Ritchie J L, Singer J W, Thorning D, Sorensen S G, Hamilton G W
Cancer. 1980 Sep 1;46(5):1109-16. doi: 10.1002/1097-0142(19800901)46:5<1109::aid-cncr2820460506>3.0.co;2-b.
A clinical syndrome of severe cardiomyopathy often accompanies administration of high doses of anthracycline agents. We studied 36 patients serially with radionuclide angiography. At three weeks following drug administration, 8 of 36 patients showed depression of ejection fraction (EF). All had received at least 280 mg/m2 of the drug and 7 had received more than 380 mg/M2. Definite clinical syndromes of congestive cardiomyopathy developed only in patients showing EF depression and in some patients, EF depression developed without signs of congestive heart failure. Ejection fraction studies at 5 minutes, 1 hour, 4 hours, 24 hours, 72 hours, and one week following drug administration showed no changes when compared to immediate preg-drug EF. Seven patients who died during the study underwent histologic examination. Only the single patient with a depressed EF showed histologic evidence of athracycline cardiotoxicity, although all but 1 of these patients had received at least 400 mg/M2. We conclude that serial radionuclide EF just prior to anthracycline administration is a potentially useful predictor of cardiac toxicity, and that EF depression and/or preservation of a normal EF should be weighed in the decision for administering a drug of this type at high dosage levels.
高剂量蒽环类药物给药时常伴有严重心肌病的临床综合征。我们对36例患者进行了连续放射性核素血管造影研究。给药三周后，36例患者中有8例射血分数（EF）降低。所有患者至少接受了280mg/m²的药物，7例接受了超过380mg/m²的药物。充血性心肌病明确的临床综合征仅在射血分数降低的患者中出现，而在一些患者中，射血分数降低时无充血性心力衰竭的体征。与给药前即刻的射血分数相比，给药后5分钟、1小时、4小时、24小时、72小时和1周的射血分数研究无变化。研究期间死亡的7例患者进行了组织学检查。尽管除1例患者外所有患者至少接受了400mg/m²的药物，但仅1例射血分数降低的患者有蒽环类药物心脏毒性的组织学证据。我们得出结论，蒽环类药物给药前连续放射性核素射血分数是心脏毒性的潜在有用预测指标，在决定高剂量使用此类药物时应权衡射血分数降低和/或正常射血分数的维持情况。
