Garzon-Dangond Juan Manuel, Ardila Maria F Gomez, Garcia Eduardo Tellez, Daryanani Andres E, Peethambaram Prema P, Thicke Lori A, Stan Daniela L, Villarraga Hector R
Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Cardiooncology. 2025 Jun 13;11(1):54. doi: 10.1186/s40959-025-00350-5.
Breast cancer survivors treated with radiotherapy (RT) face elevated long-term risk of cardiovascular complications. Double product (DP), the product of systolic blood pressure and heart rate, reflects myocardial workload and may serve as a simple prognostic marker. We evaluated whether peak DP during exercise or dobutamine stress echocardiography predicts major adverse cardiovascular events (MACE) and all-cause mortality (ACM).
We retrospectively studied patients who had breast cancer treated with RT and underwent follow-up testing with ESE or DSE from 2000 through 2022. Univariate and multivariate Cox regression models were used to evaluate the association between MACE/ACM and risk factors in each group. Kaplan-Meier analysis was used to compare ACM and MACE-free survival among the different DP quartiles.
Our study included 696 patients. ESE (n = 425) or DSE (n = 271) was performed at a median of 4.4 (IQR, 2.2-7.5) years after RT. For the ESE group, the rate of MACE was higher in the lowest quartile. Patients in the 3rd and 4th quartile had a decreased risk of MACE and ACM (hazard ratio [HR] per 1,000-mm Hg/min increase, 0.92 [95% CI, 0.88-0.97]; P < .001 and HR, 0.91 [95% CI, 0.87-0.96]; P < .001) respectively. Advanced age (> 60 years) was also seen to be a predictor of MACE in this group (HR, 5.22 [95% CI, 2.13-12.75]; P = < .001). Additionally, treatment with doxorubicin-based chemotherapy was associated with an increased risk of ACM but not MACE (HR, 1.78 [95% CI, 1.04-3.05]; P = .03). For the DSE group, rate of MACE was similar among DP quartiles, indicating that this is not a prognostic indicator. However, a history of diabetes and dyslipidemia were shown to be predictors of MACE (HR, 1.58 [95% CI, 1.05-2.37]; P = .02; and HR, 1.77 [95% CI, 1.12-2.79]; P = .01).
DP achieved during ESE but not DSE is an excellent tool for the prediction of MACE and ACM in this patient population; therefore, ESE should be recommended as the test of choice when possible. A history of atrial fibrillation, diabetes and dyslipidemia were identified as significant predictors of adverse cardiovascular outcomes in the DSE group, highlighting individualized monitoring and early intervention for patients at higher risk.
接受放射治疗（RT）的乳腺癌幸存者面临心血管并发症的长期风险升高。双乘积（DP），即收缩压与心率的乘积，反映心肌工作量，可作为一个简单的预后指标。我们评估了运动或多巴酚丁胺负荷超声心动图期间的峰值DP是否能预测主要不良心血管事件（MACE）和全因死亡率（ACM）。
我们回顾性研究了2000年至2022年期间接受RT治疗并接受运动负荷超声心动图（ESE）或多巴酚丁胺负荷超声心动图（DSE）随访检测的乳腺癌患者。单因素和多因素Cox回归模型用于评估每组中MACE/ACM与危险因素之间的关联。Kaplan-Meier分析用于比较不同DP四分位数之间的ACM和无MACE生存率。
我们的研究纳入了696例患者。ESE（n = 425）或DSE（n = 271）在RT后中位数4.4（IQR，2.2 - 7.5）年进行。对于ESE组，最低四分位数的MACE发生率更高。第三和第四四分位数的患者发生MACE和ACM的风险降低（每增加1000 mmHg/min的风险比[HR]分别为0.92 [95% CI，0.88 - 0.97]；P <.001和HR，0.91 [95% CI，0.87 - 0.96]；P <.001）。高龄（> 60岁）在该组中也是MACE的一个预测因素（HR，5.22 [95% CI，2.13 - 12.75]；P = <.001）。此外，基于阿霉素的化疗治疗与ACM风险增加相关，但与MACE无关（HR，1.78 [95% CI，1.04 - 3.05]；P =.03）。对于DSE组，DP四分位数之间的MACE发生率相似，表明这不是一个预后指标。然而，糖尿病和血脂异常病史被证明是MACE的预测因素（HR，1.58 [95% CI，1.05 - 2.37]；P =.02；和HR，1.77 [95% CI，1.12 - 2.79]；P =.01）。
ESE期间达到的DP而非DSE期间达到的DP是预测该患者群体MACE和ACM的优秀工具；因此，应尽可能推荐ESE作为首选检测方法。房颤、糖尿病和血脂异常病史被确定为DSE组不良心血管结局的重要预测因素，突出了对高危患者进行个体化监测和早期干预的重要性。
