Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
ESC Heart Fail. 2022 Jun;9(3):1792-1800. doi: 10.1002/ehf2.13867. Epub 2022 Mar 15.
Understanding cardiac function after anthracycline administration is very important from the perspective of preventing the onset of heart failure. Although cardiac magnetic resonance and echocardiography are recognized as the 'gold standard' for detecting cardiotoxicity, they have many shortcomings. We aimed to investigate whether cardiac computed tomography (CCT) could replace these techniques, assessing serial changes in cardiac tissue characteristics as determined by CCT after anthracycline administration.
We prospectively investigated 15 consecutive breast cancer patients who were scheduled to receive anthracycline therapy. We performed echocardiography and CCT before and 3, 6, and 12 months after anthracycline treatment. The mean cumulative administered anthracycline dose was 269.9 ± 14.6 mg/m (doxorubicin-converted dose). Of the 15 enrolled patients who received anthracycline treatment for breast cancer, none met the definition of cardiotoxicity. The CCT-derived extracellular volume fraction tended to continue to increase after anthracycline treatment and had relatively similar dynamics to the left ventricular ejection fraction and global longitudinal strain as determined by echocardiography.
Our findings indicated that CCT could provide adequate information about the characteristics of myocardial tissue after anthracycline administration. CCT may improve the understanding of cardiotoxicity by compensating for the weaknesses of echocardiography. This technique could be useful for understanding cardiac tissue characterization as a 'one-stop shop' evaluation, providing new insight into cardiooncology.
从预防心力衰竭发生的角度来看，了解蒽环类药物治疗后的心脏功能非常重要。虽然心脏磁共振和超声心动图被认为是检测心脏毒性的“金标准”，但它们存在许多缺点。我们旨在研究心脏计算机断层扫描（CCT）是否可以替代这些技术，评估蒽环类药物治疗后通过 CCT 检测到的心脏组织特征的连续变化。
我们前瞻性研究了 15 例连续的乳腺癌患者，这些患者计划接受蒽环类药物治疗。我们在蒽环类药物治疗前和治疗后 3、6 和 12 个月进行了超声心动图和 CCT 检查。平均累积给予的蒽环类药物剂量为 269.9±14.6mg/m（阿霉素转化剂量）。在接受蒽环类药物治疗乳腺癌的 15 例入组患者中，均未达到心脏毒性的定义。CCT 衍生的细胞外容积分数在蒽环类药物治疗后有继续增加的趋势，与超声心动图检测的左心室射血分数和整体纵向应变具有相似的动态变化。
我们的研究结果表明，CCT 可以为蒽环类药物治疗后心肌组织的特征提供充分的信息。CCT 可以通过弥补超声心动图的弱点来提高对心脏毒性的理解。这种技术可以通过提供“一站式”评估的心脏组织特征理解，为心脏肿瘤学提供新的见解，从而变得有用。
