Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines
Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines
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DOI：
10.1200/jco.2004.06.022
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发表时间：
2004-03-01
影响因子：
45.3
通讯作者：
Zhao, HQ
中科院分区：
文献类型：
--
作者：
Silber, JH;Cnaan, A;Zhao, HQ
目的探讨血管紧张素转换酶(ACE)抑制剂依那普利能否预防长期存活的儿童癌症患者的心功能恶化(通过运动试验的最大心脏指数[MCI]或左心室收缩末期壁应力[LVESWS]增加来定义)。结果依那普利组和安慰剂组间MCI年变化率差异无统计学意义(0.30vs0.18 L/分/m~2)；P=.55)。然而，在第一年的治疗中，依那普利组的LVESWS变化率大于安慰剂组(-8.59比1.85克/厘米(2)；P=.033)，并且在整个研究期间保持了这种差异，导致依那普利组到第5年时估计的LVESWS减少了9%。由于心脏恶化而被随机分配接受治疗的7名患者中，有6名最初接受了安慰剂治疗(P=.11)，1名死于心力衰竭。依那普利的副作用包括头晕或低血压(安慰剂组为22%比3%；P=.0003)和乏力(10%比0%；P=.013)。结论依那普利治疗不影响运动能力，但在第一年确实减少了LVESWS；这种减少在整个研究期间保持。在做出治疗决定时，必须权衡在这一暴露于蒽环类药物的人群中减少LVESWS的任何理论益处与血管紧张素转换酶抑制剂的潜在副作用。(C)2004年，美国临床肿瘤学会。
Purpose To determine whether an angiotensin-converting enzyme (ACE) inhibitor, enalapril, prevents cardiac function deterioration (defined using maximal cardiac index [MCI] on exercise testing or increase in left ventricular end-systolic wall stress [LVESWS]) in long-term survivors of pediatric cancer.Patients and Methods This was a randomized, double-blind, controlled clinical trial comparing enalapril to placebo in 135 long-term survivors of pediatric cancer who had at least one cardiac abnormality identified at any time after anthracycline exposure.Results There was no difference in the rate of change in MCI per year between enalapril and placebo groups (0.30 v 0.18 L/min/m(2); P =.55). However, during the first year of treatment, the rate of change in LVESWS was greater in the enalapril group than in the placebo group (-8.59 v 1.85 g/cm(2); P = .033) and this difference was maintained over the study period, resulting in a 9% reduction in estimated LVESWS by year 5 in the enalapril group. Six of seven patients removed from random assignment to treatment because of cardiac deterioration were initially treated with placebo (P = .11), and one has died as a result of heart failure. Side effects from enalapril included dizziness or hypotension (22% v 3% in the placebo group; P = .0003) and fatigue (10% v 0%; P = .013).Conclusion Enalapril treatment did not influence exercise performance, but did reduce LVESWS in the first year; this reduction was maintained over the study period. Any theoretical benefits of LVESWS reduction in this anthracycline-exposed population must be weighed against potential side effects from ACE inhibitors when making treatment decisions.(C) 2004 by American Society of Clinical Oncology.