Zahler David, Arnold Joshua H, Bar-On Tali, Raphael Ari, Khoury Shafik, Rozenbaum Zach, Banai Shmuel, Arbel Yaron, Topilsky Yan, Laufer-Perl Michal
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Life (Basel). 2022 Aug 20;12(8):1275. doi: 10.3390/life12081275.
The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). Patients underwent echocardiography exams at baseline (T1), during ANT therapy (T2), and after completion within 3 months (T3) and 6 months (T4). A total of 141 female patients were included, with a mean age of 51 ± 12 years. From T1 to T4, we observed a significant deterioration in LV ejection fraction (60.2 ± 1.5 to 59.2 ± 2.7%, p = 0.0004) and LV global longitudinal strain (−21.6 (−20.0−−23.0) to −20.0 (−19.1−−21.1)%, p < 0.0001)), and an increase in LV end-systolic diameter (25 (22−27) to 27 (24−30) mm, p < 0.0001). We observed a significant increase in the incidence of new mitral regurgitation (MR) development (4 to 19%, p < 0.0001), worsening with concomitant trastuzumab therapy (6% to 31%, p = 0.003), and a trend for tricuspid regurgitation development (4% to 8%, p = 0.19). ANT therapy is associated with the development of a new valvular disease, mainly MR, which may imply the need for a valvular focus in the monitoring of cancer patients.
蒽环类药物（ANT）与左心室（LV）功能障碍之间的关联已广为人知；然而，关于其对心脏瓣膜功能直接影响的数据有限。我们旨在评估ANT治疗对诊断为乳腺癌患者的瓣膜功能有何影响。作为以色列心脏肿瘤登记处（ICOR）的一部分，前瞻性收集了数据。患者在基线时（T1）、ANT治疗期间（T2）以及完成治疗后3个月（T3）和6个月（T4）接受了超声心动图检查。共纳入141名女性患者，平均年龄为51±12岁。从T1到T4，我们观察到左心室射血分数显著恶化（从60.2±1.5降至59.2±2.7%，p = 0.0004）以及左心室整体纵向应变降低（从−21.6（−20.0−−23.0）降至−20.0（−19.1−−21.1）%，p < 0.0001），并且左心室收缩末期直径增加（从25（22−27）增至27（24−30）mm，p < 0.0001）。我们观察到新的二尖瓣反流（MR）发生率显著增加（从4%增至19%，p < 0.0001），在联合曲妥珠单抗治疗时情况恶化（从6%增至31%，p = 0.003），并且三尖瓣反流有发展趋势（从4%增至8%，p = 0.19）。ANT治疗与新的瓣膜疾病的发生相关，主要是MR，这可能意味着在癌症患者监测中需要关注瓣膜问题。
