Gottdiener J S, Appelbaum F R, Ferrans V J, Deisseroth A, Ziegler J
Arch Intern Med. 1981 May;141(6):758-63.
The cardiac effects of chemotherapeutic regimens using high doses of cyclophosphamide (180 mg/kg over four days) were assessed in 32 patients with hematologic malignant neoplasms. Left ventricular systolic function, determined by the fractional shortening on echocardiogram, declined substantially five to 16 days after the initiation of cyclophosphamide therapy. Although pericardial effusion on echocardiogram occurred in 33% of the patients studied, ECG voltage decreased five to 14 days after beginning cyclophosphamide therapy even in those patients without pericardial effusion. Congestive heart failure was noted in nine patients (28%) within three weeks of cyclophosphamide administration. Six of these patients (19%) died of myocardial failure. Pericardial tamponade occurred in six patients (19%), including five who died of myocardial failure. Histopathologic and electron microscopic findings showed endothelial injury and a hemorrhagic myopericarditis. Cyclophosphamide in this high dose is associated with a toxic, often fatal, pericardiomyopathy. Depression of ECG voltage and systolic left ventricular function, though common, do not necessarily predict clinical cardiac deterioration.
在32例血液系统恶性肿瘤患者中评估了使用高剂量环磷酰胺（4天内180mg/kg）的化疗方案对心脏的影响。通过超声心动图上的缩短分数确定的左心室收缩功能在环磷酰胺治疗开始后5至16天显著下降。虽然在研究的患者中有33%在超声心动图上出现心包积液，但即使在那些没有心包积液的患者中，心电图电压在开始环磷酰胺治疗后5至14天也会下降。在环磷酰胺给药后三周内，有9例患者（28%）出现充血性心力衰竭。其中6例患者（19%）死于心肌衰竭。6例患者（19%）发生心包填塞，其中5例死于心肌衰竭。组织病理学和电子显微镜检查结果显示内皮损伤和出血性心肌心包炎。这种高剂量的环磷酰胺与一种毒性的、通常致命的心包心肌病有关。心电图电压和左心室收缩功能的降低虽然常见，但不一定预示着临床心脏恶化。
