Cardiac complications associated with hematopoietic stem-cell transplantation
Cardiac complications associated with hematopoietic stem-cell transplantation
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造血干细胞移植相关的心脏并发症
DOI：
10.1038/s41409-021-01427-2
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发表时间：
2021
影响因子：
4.8
通讯作者：
S. Fuji
中科院分区：
文献类型：
--
作者：
A. Ohmoto;S. Fuji
化疗和支持治疗的进步改善了接受造血干细胞移植（HSCT）的血液恶性肿瘤患者的临床结果。然而，造血干细胞移植与早发性和迟发性心脏毒性之间的关联仍然存在争议，因为这些心脏并发症，包括急性心力衰竭和心律失常，如心房颤动，有时可能是致命的。尽管总体病理生理学尚未阐明，但 HSCT 前的初始/挽救化疗，例如蒽环类联合方案、预处理方案、胸部放疗和预先存在的个人危险因素，可能与心脏事件风险增加相关。使用超声心动图中的整体纵向应变或左心室射血分数和血清生物标志物对心脏功能进行常规监测可能是在发生不可逆心脏并发症之前检测心脏状态早期变化的一种选择。虽然 β 受体阻滞剂和血管紧张素转换酶抑制剂常用于心脏保护，但其在 HSCT 相关心脏毒性方面的临床益处尚未得到充分证实。未来，有必要进行遗传分析来揭示个体对心脏毒性的脆弱性，并进行前瞻性试验来评估早期干预措施的临床益处，包括血管紧张素受体-脑啡肽酶抑制剂等新型药物。肿瘤学家和心脏病专家之间的合作对于制定预防心脏并发症的策略至关重要。
Advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in patients with hematological malignancies undergoing hematopoietic stem-cell transplantation (HSCT). However, the association between HSCT and early- and late-onset cardiotoxicity remains controversial as these cardiac complications, including acute heart failure and arrhythmia, such as atrial fibrillation, can occasionally be lethal. Although the overall pathophysiology has not been elucidated, initial/salvage chemotherapy before HSCT, such as anthracycline-combined regimens, conditioning regimens, thoracic radiotherapy, and pre-existing personal risk factors, could be associated with an increased risk of cardiac events. Routine monitoring of cardiac function using global longitudinal strain or left ventricular ejection fraction in echocardiogram and serum biomarkers could be an option to detect early changes in cardiac status before irreversible cardiac complications develop. While beta-blockers and angiotensin-converting enzyme inhibitors are commonly used for cardioprotection, their clinical benefit has not been fully established in HSCT-associated cardiotoxicity. In the future, genetic analysis to reveal individual vulnerability to cardiotoxicity and prospective trials assessing the clinical benefit of early interventions, including novel agents such as angiotensin receptor-neprilysin inhibitor, are warranted. Collaboration between oncologists and cardiologists is crucial to establishing a strategy to prevent cardiac complications.
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DOI：
10.1016/s1470-2045(18)30608-9
发表时间：
2018-12
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Salem JE;Manouchehri A;Moey M;Lebrun-Vignes B;Bastarache L;Pariente A;Gobert A;Spano JP;Balko JM;Bonaca MP;Roden DM;Johnson DB;Moslehi JJ
通讯作者：
Moslehi JJ
影响因子：
20.3
作者：
Armenian, Saro H.;Sun, Can-Lan;Bhatia, Smita
通讯作者：
Bhatia, Smita
影响因子：
20.3
作者：
M. Goldberg;J. Antin;E. Guinan;J. Rappeport
通讯作者：
M. Goldberg;J. Antin;E. Guinan;J. Rappeport
影响因子：
45.3
作者：
Blanco, Javier G.;Sun, Can-Lan;Bhatia, Smita
通讯作者：
Bhatia, Smita
影响因子：
4.3
作者：
Armenian, Saro H.;Sun, Can-Lan;Mills, George;Teh, Jennifer Berano;Francisco, Liton;Durand, Jean-Bernard;Wong, F. Lennie;Forman, Stephen J.;Bhatia, Smita
通讯作者：
Bhatia, Smita