Cardiac abnormalities 15 years and more after adriamycin therapy in 229 childhood survivors of a solid tumour at the Institut Gustave Roussy.
Cardiac abnormalities 15 years and more after adriamycin therapy in 229 childhood survivors of a solid tumour at the Institut Gustave Roussy.
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阿霉素治疗后229个幼儿园幸存者的心脏异常15年及以后，在古斯塔夫·鲁西斯研究院（Institut Gustave Roussy）。
DOI：
10.1038/sj.bjc.6601904
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发表时间：
2004-07-05
影响因子：
8.8
通讯作者：
Hartmann, O
中科院分区：
文献类型：
--
作者：
Pein, F;Sakiroglu, O;Dahan, M;Lebidois, J;Merlet, P;Shamsaldin, A;Villain, E;de Vathaire, F;Sidi, D;Hartmann, O
本文的目的是确定心脏状态的儿童阿霉素治疗后15年或以上的实体瘤。在447例患者中，229例患者接受了充分研究，218例未接受研究。建议对所有447例连续患者（患者）进行以下心脏评价：（1）由两名心脏病专家之一进行心脏多普勒超声检查;（2）心律和传导异常，包括24小时动态霍尔特心电图;（3）131 l-mlBG心肌造影;（4）静息时血清脑钠肽水平;（5）运动试验和最大摄氧量测量。对所有接受放射治疗的患者，估计了心脏6个点的辐射剂量。在229例（10%）评价患者中，24例诊断为充血性心力衰竭，从阿霉素治疗后首次出现症状的中位间隔时间为15年（0.3-24年）。其余205例患者中，13例无症状患者（6%）有严重（n=4）（FS<20%）或显著（n=9）（20例FS<25%）收缩功能障碍。在其他192例患者中，中位收缩末期室壁应力为91（53-135），52例患者超过100 g cm-2。使用考克斯模型，只有累积剂量的阿霉素和平均辐射剂量的心脏，被确定为危险因素的病理性心脏状态。总之，心力衰竭或严重异常的风险随着阿霉素治疗、放疗和治疗后时间的增加而增加，即使是在15年或更长时间的随访后也是如此。在我们的系列中，经过平均18年的随访，39%的儿童有严重的心功能不全或严重的心室超负荷状况。该风险随着阿霉素剂量和心脏接受的辐射而增加，没有阈值的证据。
The purpose of this paper was to determine the cardiac status in children 15 years or more after adriamycin therapy for a solid tumour. Of the 447 pts, 229 pts were fully studied and 218 were not. The following cardiac evaluations were proposed to all the 447 consecutive patients (pts): (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-hour holter ECG; (3) 131l-mlBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO2 max measurement. The radiation doses delivered to 6 points in the heart were estimated for all patients who had received radiotherapy. Congestive heart failure was diagnosed in 24 of 229 (10%) evaluated pts, with a median interval of 15 years (0.3–24 years) from the first symptom after adriamycin treatment. Among the 205 remaining pts, 13 asymptomatic pts (6%) had severe (n=4) (FS<20%) or marked (n=9) (20⩽FS<25%) systolic dysfunction. In the 192 others, the median meridional end-systolic wall stress was 91 (53–135) and it exceeded 100 g cm−2 in 52 pts. Using a Cox model, only the cumulative dose of adriamycin and the average radiation dose to the heart, were identified as risk factors for a pathological cardiac status. In conclusion, the risk of cardiac failure or severe abnormalities increases with adriamycin treatment, radiotherapy and time since treatment, even after a follow-up of 15 years or more. In our series, after an average follow-up of 18 years, 39% of the children had a severe cardiac dysfunction or major ventricular overload conditions. The risk increases with the dose of adriamycin and radiation received to the heart, without evidence for threshold.
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DOI：
10.1002/mpo.2950240604
发表时间：
1995-06-01
期刊：
MEDICAL AND PEDIATRIC ONCOLOGY
影响因子：
--
作者：
STEINHERZ, LJ;STEINHERZ, PG;TAN, C
通讯作者：
TAN, C
影响因子：
45.3
作者：
SORENSEN, K;LEVITT, G;SULLIVAN, I
通讯作者：
SULLIVAN, I
影响因子：
120.7
作者：
STEINHERZ, LJ;STEINHERZ, PG;MURPHY, ML
通讯作者：
MURPHY, ML
影响因子：
39.2
作者：
VONHOFF, DD;LAYARD, MW;MUGGIA, FM
通讯作者：
MUGGIA, FM
影响因子：
158.5
作者：
LIPSHULTZ, SE;COLAN, SD;SANDERS, SP
通讯作者：
SANDERS, SP