Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, 2713, Doha, Qatar.
Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
Cardiovasc Toxicol. 2024 Jun;24(6):563-575. doi: 10.1007/s12012-024-09866-1. Epub 2024 May 3.
Anthracycline antibiotic is one of the most effective anti-tumor drugs used to manage certain types of breast cancers, lymphomas, and leukemias. However, anthracyclines induce a dose-dependent cardiotoxicity that may progress to heart failure. Thus, using a sensitive predictor of early cardiac dysfunction in patients treated with anthracyclines can help detect subclinical cardiac dysfunction early and help initiate interventions to protect these patients. Among parameters of myocardial measure, cardiac magnetic resonance (CMR)-measured native myocardial T1 mapping is considered a sensitive and accurate quantitative measure of early subclinical cardiac changes, particularly cardiac inflammation and fibrosis. However, to understand the quality and the validity of the current evidence supporting the use of these measures in patients treated with anthracyclines, we aimed to conduct a systematic review of clinical studies of this measure to detect early myocardial changes in cancer patients treated with anthracyclines. The primary outcome was the level of native T1 mapping. We performed fixed-effects meta-analyses and assessed certainty in effect estimates. Of the 1780 publications reviewed (till 2022), 23 were retrieved, and 9 articles met the inclusion criteria. Our study showed that exposure to anthracycline was associated with a significant elevation of native myocardial T1 mapping from baseline (95% CI 0.1121 to 0.5802; p = 0.0037) as well as compared to healthy control patients (95% CI 0.2925 to 0.7448; p < 0.0001). No significant publication bias was noted on the assessment of the funnel plot and Egger's test. According to the Q test, there was no significant heterogeneity in the included studies (I = 0.0000% versus healthy controls and I = 14.0666% versus baseline). Overall, our study suggests that native myocardial T1 mapping is useful for detecting anthracycline-induced cardiotoxicity in patients with cancer.
蒽环类抗生素是用于治疗某些类型乳腺癌、淋巴瘤和白血病的最有效抗肿瘤药物之一。然而，蒽环类药物会引起剂量依赖性的心脏毒性，进而导致心力衰竭。因此，在接受蒽环类药物治疗的患者中使用一种能够早期预测心脏功能障碍的敏感指标，可以帮助早期发现亚临床心脏功能障碍，并有助于启动干预措施来保护这些患者。在心肌测量参数中，心脏磁共振（CMR）测量的心肌固有 T1 映射被认为是一种早期亚临床心脏变化的敏感和准确的定量测量方法，尤其是心脏炎症和纤维化。然而，为了了解支持在接受蒽环类药物治疗的患者中使用这些指标的当前证据的质量和有效性，我们旨在对该指标的临床研究进行系统综述，以检测接受蒽环类药物治疗的癌症患者的早期心肌变化。主要结局是固有 T1 映射的水平。我们进行了固定效应荟萃分析，并评估了效应估计的确定性。在审查的 1780 篇论文中（截止到 2022 年），有 23 篇被检索到，其中 9 篇文章符合纳入标准。我们的研究表明，与基线相比，暴露于蒽环类药物与心肌固有 T1 映射的显著升高相关（95%CI 0.1121 至 0.5802；p=0.0037），与健康对照组相比也有显著升高（95%CI 0.2925 至 0.7448；p<0.0001）。在漏斗图和 Egger 检验评估中未发现显著的发表偏倚。根据 Q 检验，纳入的研究无显著异质性（I=0.0000% 与健康对照组比较，I=14.0666% 与基线比较）。总体而言，我们的研究表明，心肌固有 T1 映射可用于检测癌症患者接受蒽环类药物治疗后的心脏毒性。
