groups.
CONCLUSIONS
The existence of a modified LV strain despite normal LV function in children treated with anthracyclines represents an important perspective for cardiomyopathy surveillance in childhood cancer survivors. Clinical Trial Registration -ClinicalTrials.gov Identifier: NCT02893787.
背景
本研究旨在使用斑点追踪超声心动图（STE）检测蒽环类药物治疗结束12个月以上癌症缓解期儿童心脏功能障碍的晚期亚临床模式。
方法
本前瞻性对照研究纳入196名儿童，其中98名接受过蒽环类药物治疗（平均年龄10.8±3.6岁；51%为女性），98名年龄和性别匹配的健康受试者按1:1病例对照设计纳入。收集左心室（LV）和右心室（RV）的常规超声心动图变量。对LV的纵向、径向和圆周位移以及RV游离壁纵向位移进行STE分析。评估LV整体纵向应变（GLS）与主要临床和生物学参数之间的关联。
结果
化疗结束后平均时间间隔为5.1±3.2年（平均累积蒽环类药物剂量为192±96mg/m），常规超声心动图测量结果正常。蒽环类药物组的GLS显著降低（-19.1%对-21.5%，P<0.0001），异常值儿童的比例更高（Z评分<-2的比例为18.6%对1.0%，P<0.0001）。未发现GLS与临床或生物学参数之间存在关联。蒽环类药物组的圆周应变显著更差（-16.8%对-19.4%，P<0.0001），径向应变显著更好（+51.4%对+35.9%，P<0.0001）。RV常规超声心动图和STE参数正常，蒽环类药物组与对照组之间无差异。
结论
在接受蒽环类药物治疗的儿童中，尽管LV功能正常，但存在LV应变改变，这代表了儿童癌症幸存者心肌病监测的一个重要方面。临床试验注册 - ClinicalTrials.gov标识符：NCT02893787。
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