Valdés Olmos R A, ten Bokkel Huinink W W, ten Hoeve R F, van Tinteren H, Bruning P F, van Vlies B, Hoefnagel C A
Dept. of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam.
Eur J Cancer. 1995;31A(1):26-31. doi: 10.1016/0959-8049(94)00357-b.
Myocardial adrenergic neuron integrity and function were evaluated in 21 patients who had received doxorubicin or epirubicin for various malignancies. Myocardial uptake of iodine-123 metaiodobenzylguanidine ([123I]MIBG), a marker suitable for the study of myocardial neuron injury, was calculated from planar scintigraphic images after 4 h and the washout between 15 min and 4 h. In 13 patients with normal left ventricle ejection fraction (LVEF) analysed at three cumulative dose levels (no, low and middle dose), [123I]MIBG uptake tended to be significantly impaired (z = -2.772, P = 0.0056), at higher cumulative dose levels, before significant LVEF changes were observed. [123I]MIBG values were considerably decreased in 2/7 patients investigated at low cumulative dose and in 3/8 cases at the middle dose level. On follow-up, 1 of these patients, who had normal LVEF after completion of chemotherapy but whose [123I]MIBG values had progressively deteriorated during anthracycline therapy, subsequently developed congestive heart failure; another patient, whose [123I]MIBG values were impaired at the middle dose level, developed persistent reduced LVEF 5 months after completing therapy. In 8 patients, who had developed persistently, reduced LVEF at high doxorubicin cumulative dose levels, [123I]MIBG, performed in the period after chemotherapy discontinuation, was invariably abnormal. These data suggest that myocardial adrenergic derangement plays a role in anthracycline-associated cardiotoxicity: its appearance, even at low cumulative anthracycline dose levels, may reflect impairment of the intravesicular norepinephrine storage by incipient anthracycline-associated cardiac neuron injury. [123I]MIBG scintigraphy may be useful to assess myocardial adrenergic derangement during and in the follow-up of anthracycline therapy and potentially detect patients who are at risk.
对21例因各种恶性肿瘤接受多柔比星或表柔比星治疗的患者的心肌肾上腺素能神经元完整性和功能进行了评估。从4小时后的平面闪烁图像以及15分钟至4小时之间的洗脱情况计算心肌对碘-123间碘苄胍（[123I]MIBG）的摄取，[123I]MIBG是一种适用于研究心肌神经元损伤的标志物。在13例左心室射血分数（LVEF）正常的患者中，按三个累积剂量水平（无、低和中剂量）进行分析，在观察到显著的LVEF变化之前，较高累积剂量水平时，[123I]MIBG摄取往往显著受损（z = -2.772，P = 0.0056）。在低累积剂量研究的7例患者中有2例以及中剂量水平的8例患者中有3例[123I]MIBG值显著降低。随访发现，这些患者中有1例化疗结束后LVEF正常，但在蒽环类药物治疗期间其[123I]MIBG值逐渐恶化，随后发展为充血性心力衰竭；另1例患者在中剂量水平时[123I]MIBG值受损，在完成治疗5个月后LVEF持续降低。在8例因高多柔比星累积剂量水平导致LVEF持续降低的患者中，化疗停药后进行的[123I]MIBG检查均异常。这些数据表明，心肌肾上腺素能紊乱在蒽环类药物相关心脏毒性中起作用：即使在蒽环类药物低累积剂量水平时其出现，可能反映早期蒽环类药物相关心脏神经元损伤导致的囊泡内去甲肾上腺素储存受损。[123I]MIBG闪烁扫描可能有助于评估蒽环类药物治疗期间及随访中的心肌肾上腺素能紊乱，并可能检测出有风险的患者。
