Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Cardiology, Nepean Hospital, Penrith, New South Wales, Australia.
Open Heart. 2023 Jul;10(2). doi: 10.1136/openhrt-2023-002344.
The purpose of this meta-analysis is to compare the magnitude of the changes in left ventricular ejection fraction (LVEF) and cardiac magnetic resonance (CMR) relaxometry techniques soon after the completion of anthracycline therapy. Anthracyclines are associated with myocardial functional and morphological changes. LVEF is currently used to identify the functional changes. Anthracyclines can also cause myocardial inflammation and oedema. This can be assessed using CMR relaxometry techniques; T1 and T2 mapping and extracellular volume (ECV) fraction.
Three databases were systematically searched for studies evaluating CMR relaxometry parameter at baseline and 1±1 months after anthracycline completion (the last search date 17 March 2023). CMR parameters pre and post anthracycline-based chemotherapy were abstracted. A random effects model was used to pool mean difference (MD) in LVEF and ECV. Standardised mean difference (SMD) was also calculated for T1 and T2 mapping due to the variations in techniques, normal ranges and for the comparison among the parameters.
A total of 296 patients were included from 10 studies. 84% were female with a mean age of 54.9 years. Statistically significant alterations were observed in LVEF (MD -3.38% (95% CI -5.13%, -1.62%)) and ECV (1.92% (1.30%, 2.53%)). The pooled SMDs were also significant in LVEF, T1, T2 and ECV with -0.61 (-0.91, -0.30), 0.53 (0.16, 0.90), 0.59 (0.22, 0.96) and 0.74 (0.41, 1.06), respectively.
Our meta-analysis demonstrated small but significant alterations in CMR relaxometry parameters soon after anthracycline therapy, where ECV was superior to LVEF and T1 or T2 mapping. However, these short-term MDs were below the minimal detectable differences.
CRD42020196296.
本荟萃分析的目的是比较蒽环类药物治疗完成后不久左心室射血分数（LVEF）和心脏磁共振（CMR）弛豫技术变化的幅度。蒽环类药物与心肌功能和形态变化有关。LVEF 目前用于识别功能变化。蒽环类药物还会引起心肌炎症和水肿。这可以使用 CMR 弛豫技术评估；T1 和 T2 映射和细胞外容积（ECV）分数。
系统检索了三个数据库，以评估蒽环类药物完成后 1±1 个月时基线和 CMR 弛豫技术参数的研究（最后一次检索日期为 2023 年 3 月 17 日）。摘要了蒽环类药物化疗前后的 CMR 参数。由于技术、正常范围的变化以及参数之间的比较，使用随机效应模型汇总 LVEF 和 ECV 的平均差异（MD）。由于技术、正常范围和参数之间的比较，还计算了 T1 和 T2 映射的标准化平均差异（SMD）。
共有 10 项研究中的 296 名患者被纳入。84%为女性，平均年龄为 54.9 岁。观察到 LVEF（MD-3.38%（95%CI-5.13%，-1.62%））和 ECV（1.92%（1.30%，2.53%））有统计学显著变化。LVEF、T1、T2 和 ECV 的合并 SMD 也具有统计学意义，分别为-0.61（-0.91，-0.30）、0.53（0.16，0.90）、0.59（0.22，0.96）和 0.74（0.41，1.06）。
我们的荟萃分析表明，蒽环类药物治疗后不久 CMR 弛豫技术参数有较小但有统计学意义的改变，其中 ECV 优于 LVEF 和 T1 或 T2 映射。然而，这些短期 MD 低于最小可检测差异。
PROSPERO 注册号：CRD42020196296。
