Ivane Javakhishvili Tbilisi State University (TSU), Georgia.
Georgian Med News. 2024 Jul-Aug(352-353):284-293.
Anti-cancer therapy with anthracyclines and trastuzumab has raised concerns regarding cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer (BC) patients. This study aimed to assess left ventricular (LV) ultrasound parameters in BC postmenopausal women during a 2-year follow-up period after starting anti-cancer therapy.
We studied 74 women with early-stage BC with, a mean age of 62.3 (SD-8.6), who underwent adjuvant doxorubicin or doxorubicin + trastuzumab therapy. Parameters such as LV ejection fraction (LVEF), global longitudinal strain (LVGLS), and mitral annulus systolic velocity(S') were evaluated. Serial evaluations were conducted at baseline(T0) and the first (T1), second (T2), third (T3), sixth (T4), ninth (T5), twelfth (T6), and twenty-fourth month (T7) following the initiation of the chemotherapy. Cardioprotective therapy (CPT) was administered to high-risk patients and those with worsening LV systolic parameters. A multiple regression model was employed to assess the combined effects of various factors and co-factors on the outcome variables. Cardiotoxicity was evaluated using the survival analysis tools (Kaplan-Meier curves and Cox proportional model).
A total of 27 (36.5%) patients developed CTRCD, although no patients were presented with symptomatic heart failure. LVGLS started to decline one month after the first anthracycline dose (T1) in 13.5% of the cohort and 34.5% of patients with CTRCD (p<0.000). From the third month, 10.8% of the patients showed a decrease in EF%, including 27.6% of patients with CTRCD in (P<0.000). Throughout, the study, S' remained within the normal range in patients without CTRCD, only patients with CTRCD showed a decline in S'.
This prospective study revealed that:1) The dynamic assessment of GLS should be prioritized for the early detection of systolic dysfunction .2) S' possesses a high diagnostic value for identifying cardiotoxicity. 3) Implementing the optimal medical cardioprotective strategies and closely monitoring LV systolic function can prevent serious cardiac complications in patients undergoing highly cardiotoxic anti-cancer treatment.
评估乳腺癌（BC）绝经后女性在开始抗癌治疗后 2 年的随访期间左心室（LV）超声参数。
我们研究了 74 名接受辅助多柔比星或多柔比星+曲妥珠单抗治疗的早期 BC 女性患者，平均年龄为 62.3（SD-8.6）岁。评估了 LV 射血分数（LVEF）、整体纵向应变（LVGLS）和二尖瓣环收缩速度（S'）等参数。基线（T0）和第一次（T1）、第二次（T2）、第三次（T3）、第六次（T4）、第九次（T5）、第十二次（T6）和第二十四次（T7）进行了连续评估化疗开始后一个月。对高危患者和 LV 收缩参数恶化的患者进行心脏保护治疗（CPT）。采用多元回归模型评估各种因素和协变量对因变量的综合影响。使用生存分析工具（Kaplan-Meier 曲线和 Cox 比例模型）评估心脏毒性。
共有 27 名（36.5%）患者发生 CTRCD，但无患者出现症状性心力衰竭。在队列中的 13.5%和 34.5%的 CTRCD 患者中，LVGLS 在第一次蒽环类药物剂量后一个月（T1）开始下降（p<0.000）。从第三个月开始，10.8%的患者 EF%下降，其中 27.6%的患者有 CTRCD（P<0.000）。在整个研究过程中，无 CTRCD 的患者 S'仍在正常范围内，只有 CTRCD 的患者 S'下降。
这项前瞻性研究表明：1）动态评估 GLS 应优先用于早期检测收缩功能障碍。2）S'对识别心脏毒性具有很高的诊断价值。3）实施最佳的医学心脏保护策略并密切监测 LV 收缩功能，可以防止接受高心脏毒性抗癌治疗的患者发生严重心脏并发症。
