Del Bene Maria Riccarda, Meattini Icro, Pilato Giuseppe, Becherini Carlotta, Martella Francesca, Salvestrini Viola, Marrazzo Livia, Saieva Calogero, Olivotto Iacopo, Barletta Giuseppe, Livi Lorenzo
Diagnostic Cardiology, CardioThoracic and Vascular Department, Careggi University Hospital, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.
Echocardiography. 2025 Sep;42(9):e70291. doi: 10.1111/echo.70291.
To evaluate the effects of cardioprotective therapy (CPT) with neurohormonal inhibitors on cancer therapeutics-related cardiac dysfunction (CTRCD) in breast cancer patients, focusing on right ventricular (RV) function.
This is a secondary analysis of SAFE study, a randomized, phase 3, double-blind, placebo-controlled, four-arm trial, in which the effects of short-term CPT (bisoprolol, ramipril, or both) compared to placebo (P-arm) on subclinical CTRCD were evaluated in 222 women without cardiac risk factors who received intensive anthracycline-based chemotherapy (median isoequivalent doxorubicin dose 288 mg/m). Among them, 35% received trastuzumab, 98% taxanes, 22% underwent neoadjuvant therapy, 78% adjuvant therapy, and 56% had postoperative radiotherapy. CPT started with chemotherapy and continued for 1 year, or until the completion of trastuzumab therapy. All the patients underwent cardiac surveillance at baseline and 3, 6, 12, and 24 months. Left ventricular CTRCD was assessed following the 2022 ESC guidelines. RV function was evaluated according to established recommendations. RV CTRCD was defined as a greater than 10% reduction in RV fractional area change (FAC).
At 24 months, LV CTRCD was observed in 42.9% of P-arm and 3.1% of the CPT arms (p < 0.001). Compared to the CPT arms, there was a significant reduction in RV FAC (-10.5%), S'-wave velocity (-12.2%), and tricuspid annular plane systolic excursion (-9.6%) in the P-arm. Additionally, the RV diameter increased by 7% in the P-arm. RV CTRCD was found in 49.2% of the P-arm and 22% of the CPT arms (p < 0.001).
Short-term neurohormonal cardioprotection was effective in reducing RV CTRCD.
评估使用神经激素抑制剂的心脏保护疗法（CPT）对乳腺癌患者癌症治疗相关心脏功能障碍（CTRCD）的影响，重点关注右心室（RV）功能。
这是对SAFE研究的二次分析，SAFE研究是一项随机、3期、双盲、安慰剂对照的四臂试验，在222名无心脏危险因素且接受强化蒽环类化疗（中位等效阿霉素剂量288mg/m）的女性中，评估了短期CPT（比索洛尔、雷米普利或两者联用）与安慰剂（P组）相比对亚临床CTRCD的影响。其中，35%接受曲妥珠单抗治疗，98%接受紫杉烷治疗，22%接受新辅助治疗，78%接受辅助治疗，56%接受术后放疗。CPT在化疗开始时进行，并持续1年，或直至曲妥珠单抗治疗完成。所有患者在基线、3、6、12和24个月时接受心脏监测。左心室CTRCD根据2022年欧洲心脏病学会（ESC）指南进行评估。RV功能根据既定建议进行评估。RV CTRCD定义为RV面积变化分数（FAC）降低超过10%。
在24个月时，P组中42.9%观察到左心室CTRCD，CPT组中为3.1%（p<0.001）。与CPT组相比，P组的RV FAC（-10.5%）、S波速度（-12.2%）和三尖瓣环平面收缩期位移（-9.6%）显著降低。此外，P组的RV直径增加了7%。P组中49.2%发现RV CTRCD，CPT组中为22%（p<0.001）。
短期神经激素心脏保护在降低RV CTRCD方面有效。
