Gąsior Tomasz, Zaborska Beata, Stachowiak Paweł, Sikora-Frąc Małgorzata, Mizia-Stec Katarzyna, Kasprzak Jarosław, Bodys Artur, Bijoch Julia, Szmagała Adrianna, Kosior Dariusz A, Płońska-Gościniak Edyta
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland.
Boehringer Ingelheim International GmbH, 55218 Ingelheim, Germany.
J Clin Med. 2024 Apr 26;13(9):2543. doi: 10.3390/jcm13092543.
: Oncological treatment of breast cancer may be associated with adverse effects on myocardial function. : The objective of this study was to compare the influence of three oncological treatment methods of intervention on the echocardiographic (ECHO) parameters of left ventricular function. : One hundred and fifty-five women with breast cancer were divided into three groups depending on the type of therapy used: group I (AC)-anthracyclines; group II (AC + TZ)-anthracyclines + trastuzumab; and group III (RTls+)-anthracyclines with or without trastuzumab + left-sided radiotherapy. Prospective ECHO examinations were performed at baseline and every 3 months, up to 12 months from the start of the therapy. Patients with a history of chemotherapy or who were diagnosed with heart disease were not included in the study. : Out of 155 patients, 3 died due to cancer as the primary cause, and 12 withdrew their consent for further observation. Baseline systolic and diastolic ECHO parameters did not differ between the analyzed groups. Cardiotoxicity, according to the LVEF criteria, occurred during follow-up in 20 patients (14.3%), irrespective of the treatment method used. Diastolic echocardiographic parameters did not change significantly after 12 months in each group, except for the left atrial volume index (LAVi), which was significantly higher in the AC + TZ compared to the values in the RTls+ group. : All three oncologic therapeutic modalities in women with breast cancer showed no significant differences in relation to the incidence of echocardiographic cardiotoxicity criterion; however, transient systolic decrease in LVEF was most frequently observed in the AC + TZ therapeutic regimen. Left-sided radiotherapy was not associated with excess left ventricular systolic and diastolic dysfunction during a 12-month follow-up period. The predictors of negative changes in diastolic parameters included age and combined anthracycline and trastuzumab therapy.
乳腺癌的肿瘤治疗可能会对心肌功能产生不良影响。本研究的目的是比较三种肿瘤干预治疗方法对左心室功能超声心动图(ECHO)参数的影响。155名乳腺癌女性根据所采用的治疗类型分为三组:第一组(AC)——蒽环类药物;第二组(AC + TZ)——蒽环类药物+曲妥珠单抗;第三组(RTls+)——含或不含曲妥珠单抗的蒽环类药物+左侧放疗。在基线时以及治疗开始后的每3个月进行一次前瞻性ECHO检查,直至治疗开始后的12个月。有化疗史或被诊断患有心脏病的患者未纳入本研究。在155名患者中,3人因癌症作为主要原因死亡,12人撤回了进一步观察的同意书。分析组之间的基线收缩期和舒张期ECHO参数没有差异。根据左心室射血分数(LVEF)标准,在随访期间有20名患者(14.3%)发生了心脏毒性,无论采用何种治疗方法。除左心房容积指数(LAVi)外,每组在12个月后舒张期超声心动图参数没有显著变化,AC + TZ组的LAVi显著高于RTls+组。乳腺癌女性的所有三种肿瘤治疗方式在超声心动图心脏毒性标准的发生率方面均无显著差异;然而,在AC + TZ治疗方案中最常观察到LVEF的短暂收缩期下降。在12个月的随访期内,左侧放疗与左心室收缩和舒张功能障碍增加无关。舒张期参数负面变化的预测因素包括年龄以及蒽环类药物和曲妥珠单抗联合治疗。