Biochemical Markers for Prediction of Chemotherapy-Induced Cardiotoxicity Systematic Review of the Literature and Recommendations for Use
Biochemical Markers for Prediction of Chemotherapy-Induced Cardiotoxicity Systematic Review of the Literature and Recommendations for Use
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DOI：
10.1309/ajcpb66lriivmqdr
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发表时间：
2008-11-01
影响因子：
3.5
通讯作者：
Panteghini, Mauro
中科院分区：
文献类型：
--
作者：
Dolci, Alberto;Dominici, Roberto;Panteghini, Mauro
化疗是几种恶性肿瘤的成熟治疗方法，但其临床疗效往往受到其相关心脏毒性的限制，导致心肌病，可能演变为心力衰竭。为了检测心脏损伤，采用的诊断方法是通过超声心动图估计左心室射血分数。这种方法显示出对心肌病早期预测的敏感性较低，此时适当治疗的可能性仍然可以改善患者的结果。然而，心肌肌钙蛋白早在心肌病临床发作前3个月就显示出较高的诊断效力。其浓度的增加与疾病严重程度相关，并可预测随访期间新发的主要心脏事件。阴性肌钙蛋白浓度可识别心肌病风险极低的患者（阴性预测值，99%）。关于心脏利钠肽在预测化疗诱导的心肌病中的诊断或预后作用，仍然缺乏明确的证据。
Chemotherapy is a well-established therapeutic approach for several malignancies, but its clinical efficacy is often limited by its related cardiotoxicity, which leads to cardiomyopathy, possibly evolving into heart failure. To detect cardiac damage, the adopted diagnostic approach is the estimation of left ventricular ejection fraction by echocardiography. This approach shows low sensitivity toward early prediction of cardiomyopathy, when the possibilities of appropriate treatments could still improve the patient's outcome. Cardiac troponins, however, show high diagnostic efficacy as early as 3 months before the clinical onset of cardiomyopathy. The increase in their concentrations is correlated with disease severity and may predict the new onset of major cardiac events during follow-up. Negative troponin concentrations may identify patients with a very low risk of cardiomyopathy (negative predictive value, 99%). Concerning cardiac natriuretic peptides, definitive evidence in regard to a diagnostic or prognostic role in predicting chemotherapy-induced cardiomyopathy is still lacking.