Early and late changes in markers of aortic stiffness with breast cancer therapy
Early and late changes in markers of aortic stiffness with breast cancer therapy
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DOI：
10.1111/imj.12645
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发表时间：
2015-02-01
影响因子：
2.1
通讯作者：
Selvanayagam, J. B.
中科院分区：
文献类型：
--
作者：
Grover, S.;Lou, P. W.;Selvanayagam, J. B.
蒽环类药物和曲妥珠单抗是公认的心脏毒性药物。除了对左心室（LV）功能的影响外，蒽环类药物特别被认为会引起负性动脉重塑。这些变化是否会逆转还不得而知。接受这些药物治疗乳腺癌的患者和健康志愿者前瞻性地在基线、治疗后1、4和14个月进行临床评价和心血管磁共振（CMR）成像，包括功能评估，采用速度编码成像和扩张性测量升主动脉（AA）和近端降主动脉（PDA）的主动脉脉搏波速度（PWV）。扩张性和LV功能。在癌症患者中，PWV在4个月时急剧增加，P = 0.002，然后在14个月时下降（P < 0.001）。此外，在开始治疗的1个月（P = 0.001）和4个月（P < 0.001）内观察到AA的扩张性降低。在PDA，与基线相比，仅在14个月时观察到扩张性显著降低，P < 0.001。蒽环类药物治疗组主动脉扩张性随时间的延长而降低，1个月时P = 0.005，4个月时P < 0.001，14个月时P = 0.009.Conclusion：乳腺癌化疗后，主动脉扩张性和PWV发生了急性变化，停药1年后部分逆转。用蒽环类药物观察到更严重的影响。
BackgroundAnthracyclines and trastuzumab are well recognised to cause cardiac toxicity. Further to their effects on left ventricular (LV) function, anthracyclines in particular are considered to cause negative arterial remodelling. Whether these changes reverse is unknown. In addition, whether trastuzumab causes specific effects on arterial remodelling is yet undetermined.MethodsPatients receiving these agents for treatment of breast cancer and healthy volunteers prospectively underwent clinical evaluation and cardiovascular magnetic resonance (CMR) imaging at baseline, 1, 4 and 14 months post-therapy, including functional assessment, measurement of aortic pulse wave velocity (PWV) using velocity encoded imaging and distensibility at ascending aorta (AA) and proximal descending aorta (PDA).ResultsTwenty-nine patients pretherapy and 12 volunteers demonstrated no differences in PWV, distensibility and LV function. Among cancer subjects, PWV increased acutely, P = 0.002 (4 months), then decreased by 14 months (P < 0.001). In addition, a decrease was observed in distensibility at the AA within 1 (P = 0.001) and 4 months (P < 0.001) of commencing therapy. At the PDA, only significant reduction was observed at 14 month distensibility when compared with baseline, P < 0.001. Patients with anthracycline exposure only had a greater reduction in aortic distensibility in the AA with time, P = 0.005 at 1 month, P < 0.001 at 4 months and P = 0.009 at 14 months.ConclusionAcute changes are observed in PWV and distensibility at the AA following contemporary breast cancer chemotherapy and partially reverse a year after therapy is discontinued, with more severe effects seen with anthracyclines.