Farshidgohar Mina, Vafaie Majid, Oveisi Sonia, Bakhshi Maryam
Clinical Research Development Unit of Advanced Medicine, Qazvin University of Medical Science, Qazvin, Iran.
Non-communicable Diseases Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
PLoS One. 2025 Aug 7;20(8):e0328632. doi: 10.1371/journal.pone.0328632. eCollection 2025.
Adriamycin (doxorubicin hydrochloride) is a widely used chemotherapeutic agent for treating various malignancies. However, its most significant adverse effect is cardiac toxicity. Early detection of Adriamycin-induced cardiac dysfunction is crucial in preventing heart failure through interventions such as angiotensin-converting enzyme inhibitors and beta-blockers. Adriamycin-induced cardiotoxicity is classified into Type I (irreversible, involving cardiomyocyte necrosis) and Type II (potentially reversible, involving cardiomyocyte dysfunction). Type I toxicity is more common, leading to long-term heart cell necrosis. Monitoring cardiac function in children receiving Adriamycin is essential. Non-invasive imaging techniques like transthoracic echocardiography, cardiac magnetic resonance imaging, and computed tomography are used to evaluate left ventricular (LV) systolic and diastolic functions. However, the role of cardiac Troponin I for early detection of anthracycline-induced cardiomyopathy remains debated.
This prospective study included 50 children (26 males, 24 females) with a median age of 8 years (range: 2-14) receiving Adriamycin. Troponin I levels were measured before and 24 hours after Adriamycin administration. Standard Doppler Echocardiography and Tissue Doppler Imaging (TDI) were performed at baseline, one month, and six months' post-treatment to assess LV function.
Out of 50 patients, two showed a decrease in left ventricular ejection fraction (LVEF) below the normal range (<55%) one month post-treatment, along with significant increases in Troponin I levels. No significant decline in LVEF was observed at one or six months' post-treatment using Standard Doppler Echocardiography. However, TDI revealed a decrease in LV systolic and diastolic function in all patients one month after Adriamycin administration.
TDI is more sensitive than Standard Doppler Echocardiography in detecting Adriamycin-induced cardiotoxicity. Elevated cardiac Troponin I levels correlate with a decline in LVEF, but subclinical cardiac dysfunction is better detected with TDI.
阿霉素（盐酸多柔比星）是一种广泛用于治疗各种恶性肿瘤的化疗药物。然而，其最显著的不良反应是心脏毒性。早期发现阿霉素引起的心脏功能障碍对于通过使用血管紧张素转换酶抑制剂和β受体阻滞剂等干预措施预防心力衰竭至关重要。阿霉素引起的心脏毒性分为I型（不可逆，涉及心肌细胞坏死）和II型（潜在可逆，涉及心肌细胞功能障碍）。I型毒性更为常见，会导致长期心脏细胞坏死。监测接受阿霉素治疗的儿童的心脏功能至关重要。诸如经胸超声心动图、心脏磁共振成像和计算机断层扫描等非侵入性成像技术用于评估左心室（LV）的收缩和舒张功能。然而，心肌肌钙蛋白I在早期检测蒽环类药物引起的心肌病中的作用仍存在争议。
这项前瞻性研究纳入了50名接受阿霉素治疗的儿童（26名男性，24名女性），中位年龄为8岁（范围：2 - 14岁）。在阿霉素给药前和给药后24小时测量肌钙蛋白I水平。在基线、治疗后1个月和6个月进行标准多普勒超声心动图和组织多普勒成像（TDI）以评估左心室功能。
50名患者中，有两名在治疗后1个月左心室射血分数（LVEF）降至正常范围以下（<55%），同时肌钙蛋白I水平显著升高。使用标准多普勒超声心动图在治疗后1个月或6个月未观察到LVEF有显著下降。然而，TDI显示所有患者在阿霉素给药后1个月左心室收缩和舒张功能下降。
在检测阿霉素引起的心脏毒性方面，TDI比标准多普勒超声心动图更敏感。心肌肌钙蛋白I水平升高与LVEF下降相关，但TDI能更好地检测亚临床心脏功能障碍。
