Ulmer H E, Ludwig R, Geiger H
Eur J Pediatr. 1979 Apr 25;131(1):21-31. doi: 10.1007/BF00442782.
In a prospective study, 44 children receiving Adriamycin (ADR) for various neoplastic diseases underwent serial estimations of the systolic time intervals (STI) for the noninvasive assessment of left ventricular myocardial performance. Five of the 44 children developed clinical signs of ADR-related congestive heart failure at a cumulative dose of less than 550 mg/m2 body surface area. Clinical symptoms, changes in the electrocardiogram and in the chest X-ray were preceded in every case by changes of the STI, mainly a prolongation of the left ventricular pre-ejection period (PEP), or a decrease of the ejection time (ET)/pre-ejection period (PEP) ratio (ET/PEP). A continous increase of the PEP and a decrease of the ET/PEP-ratio also gave an indication of myocardial dysfunction during ADR treatment in the other children without clinical signs of congestive heart failure. This subclinical cardiotoxic effect of ADR below the critical cumulative dose of 550 mg/m2 was observed in children with pre-existent myocardial damage, with preceding thoracic irradiation, or during concurrent chemotherapy, of which cyclophosphamide seemed to be most important. Thus, the estimation of the STI proved helpful and reliable in the early detection of incipient heart failure and in the selection of high risk patients in children receiving ADR treatment.
在一项前瞻性研究中，44名因各种肿瘤疾病接受阿霉素（ADR）治疗的儿童接受了一系列收缩期时间间期（STI）评估，以无创方式评估左心室心肌功能。44名儿童中有5名在累积剂量低于550mg/m²体表面积时出现了与ADR相关的充血性心力衰竭的临床症状。在每种情况下，临床症状、心电图和胸部X线的变化之前都有STI的变化，主要是左心室射血前期（PEP）延长，或射血时间（ET）/射血前期（PEP）比值（ET/PEP）降低。在没有充血性心力衰竭临床症状的其他儿童中，PEP持续增加和ET/PEP比值降低也表明在ADR治疗期间存在心肌功能障碍。在有心肌损伤史、先前接受胸部放疗或同时进行化疗的儿童中观察到ADR在低于550mg/m²的临界累积剂量时的这种亚临床心脏毒性作用，其中环磷酰胺似乎最为重要。因此，STI评估被证明在早期发现早期心力衰竭以及在接受ADR治疗的儿童中选择高危患者方面是有帮助且可靠的。
