Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy
Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy
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DOI：
10.1016/j.jacc.2020.11.020
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发表时间：
2021-01-25
影响因子：
24
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
--
作者：
Thavendiranathan, Paaladinesh;Negishi, Tomoko;Marwick, Thomas H.
背景 对于存在癌症治疗相关心功能障碍 (CTRCD) 风险的患者，心脏保护治疗 (CPT) 的启动受到射血分数 (EF) 对左心室 (LV) 功能微小变化的低敏感性的限制。整体纵向应变 (GLS) 是 LV 功能障碍的稳健且敏感的标志物，但现有的观察数据不足以支持常规 GLS 指导的 CPT 策略。 目的 本研究旨在确定与常规治疗相比，GLS 指导的 CPT 是否可以防止接受潜在心脏毒性化疗的高危患者 LVEF 降低和 CTRCD 的发展。 方法 在这项国际、多中心、前瞻性、随机对照试验中，331 名接受蒽环类药物治疗的患者接受另一种药物治疗。心力衰竭危险因素被随机分配至 CPT 启动，指导原则为 GLS 相对降低 12%（n = 166）或 LVEF 绝对降低 10%（n = 165）。对患者进行 EF 和 CTRCD 的发展跟踪（有症状的 EF 降低 >5% 或无症状的 EF 降低 >10%）
BACKGROUND In patients at risk of cancer therapy-related cardiac dysfunction (CTRCD), initiation of cardioprotective therapy (CPT) is constrained by the low sensitivity of ejection fraction (EF) for minor changes in left ventricular (LV) function. Global longitudinal strain (GLS) is a robust and sensitive marker of LV dysfunction, but existing observational data have been insufficient to support a routine GLS-guided strategy for CPT.OBJECTIVES This study sought to identify whether GLS-guided CPT prevents reduction in LVEF and development of CTRCD in high-risk patients undergoing potentially cardiotoxic chemotherapy, compared with usual care.METHODS In this international, multicenter, prospective, randomized controlled trial, 331 anthracycline-treated patients with another heart failure risk factor were randomly allocated to CPT initiation guided by either $12% relative reduction in GLS (n = 166) or 10% absolute reduction of LVEF (n = 165). Patients were followed for EF and development of CTRCD (symptomatic EF reduction of >5% or >10% asymptomatic to