Terui Yosuke, Sugimura Koichiro, Ota Hideki, Tada Hiroshi, Nochioka Kotaro, Sato Haruka, Katsuta Yuko, Fujiwara Junko, Harada-Shoji Narumi, Sato-Tadano Akiko, Morita Yoshiaki, Sun Wenyu, Higuchi Satoshi, Tatebe Shunsuke, Fukui Shigefumi, Miyamichi-Yamamoto Saori, Suzuki Hideaki, Yaoita Nobuhiro, Kikuchi Nobuhiro, Sakota Miku, Miyata Satoshi, Sakata Yasuhiko, Ishida Takanori, Takase Kei, Yasuda Satoshi, Shimokawa Hiroaki
Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiology, International University of Health and Welfare, School of Medicine, Narita, Japan.
Int J Cardiol. 2023 Jan 15;371:472-479. doi: 10.1016/j.ijcard.2022.09.025. Epub 2022 Sep 15.
Prognosis of breast cancer patients has been improved along with the progress in cancer therapies. However, cancer therapeutics-related cardiac dysfunction (CTRCD) has been an emerging issue. For early detection of CTRCD, we examined whether native T1 mapping and global longitudinal strain (GLS) using cardiac magnetic resonance (CMR) and biomarkers analysis are useful.
We prospectively enrolled 83 consecutive chemotherapy-naïve female patients with breast cancer (mean age, 56 ± 13 yrs.) between 2017 and 2020. CTRCD was defined based on echocardiography as left ventricular ejection fraction (LVEF) below 53% at any follow-up period with LVEF>10% points decrease from baseline after chemotherapy. To evaluate cardiac function, CMR (at baseline and 6 months), 12‑lead ECG, echocardiography, and biomarkers (at baseline and every 3 months) were evaluated.
A total of 164 CMRs were performed in 83 patients. LVEF and GLS were significantly decreased after chemotherapy (LVEF, from 71.2 ± 4.4 to 67.6 ± 5.8%; GLS, from -27.9 ± 3.9 to -24.7 ± 3.5%, respectively, both P < 0.01). Native T1 value also significantly elevated after chemotherapy (from 1283 ± 36 to 1308 ± 39 msec, P < 0.01). Among the 83 patients, 7 (8.4%) developed CTRCD. Of note, native T1 value before chemotherapy was significantly higher in patients with CTRCD than in those without it (1352 ± 29 vs. 1278 ± 30 msec, P < 0.01). The multivariable logistic regression analysis revealed that native T1 value was an independent predictive factor for the development of CTRCD [OR 2.33; 95%CI 1.15-4.75, P = 0.02].
These results indicate that CMR is useful to detect chemotherapy-related myocardial damage and predict for the development of CTRCD in breast cancer patients.
随着癌症治疗方法的进步，乳腺癌患者的预后有所改善。然而，癌症治疗相关的心脏功能障碍（CTRCD）已成为一个新出现的问题。为了早期检测CTRCD，我们研究了使用心脏磁共振（CMR）进行的固有T1映射和整体纵向应变（GLS）以及生物标志物分析是否有用。
我们前瞻性地纳入了2017年至2020年间连续83例未接受过化疗的乳腺癌女性患者（平均年龄56±13岁）。根据超声心动图，CTRCD定义为在任何随访期左心室射血分数（LVEF）低于53%，且化疗后LVEF较基线下降超过10个百分点。为了评估心脏功能，对CMR（基线和6个月时）、12导联心电图、超声心动图以及生物标志物（基线和每3个月）进行了评估。
83例患者共进行了164次CMR检查。化疗后LVEF和GLS显著降低（LVEF分别从71.2±4.4%降至67.6±5.8%；GLS分别从-27.9±3.9降至-24.7±3.5%，P均<0.01）。化疗后固有T1值也显著升高（从1283±36毫秒升至1308±39毫秒，P<0.01）。在83例患者中，7例（8.4%）发生了CTRCD。值得注意的是，发生CTRCD的患者化疗前的固有T1值显著高于未发生CTRCD的患者（1352±29毫秒对1278±30毫秒，P<0.01）。多变量逻辑回归分析显示，固有T1值是CTRCD发生的独立预测因素[比值比2.33；95%置信区间1.15-4.75，P=0.02]。
这些结果表明，CMR有助于检测化疗相关的心肌损伤，并预测乳腺癌患者CTRCD的发生。
