Cardiology Department, Hospital Universitario de Fuenlabrada., Spain.
Cardiology Department, Hospital Universitario de Getafe, Spain.
Int J Cardiol. 2023 Jul 1;382:52-59. doi: 10.1016/j.ijcard.2023.04.026. Epub 2023 Apr 18.
Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data on longitudinal studies about early and late onset cardiotoxicity in this group of patients is scarce. The objective of the present study was to assess predictors of early and late onset cardiotoxicity in patients with breast cancer treated with A.
100 consecutive patients receiving anthracycline-based chemotherapy (CHT) to treat breast cancer were included in this prospective study. All patients underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac biomarkers including high sensitivity Troponin T (TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Heart-type fatty acid binding protein (H-FABP) were assessed.
Mean doxorubicin dose was 243 mg/m2. Mean follow-up was 51.8 ± 8.2 months. At one-year incidence of anthracycline related-cardiotoxicity (AR-CT) was 4% and at the end of follow-up was 18% (15 patients asymptomatic left ventricular systolic dysfunction, 1 patients heart failure and 2 patients a sudden cardiac death). Forty-nine patients developed diastolic dysfunction (DD) during first year. In the univariate analysis DD during first year was the only parameter associated with AR-CT (Table 1). In the logistic regression model DD was independently related with the development of AR-CT, with an odds ratio value of 7.5 (95% CI 1.59-35.3).
Incidence of late-onset cardiotoxicity is high but mostly subclinical. Diastolic dysfunction early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.
心脏毒性是乳腺癌患者使用蒽环类药物或曲妥珠单抗的主要限制因素。关于这组患者早期和晚期心脏毒性的纵向研究数据很少。本研究的目的是评估接受蒽环类药物为基础的化疗（CHT）治疗的乳腺癌患者早期和晚期心脏毒性的预测因素。
本前瞻性研究纳入了 100 例连续接受蒽环类药物为基础的化疗（CHT）治疗乳腺癌的患者。所有患者均在基线、CHT 结束时、CHT 结束后 3 个月、CHT 开始后 1 年和 4 年进行评估。评估临床数据、收缩和舒张超声参数以及心脏生物标志物，包括高敏肌钙蛋白 T（TnT）、N 端脑利钠肽前体（NT-proBNP）和心脏型脂肪酸结合蛋白（H-FABP）。
平均多柔比星剂量为 243mg/m2。平均随访时间为 51.8±8.2 个月。一年时蒽环类药物相关心脏毒性（AR-CT）的发生率为 4%，随访结束时为 18%（15 例无症状左室收缩功能障碍，1 例心力衰竭，2 例心脏性猝死）。49 例患者在第一年出现舒张功能障碍（DD）。单因素分析显示，第一年的 DD 是唯一与 AR-CT 相关的参数（表 1）。在逻辑回归模型中，DD 与 AR-CT 的发生独立相关，比值比为 7.5（95%CI 1.59-35.3）。
迟发性心脏毒性的发生率较高，但大多为亚临床。化疗后早期舒张功能障碍是蒽环类药物心脏毒性的强烈预测因子。
