CARDIAC-FAILURE AND DYSRHYTHMIAS 6-19 YEARS AFTER ANTHRACYCLINE THERAPY - A SERIES OF 15 PATIENTS
CARDIAC-FAILURE AND DYSRHYTHMIAS 6-19 YEARS AFTER ANTHRACYCLINE THERAPY - A SERIES OF 15 PATIENTS
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DOI：
10.1002/mpo.2950240604
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发表时间：
1995-06-01
期刊：
影响因子：
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通讯作者：
TAN, C
中科院分区：
文献类型：
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作者：
STEINHERZ, LJ;STEINHERZ, PG;TAN, C
本文报告了15例晚期症状性蒽环类药物心肌病的临床过程及由此引起的心功能改变。他们代表了300例患者的子集，这些患者进行了心脏评估，以确定这些患者在蒽环类药物治疗后超过4年的晚期心脏毒性的患病率。回顾了15例患者的临床过程和所有可用的心脏评估，包括心电图、连续录音心电图、超声心动图、放射性核素心脏血管造影、心导管检查和肌内膜活检。这些患者在晚期症状发作前6 - 19年（中位数12年）接受了285 - 870（中位数540）mg/M（2）的柔红霉素和/或阿霉素治疗。7例患者还接受了2，100 - 4，000 cGy纵隔放疗。5例患者在化疗结束时需要治疗心脏症状，但10例患者在晚期失代偿前没有心脏问题。晚期失代偿时超声心动图缩短分数为8 - 20%（中位数17%），放射性核素左心室射血分数为8 - 59%（中位数38%）。所有患者均接受洋地黄和利尿剂治疗，13/15例患者接受后负荷减少治疗，症状至少有短暂改善。他们在晚期失代偿后随访1 - 9年（中位数3年）。其中一人死于无法控制的心力衰竭。另一名患者接受了成功的心脏移植。14/15例患者存在传导异常和心律失常，3例突然死亡。另外两人晕厥，一人需要自动心脏除颤器。肌内膜活检或尸检显示10/10例患者肥大和纤维化。我们的患者早期心脏症状短暂改善，但失代偿后期和患者没有早期症状的心脏症状超过10年后蒽环类药物治疗。因此，接受蒽环类药物治疗的患者应继续进行心脏评估。(C)1995 Wiley-Liss，Inc.
The clinical course of late symptomatic anthracycline cardiomyopathy, and resultant changes of cardiac function, were described in 15 patients. They represented a subset of 300 patients who had cardiac evaluations to identify the prevalence of late cardiotoxicity more than 4 years after anthracycline therapy in these patients. The clinical course and all available cardiac evaluations including electrocardiography, continuous taped electrocardiography, echocardiography, radionuclide cardiac angiography, cardiac catheterization, and endomyocardial biopsy, of the 15 patients were reviewed. The patients had received 285-870 (median 540) mg/M(2) of daunorubicin and/or doxorubicin 6-19 (median 12) years prior to the onset of late symptoms. Seven patients also had 2,100-4,000 cGy mediastinal radiotherapy. Five patients had required treatment for cardiac symptoms at the end of chemotherapy but 10 patients had no cardiac problems anteceding their late decompensation. Fractional shortening on echocardiogram at late decompensation was 8-20% (median 17%) and radionuclide left ventricular ejection fraction was 8-59% (median 38%). All were treated with digitalis and diuretics and 13/15 with afterload reduction, with at least transient improvement of symptoms. They were followed for 1-9 (median 3) years after late decompensation. One died of uncontrollable cardiac failure. Another underwent successful cardiac transplantation. Conduction abnormalities and dysrhythmias were present in 14/15 patients and 3 died suddenly. Two more had syncope, one requiring an automatic cardiac defibrillator. Endomyocardial biopsy or autopsy revealed hypertrophy and fibrosis in 10/10 patients. Our patients with early cardiac symptoms improved transiently but decompensated later and patients with no early symptoms developed cardiac symptoms more than 10 years after anthracycline therapy. Therefore, patients who have received anthracyclines; should have continued cardiac evaluation. (C) 1995 Wiley-Liss, Inc.