Anthracycline- and trastuzumab-induced cardiotoxicity: a retrospective study.
Anthracycline- and trastuzumab-induced cardiotoxicity: a retrospective study.
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蒽环类和曲妥珠单抗引起的心脏毒性：回顾性研究。
DOI：
10.1007/s12032-016-0797-x
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Dillon P
中科院分区：
文献类型：
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作者：
Hamirani Y;Fanous I;Kramer CM;Wong A;Salerno M;Dillon P
一些化疗药物引起心脏毒性作用，包括左心室射血分数（LVEF）降低和偶尔的充血性心力衰竭。蒽环类药物和HER2单克隆抗体是常见的罪犯，但缺乏LVEF变化，危险因素和急性恢复的临床实践数据。我们回顾性地检查了一家学术医疗中心2000年至2013年癌症患者接受蒽环类药物和/或曲妥珠单抗的电子病历。收集患者特征和连续LVEF评估。对有无LVEF下降的患者进行单因素和多因素分析。共有549名患者被确定使用蒽环类/曲妥珠单抗，216名患者进行了多次LVEF评估。在216例多次进行LVEF评估的患者中，只有27例（12.5%）出现临床显著的LVEF下降，有症状的CHF罕见（0.5%）。与未受影响的患者相比，LVEF下降的患者更有可能患有高血压、高脂血症或冠状动脉疾病（CAD）。曲妥珠单抗和蒽环类药物合用是一个危险因素（36% vs单独使用蒽环类药物9.5%,p < 0.001）。从化疗开始到LVEF降低的中位时间为202天（5-3008）。在多变量分析中，高血压和曲妥珠单抗的使用仍然是LVEF下降的独立预测因素。44%的患者出现LVEF急性恢复。癌症治疗导致的LVEF变化频繁且难以预测。高血压、高脂血症和冠心病与LVEF下降有关。在经历治疗相关心脏毒性的患者中观察到LVEF的急性恢复。建议注意及时中断心脏毒性化疗。
Some chemotherapeutic agents cause cardiotoxic effects including reduction in left ventricular ejection fraction (LVEF) and occasionally congestive heart failure. Anthracyclines and HER2 monoclonal antibodies are common offenders, but clinical practice data on LVEF changes, risk factors and acute recovery is lacking. We retrospectively examined the electronic medical record at an academic medical center for receipt of anthracyclines and/or trastuzumab from 2000 to 2013 in cancer patients. Patient characteristics and serial LVEF assessments were collected. Patients with and without LVEF decline were analyzed by univariate and multivariate analysis. A total of 549 patients were identified with anthracycline/trastuzumab use and 216 had multiple LVEF assessments. Only 27 of the 216 patients who had multiple LVEF assessments at multiple occasions suffered a clinically significant LVEF fall (12.5 %), and symptomatic CHF was rare (0.5 %). Compared to unaffected patients, those with a fall in LVEF were more likely to have hypertension, hyperlipidemia or coronary artery disease (CAD). Concomitant trastuzumab and anthracycline use was a risk factor (36 vs 9.5 % for anthracycline alone, p < 0.001). The median time from start of chemotherapy to reduced LVEF was 202 days (5–3008). On multivariate analysis, hypertension and use of trastuzumab remained independent predictors of LVEF fall. Acute recovery in LVEF was observed in 44 % of patients. LVEF changes from cancer therapies are frequent and hard to predict. Hypertension, hyperlipidemia and CAD are associated with LVEF decline. Acute recovery of LVEF is observed in those experiencing treatment-related cardiotoxicity. Attention to timely interruption of cardiotoxic chemo is recommended.