Zhang Ning, Wang Na, Zhang Yanyan, Liu Ya, Pei Miaomiao, Liu Gaiqin, Jia Xinle, Guo Xuejia
Department of Ultrasound, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Front Cardiovasc Med. 2024 Sep 13;11:1413827. doi: 10.3389/fcvm.2024.1413827. eCollection 2024.
Chemotherapy-induced cardiotoxicity poses a significant challenge in the treatment of breast cancer, potentially compromising both the efficacy of cancer therapy and cardiac health of patients. This study aimed to enhance the early detection of cardiotoxic effects by integrating advanced imaging modalities and biomarker analysis, thereby facilitating timely interventions to mitigate cardiac risk.
A prospective cohort design was employed, enrolling breast cancer patients scheduled for potentially cardiotoxic chemotherapy regimens. The study utilized a comprehensive diagnostic toolkit, including echocardiography with strain imaging, cardiac MRI, and serial measurements of cardiac biomarkers such as high-sensitivity troponins and natriuretic peptides.
The analysis revealed that subtle changes in myocardial strain parameters and early biomarker elevations were predictive of subsequent declines in left ventricular function, preceding conventional echocardiographic evidence of cardiotoxicity. Logistic regression analysis highlighted the additive predictive value of integrating biomarker data with advanced imaging findings to identify patients with the highest risk of significant cardiotoxicity.
The study concluded that an integrated diagnostic approach, combining detailed imaging assessments with sensitive biomarker analysis, offers a superior strategy for the early detection of chemotherapy-induced cardiotoxicity in breast cancer patients. This proactive diagnostic strategy empowers clinicians to tailor cancer therapy more precisely, balancing oncologic efficacy with cardiovascular safety and underscores the importance of a multidisciplinary approach in the management of patients undergoing potentially cardiotoxic chemotherapy.
化疗引起的心脏毒性在乳腺癌治疗中构成了重大挑战，可能会影响癌症治疗的疗效以及患者的心脏健康。本研究旨在通过整合先进的成像方式和生物标志物分析来加强对心脏毒性作用的早期检测，从而促进及时干预以降低心脏风险。
采用前瞻性队列设计，纳入计划接受可能具有心脏毒性化疗方案的乳腺癌患者。该研究使用了一套综合诊断工具，包括应变成像超声心动图、心脏磁共振成像以及对心脏生物标志物（如高敏肌钙蛋白和利钠肽）的系列测量。
分析显示，心肌应变参数的细微变化和生物标志物的早期升高可预测左心室功能随后的下降，这发生在心脏毒性的传统超声心动图证据出现之前。逻辑回归分析强调了将生物标志物数据与先进成像结果相结合以识别具有显著心脏毒性高风险患者的附加预测价值。
该研究得出结论，将详细的成像评估与敏感的生物标志物分析相结合的综合诊断方法，为早期检测乳腺癌患者化疗引起的心脏毒性提供了一种更优策略。这种积极主动的诊断策略使临床医生能够更精确地调整癌症治疗方案，在肿瘤疗效与心血管安全性之间取得平衡，并强调了多学科方法在管理接受可能具有心脏毒性化疗患者中的重要性。
