Usefulness of cardiac magnetic resonance for early detection of cancer therapeutics-related cardiac dysfunction in breast cancer patients
Usefulness of cardiac magnetic resonance for early detection of cancer therapeutics-related cardiac dysfunction in breast cancer patients
复制标题
心脏磁共振在乳腺癌患者癌症治疗相关心脏功能障碍早期检测中的作用
DOI：
10.1016/j.ijcard.2022.09.025
复制
发表时间：
2023
影响因子：
3.5
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Terui Yosuke;Sugimura Koichiro;Miyata Satoshi;Shimokawa Hiroaki;et al.
背景随着癌症治疗的进展，乳腺癌患者的预后得到了改善。然而，癌症治疗相关性心功能障碍（CTRCD）已成为一个新兴问题。为了早期检测CTRCD，我们研究了使用心脏磁共振（CMR）和生物标志物分析的原生T1定位和全局纵向应变（GLS）是否有用。方法前瞻性纳入2017年至2020年期间连续83例chemotherapy-naïve女性乳腺癌患者（平均年龄56±13岁）。超声心动图将CTRCD定义为化疗后左室射血分数（LVEF）低于53%且LVEF比基线下降10%。为了评估心功能，对CMR（基线和6个月）、12导联心电图、超声心动图和生物标志物（基线和每3个月）进行评估。结果83例患者共行164次cmr。化疗后LVEF、GLS均显著降低（LVEF由71.2±4.4降至67.6±5.8%，GLS由- 27.9±3.9降至- 24.7±3.5%，p均< 0.01）。化疗后T1值也显著升高（由1283±36 msec升高至1308±39 msec，P< 0.01）。83例患者中，7例（8.4%）发生CTRCD。值得注意的是，CTRCD患者化疗前的原生T1值明显高于无CTRCD患者（1352±29比1278±30 msec， P < 0.01）。多变量logistic回归分析显示，原生T1值是CTRCD发展的独立预测因素[OR 2.33；95%ci 1.15-4.75, p = 0.02]。结论CMR对乳腺癌化疗相关心肌损害的检测及CTRCD的发展具有重要意义。
BackgroundPrognosis of breast cancer patients has been improved along with the progress in cancer therapies. However, cancer therapeutics-related cardiac dysfunction (CTRCD) has been an emerging issue. For early detection of CTRCD, we examined whether native T1 mapping and global longitudinal strain (GLS) using cardiac magnetic resonance (CMR) and biomarkers analysis are useful.MethodsWe prospectively enrolled 83 consecutive chemotherapy-naïve female patients with breast cancer (mean age, 56 ± 13 yrs.) between 2017 and 2020. CTRCD was defined based on echocardiography as left ventricular ejection fraction (LVEF) below 53% at any follow-up period with LVEF>10% points decrease from baseline after chemotherapy. To evaluate cardiac function, CMR (at baseline and 6 months), 12‑lead ECG, echocardiography, and biomarkers (at baseline and every 3 months) were evaluated.ResultsA total of 164 CMRs were performed in 83 patients. LVEF and GLS were significantly decreased after chemotherapy (LVEF, from 71.2 ± 4.4 to 67.6 ± 5.8%; GLS, from −27.9 ± 3.9 to −24.7 ± 3.5%, respectively, bothP< 0.01). Native T1 value also significantly elevated after chemotherapy (from 1283 ± 36 to 1308 ± 39 msec,P< 0.01). Among the 83 patients, 7 (8.4%) developed CTRCD. Of note, native T1 value before chemotherapy was significantly higher in patients with CTRCD than in those without it (1352 ± 29 vs. 1278 ± 30 msec, P < 0.01). The multivariable logistic regression analysis revealed that native T1 value was an independent predictive factor for the development of CTRCD [OR 2.33; 95%CI 1.15–4.75,P= 0.02].ConclusionsThese results indicate that CMR is useful to detect chemotherapy-related myocardial damage and predict for the development of CTRCD in breast cancer patients.