新型 HFA/ICOS 风险评估工具，用于识别慢性髓性白血病患者发生心脏毒性的高危风险。
The new HFA/ICOS risk assessment tool to identify patients with chronic myeloid leukaemia at high risk of cardiotoxicity.
机构信息
Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
出版信息
ESC Heart Fail. 2022 Jun;9(3):1914-1919. doi: 10.1002/ehf2.13897. Epub 2022 Mar 31.
AIMS
Tyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukaemia (CML) can cause cardiovascular adverse events. So far, the Systematic Coronary Risk Evaluation (SCORE) charts of the European Society of Cardiology (ESC) have been used to identify cancer patients at increased cardiovascular risk. The primary aim of our study was to evaluate the usefulness of the new cardiovascular risk assessment model proposed by the Cardio-Oncology Study Group of the Heart Failure Association (HFA) of the ESC in collaboration with the International Cardio-Oncology Society (ICOS) to stratify the cardiovascular risk in CML patients, compared with SCORE risk charts. The secondary aim was to establish the incidence of adverse arterial events (AEs) in patients with CML treated with TKIs and the influence of preventive treatment with aspirin.
METHODS AND RESULTS
A retrospective single-centre observational study was carried out on 58 patients (32 men and 26 women; mean age ± SD: 59 ± 15 years) with CML treated with TKIs for a median period of 43 ± 31 months. Cardiological evaluation was performed and cardiovascular risk was estimated with SCORE risk charts and with the new risk assessment tool proposed by HFA/ICOS. AEs were recorded. According to SCORE charts and the new HFA/ICOS risk stratification tool, respectively, 46% (Group A1) and 60% (Group A2) of patients were at high-very high risk, and 54% (Group B1) and 40% (Group B2) at low-moderate risk. AEs were significantly more frequent in Group A1 than Group B1 (P value < 0.01) when considered overall; they were significantly more frequent in Group A2 than Group B2 either overall or considered individually. HFA/ICOS risk stratification tool was significantly more sensitive than SCORE (P < 0.01) in identifying patients at higher risk of cardiovascular toxicity. In addition, we did not find AEs in patients pretreated with aspirin.
CONCLUSIONS
The new HFA/ICOS risk stratification model allows a more tailored cardiovascular risk stratification in patients with CML and it is more sensitive than SCORE charts.
目的
用于治疗慢性髓性白血病（CML）的酪氨酸激酶抑制剂（TKI）可引起心血管不良事件。到目前为止，欧洲心脏病学会（ESC）的系统性冠状动脉风险评估（SCORE）图表已用于识别心血管风险增加的癌症患者。我们研究的主要目的是评估 ESC 心力衰竭协会（HFA）心脏肿瘤学研究组与国际心脏肿瘤学会（ICOS）合作提出的新心血管风险评估模型在分层 CML 患者心血管风险方面的有用性，与 SCORE 风险图表相比。次要目的是确定接受 TKI 治疗的 CML 患者不良动脉事件（AE）的发生率以及阿司匹林预防治疗的影响。
方法和结果
对 58 例（32 名男性和 26 名女性；平均年龄 ± 标准差：59 ± 15 岁）接受 TKI 治疗 CML 的患者进行了回顾性单中心观察性研究，中位治疗时间为 43 ± 31 个月。进行了心脏评估，并使用 SCORE 风险图表和 HFA/ICOS 提出的新风险评估工具评估心血管风险。记录 AE。根据 SCORE 图表和新的 HFA/ICOS 风险分层工具，分别有 46%（A1 组）和 60%（A2 组）的患者处于高-极高风险，54%（B1 组）和 40%（B2 组）处于低-中度风险。当考虑整体时，A1 组的 AE 明显比 B1 组更频繁（P 值<0.01）；当考虑整体或单独考虑时，A2 组的 AE 明显比 B2 组更频繁。HFA/ICOS 风险分层工具在识别心血管毒性风险较高的患者方面明显比 SCORE 更敏感（P<0.01）。此外，我们没有发现阿司匹林预处理患者发生 AE。
结论
新的 HFA/ICOS 风险分层模型可更精确地对 CML 患者进行心血管风险分层，并且比 SCORE 图表更敏感。
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