癌症患者心脏毒性的心脏保护策略:综述

Cardioprotective Strategies from Cardiotoxicity in Cancer Patients: A Comprehensive Review.

作者信息

Kourek Christos, Touloupaki Maria, Rempakos Athanasios, Loritis Konstantinos, Tsougkos Elias, Paraskevaidis Ioannis, Briasoulis Alexandros

机构信息

Medical School of Athens, National and Kapodistrian University of Athens, 11527 Athens, Greece.

Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece.

出版信息

J Cardiovasc Dev Dis. 2022 Aug 11;9(8):259. doi: 10.3390/jcdd9080259.

Abstract

Cardiotoxicity is a significant complication of chemotherapeutic agents in cancer patients. Cardiovascular incidents including LV dysfunction, heart failure (HF), severe arrhythmias, arterial hypertension, and death are associated with high morbidity and mortality. Risk stratification of cancer patients prior to initiation of chemotherapy is crucial, especially in high-risk patients for cardiotoxicity. The early identification and management of potential risk factors for cardiovascular side effects seems to contribute to the prevention or minimization of cardiotoxicity. Screening of cancer patients includes biomarkers such as cTnI and natriuretic peptide and imaging measurements such as LV function, global longitudinal strain, and cardiac MRI. Cardioprotective strategies have been investigated over the last two decades. These strategies for either primary or secondary prevention include medical therapy such as ACE inhibitors, ARBs, b-blockers, aldosterone antagonists, statins and dexrazoxane, physical therapy, and reduction of chemotherapeutic dosages. However, data regarding dosages, duration of medical therapy, and potential interactions with chemotherapeutic agents are still limited. Collaboration among oncologists, cardiologists, and cardio-oncologists could establish management cardioprotective strategies and approved follow-up protocols in patients with cancer receiving chemotherapy.

摘要

心脏毒性是癌症患者化疗药物的一种严重并发症。包括左心室功能障碍、心力衰竭(HF)、严重心律失常、动脉高血压和死亡在内的心血管事件与高发病率和死亡率相关。在开始化疗之前对癌症患者进行风险分层至关重要,尤其是对于心脏毒性高风险的患者。早期识别和管理心血管副作用的潜在风险因素似乎有助于预防心脏毒性或使其最小化。对癌症患者的筛查包括生物标志物如肌钙蛋白I(cTnI)和利钠肽,以及成像测量如左心室功能、整体纵向应变和心脏磁共振成像(MRI)。在过去二十年中已经对心脏保护策略进行了研究。这些用于一级或二级预防的策略包括药物治疗,如血管紧张素转换酶(ACE)抑制剂、血管紧张素Ⅱ受体阻滞剂(ARB)、β受体阻滞剂、醛固酮拮抗剂、他汀类药物和右丙亚胺,物理治疗,以及降低化疗药物剂量。然而,关于药物剂量、药物治疗持续时间以及与化疗药物潜在相互作用的数据仍然有限。肿瘤学家、心脏病学家和心脏肿瘤学家之间的合作可以为接受化疗的癌症患者制定心脏保护管理策略和批准的随访方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c5/9409997/f541fbd749c3/jcdd-09-00259-g001.jpg

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