Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy.
Cardiac Multi-Imaging Unit, Mediterranea Cardiocentro, Via Orazio 2, 80122 Naples, Italy.
Curr Probl Cardiol. 2024 Jul;49(7):102609. doi: 10.1016/j.cpcardiol.2024.102609. Epub 2024 Apr 30.
The cardiotoxic effects of anthracyclines therapy are well recognized, both in the short and long term. Echocardiography allows monitoring of cancer patients treated with this class of drugs by serial assessment of left ventricle ejection fraction (LVEF) as a surrogate of systolic function. However, changes in myocardial function may occur late in the process when cardiac damage is already established. Novel cardiac magnetic resonance (CMR) parametric techniques, like native T1 mapping and extra-cellular volume (ECV), may detect subclinical myocardial damage in these patients, recognizing early signs of cardiotoxicity before development of overt cancer therapy-related cardiac dysfunction (CTRCD) and prompting tailored therapeutic and follow-up strategies to improve outcome.
We conducted a systematic review and a meta-analysis to investigate the difference in CMR derived native T1 relaxation time and ECV values, respectively, in anthracyclines-treated cancer patients with preserved EF versus healthy controls. PubMed, Embase, Web of Science and Cochrane Central were searched for relevant studies. A total of 6 studies were retrieved from 1057 publications, of which, four studies with 547 patients were included in the systematic review on T1 mapping and five studies with 481 patients were included in the meta-analysis on ECV. Three out of the four included studies in the systematic review showed higher T1 mapping values in anthracyclines treated patients compared to healthy controls. The meta-analysis demonstrated no statistically significant difference in ECV values between the two groups in the main analysis (Hedges´s g =3.20, 95% CI -0.72-7.12, p =0.11, I =99%), while ECV was significantly higher in the anthracyclines-treated group when sensitivity analysis was performed.
Higher T1 mapping and ECV values in patients exposed to anthracyclines could represent early biomarkers of CTRCD, able to detect subclinical myocardial changes present before the development of overt myocardial dysfunction. Our results highlight the need for further studies to investigate the correlation between anthracyclines-based chemotherapy and changes in CMR mapping parameters that may guide future tailored follow-up strategies in this group of patients.
蒽环类药物治疗的心脏毒性作用无论是在短期还是长期都已被广泛认识。超声心动图通过连续评估左心室射血分数（LVEF）作为收缩功能的替代指标，从而对接受此类药物治疗的癌症患者进行监测。然而，当心脏损伤已经确立时，心肌功能的变化可能会在后期出现。新型心脏磁共振（CMR）参数技术，如心肌固有 T1 映射和细胞外容积（ECV），可能会检测到这些患者的亚临床心肌损伤，在出现明显的癌症治疗相关心脏功能障碍（CTRCD）之前识别出心脏毒性的早期迹象，并提示制定针对性的治疗和随访策略以改善预后。
我们进行了系统评价和荟萃分析，以研究在射血分数保留的接受蒽环类药物治疗的癌症患者与健康对照组之间，CMR 衍生的固有 T1 弛豫时间和 ECV 值的差异。我们在 PubMed、Embase、Web of Science 和 Cochrane Central 中搜索了相关研究。从 1057 篇文献中检索到 6 项研究，其中 4 项研究（共 547 例患者）纳入了固有 T1 映射的系统评价，5 项研究（共 481 例患者）纳入了 ECV 的荟萃分析。在系统评价中，纳入的 4 项研究中有 3 项显示接受蒽环类药物治疗的患者的 T1 映射值高于健康对照组。荟萃分析显示，在主要分析中，两组之间的 ECV 值无统计学差异（Hedges's g =3.20，95%CI-0.72-7.12，p =0.11，I =99%），而在敏感性分析中，接受蒽环类药物治疗的组中 ECV 值显著更高。
暴露于蒽环类药物的患者中较高的 T1 映射和 ECV 值可能代表 CTRCD 的早期生物标志物，能够检测到在明显的心肌功能障碍出现之前存在的亚临床心肌变化。我们的研究结果强调需要进一步研究蒽环类药物化疗与 CMR 映射参数变化之间的相关性，这可能为该类患者的未来个性化随访策略提供指导。
