Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment.
Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment.
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DOI：
10.5935/abc.20180021
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发表时间：
2018-03
影响因子：
2.6
通讯作者：
Sousa AS
中科院分区：
文献类型：
--
作者：
Gripp EA;Oliveira GE;Feijó LA;Garcia MI;Xavier SS;Sousa AS
早期使用心脏保护药物可以降低与乳腺癌抗肿瘤治疗相关的高心脏毒性发病率和死亡率。然而，左室射血分数的低敏感性限制了其在该预防策略中的应用。新的参数，如全球纵向应变，正在用于早期检测收缩功能的变化。评估乳腺癌患者心脏毒性的发生率，与该事件相关的独立因素，以及菌株早期识别它的能力。前瞻性观察研究：连续门诊诊断为乳腺癌，既往无抗肿瘤治疗，无心室功能障碍，接受蒽环类药物和/或曲妥珠单抗治疗的患者。每季度对患者进行6至12个月的随访，由一名对治疗不知情的观察者进行评估。使用Cox回归来评估心脏毒性与临床、治疗和超声心动图变量的关系。建立ROC曲线，确定第3个月的应变截止点，可以预测第6个月的射血分数下降。所有检验采用的统计学显著性水平为p≤0.05。49名女性（平均年龄49.7±12.2岁），在第三个月（n = 2）和第六个月（n = 3）个月的随访中，有5名（10%）发现心脏毒性。菌株与事件独立相关（p = 0.004; HR = 2.77; 95%CI: 1.39 ~ 5.54），绝对值的截断点为-16.6 (AUC = 0.95; 95%CI: 0.87 ~ 1.0)，百分比减少的截断点为14% （AUC = 0.97; 95%CI: 0.9 ~ 1.0）。菌株减少14%（绝对值为-16.6）可以早期识别可能发生蒽环类药物和/或曲妥珠单抗诱导的心脏毒性的患者。
The high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes. To assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early. Prospective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05. Of 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0). The 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.
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影响因子：
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作者：
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通讯作者：
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