Mazzarello G P, Morra L
Istituto Scientifico di Medicina Interna, Università, Genova.
Recenti Prog Med. 1998 Sep;89(9):459-64.
Cardiotoxicity is the most important side effect of the highly effective chemotherapeutic drugs anthracyclines. The total dose that must not be surpassed to avoid cardiotoxicity is specific for each anthracycline. For doxorubicin the maximal dose is 450-550 mg/mq. Nevertheless cardiotoxicity can be observed in some cases even with doses smaller than the critical ones. Clinical signs of cardiotoxic damage can appear at any stage during the course of therapy. The prevention of cardiac damage can be tried in three ways. Firstly one should extend the administration period of the total dose of the drug for about 6 hours. The second way is based on the use of anthracycline analogs less toxic and possibly equally effective than doxorubicin. Finally one can associate to the anthracycline a cardioprotective drug such as ICRF187. The diagnosis of cardiotoxicity is usually reached evaluating the reduction of left ventricular ejection fraction either with echocardiography or with angiocardiography. Other parameters, particularly those evaluating the diastolic function, are under study to make the diagnosis more quick and accurate. Both cardiac scintigraphy and tomography also seem to offer promising tools for the diagnosis of anthracycline cardiotoxicity. Endomyocardiac biopsy is highly effective for the diagnosis, but is indicated only for selected cases. The therapy of anthracycline cardiomyopathy is directed mainly to the control of congestive heart failure. In the initial phase the treatment is based on the use of digitalis and diuretics, that are substituted in the following maintaining phase by ACE inhibitors.
心脏毒性是高效化疗药物蒽环类药物最重要的副作用。为避免心脏毒性，每种蒽环类药物都有特定的不可超过的总剂量。对于阿霉素，最大剂量为450 - 550毫克/平方米。然而，即使剂量低于临界剂量，在某些情况下也可能观察到心脏毒性。心脏毒性损害的临床症状可在治疗过程中的任何阶段出现。预防心脏损害可尝试三种方法。首先，应将药物总剂量的给药期延长约6小时。第二种方法是使用毒性较小且可能与阿霉素同样有效的蒽环类类似物。最后，可以将一种心脏保护药物如ICRF187与蒽环类药物联合使用。心脏毒性的诊断通常通过超声心动图或心血管造影评估左心室射血分数的降低来实现。正在研究其他参数，特别是那些评估舒张功能的参数，以使诊断更快速、准确。心脏闪烁扫描和断层扫描似乎也为蒽环类心脏毒性的诊断提供了有前景的工具。心内膜心肌活检对诊断非常有效，但仅适用于特定病例。蒽环类心肌病的治疗主要针对控制充血性心力衰竭。在初始阶段，治疗基于使用洋地黄和利尿剂，在随后的维持阶段用ACE抑制剂替代。
