Cardiotoxicity in breast cancer treatment: What about left ventricular diastolic function and left atrial function?
Cardiotoxicity in breast cancer treatment: What about left ventricular diastolic function and left atrial function?
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DOI：
10.1111/echo.14487
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发表时间：
2019-10-01
影响因子：
1.5
通讯作者：
Ferreira, Rui Cruz
中科院分区：
文献类型：
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作者：
Timoteo, Ana Teresa;Branco, Luisa Moura;Ferreira, Rui Cruz
目的心脏毒性是癌症治疗的一种可能的并发症，尤其是使用蒽环类药物和抗HER2药物。收缩功能障碍已经被描述过了。对舒张期功能不全和左房功能的研究较少。我们试图分析心脏毒性治疗对左室舒张功能和左房(LA)功能的影响。方法与结果对100例乳腺癌患者(均为女性，平均年龄54+/-12岁)进行了为期1年的3次检查的回顾性研究。排除了有癌症治疗史、冠状动脉疾病、严重瓣膜病和房性心律失常的患者。根据国际标准对舒张期功能不全进行分类，并用二维散斑追踪技术分析左心房应变。在我们的样本中，74%接受了蒽环类药物治疗，83%接受了抗HER2治疗，76%接受了放射治疗。在随访中，20%的患者出现新的或恶化的舒张期功能障碍。年龄是唯一的独立预测因素(OR 1.93，95%CI 1.04~3.58，P=0.037)。在左房功能方面，20.8%的患者仅收缩功能显著降低，年龄也是唯一的独立预测因素，但具有保护作用(OR 0.51，95%CI 0.28~0.91，P=0.023)。结论在乳腺癌治疗过程中，20%的患者出现新的或恶化的舒张期功能障碍，年龄是主要决定因素，提示化疗对老年患者的影响更大。左心房收缩功能也受到损害，但在这种情况下，年龄似乎具有保护作用。我们的结果支持对老年患者进行更严格的监测，以最终调整化疗方案。
Aims Cardiotoxicity is a possible complication of cancer treatment, particularly with anthracyclines and anti-HER2 drugs. Systolic dysfunction has already been described. Diastolic dysfunction and left atrial function are less studied. We sought to analyze the impact of cardiotoxic treatments on left ventricular diastolic function and left atrial (LA) function. Methods and Results Retrospective study of 100 patients (all women, with a mean age of 54 +/- 12 years) with three exams in the span of 1 year during treatment for breast cancer. Patients with previous cancer treatment, coronary artery disease, significant valvular disease, and atrial arrhythmias were excluded. Diastolic dysfunction was classified according to international guidelines and left atrial strain was analyzed by two-dimensional speckle tracking. In our sample, 74% received anthracyclines, 83% anti-HER2, and 76% radiation treatment. In the follow-up, 20% developed new or worsening diastolic dysfunction. Age was the only independent predictor (OR 1.93, 95% CI 1.04-3.58, P = .037). In left atrial function, only the contractile function was significantly reduced in 20.8% of the patients and age was also the only independent predictor, but with a protective effect (OR 0.51, 95% CI 0.28-0.91, P = .023). Conclusions During breast cancer treatment, 20% of the patients develop new or worsening diastolic dysfunction, being age the main determinant, suggesting higher impact of chemotherapy in older patients. Contractile left atrial function is also compromised but, in this case, age seems to be protective. Our results support a stricter surveillance in older patients together to eventually adjust chemotherapy regimens.