Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment.
Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment.
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DOI：
10.1016/j.amjcard.2017.02.008
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发表时间：
2017-05-15
期刊：
影响因子：
--
通讯作者：
Hundley WG
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文献类型：
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作者：
Meléndez GC;Sukpraphrute B;D'Agostino RB Jr;Jordan JH;Klepin HD;Ellis L;Lamar Z;Vasu S;Lesser G;Burke GL;Weaver KE;Ntim WO;Hundley WG
我们试图确定左心室（LV）舒张末期容积（LVEDV）减少伴或不伴收缩末期容积（LVESV）增加影响早期癌症治疗相关的左心室射血分数（LVEF）或LV质量下降的频率。112名连续招募的癌症患者（年龄52 ± 14岁）在开始潜在心脏毒性化疗之前和之后3个月接受了LV体积、质量和LVEF的盲态心血管磁共振（CMR）测量（72%的参与者接受了蒽环类药物）。26名参与者在3个月时出现了>10%或<50%的左心室射血分数（LVEF）严重下降，其中分别有19%和60%的参与者因LVEDV单独下降而出现了左心室射血分数（LVEF）下降，而LVESV则增加;由于LVEDV下降而导致左心室射血分数下降的参与者比那些由于LVESV增加而导致左心室射血分数下降的参与者损失了更多的左心室质量（p=0.03）。近五分之一的人在开始潜在的心脏毒性化疗后由于LVEDV的孤立下降而经历显著的LVEF下降。由于血管内容量减少（可通过容量充盈治疗）可解释LVEDV相关的LVEF下降，因此这些数据表明，在癌症治疗期间获取心脏毒性成像研究时，应沿着LVEF审查LV容量。
We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in left ventricular ejection fraction (LVEF) or LV mass. One hundred and twelve consecutively recruited individuals (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance (CMR) measures of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72 % of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p=0.03). Nearly a fifth of individuals experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Since reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during treatment for cancer.