Rubidium-82 positron emission tomography for detection of acute doxorubicin-induced cardiac effects in lymphoma patients
Rubidium-82 positron emission tomography for detection of acute doxorubicin-induced cardiac effects in lymphoma patients
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DOI：
10.1007/s12350-018-1458-6
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发表时间：
2020-10-01
影响因子：
2.4
通讯作者：
Hutchings, Martin
中科院分区：
文献类型：
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作者：
Laursen, Adam Hogsbro;Elming, Marie Bayer;Hutchings, Martin
背景阿霉素是淋巴瘤治疗的基石，但受到剂量依赖性心脏毒性的限制。铷-82正电子发射断层扫描（Rb-82 PET）通过绝对定量心肌灌注和心肌灌注储备（MPR）评估冠状动脉微血管功能。多柔比星诱导的微血管损伤是心脏毒性的潜在早期标志。方法和结果我们纳入了70例淋巴瘤患者计划阿霉素为基础的治疗。在化疗前和首次阿霉素暴露后不久，在静息和腺苷负荷期间，用Rb-82 PET心肌灌注成像评价阿霉素毒性。MPR下降> 20%的患者被定义为心脏毒性阈值较低。在有完整数据集的54例患者中，多柔比星初始暴露后MPR显著降低（2.69 vs 2.51，P = 0.03）。我们记录到应激灌注无显著下降（3.18 vs 3.02 ml/g/min，P = 0.08），但静息心肌灌注无变化。有13例患者的心脏毒性阈值较低。这些患者的年龄显著较高，但在其他方面与研究人群的其余部分相似。结论淋巴瘤患者首次暴露多柔比星后MPR降低可能是多柔比星诱导心脏毒性的早期标志。急性阿霉素诱导的MPR改变的预后价值仍有待研究。
Background Doxorubicin is a cornerstone in lymphoma treatment, but is limited by dose-dependent cardiotoxicity. Rubidium-82 positron emission tomography (Rb-82 PET) assesses coronary microvascular function through absolute quantification of myocardial perfusion and myocardial perfusion reserve (MPR). Doxorubicin-induced microvascular injury represents a potential early marker of cardiotoxicity. Methods and results We included 70 lymphoma patients scheduled for doxorubicin-based treatment. Cardiotoxicity was evaluated with Rb-82 PET myocardial perfusion imaging during rest and adenosine stress before chemotherapy and shortly after the first doxorubicin exposure. Patients with a MPR decline > 20% were defined as having a low threshold for cardiotoxicity. In the 54 patients with complete data sets, MPR was significantly lower after the initial doxorubicin exposure (2.69 vs 2.51, P = .03). We registered a non-significant decline in stress perfusion (3.18 vs 3.02 ml/g/min, P = .08), but no change in resting myocardial perfusion. There were 13 patients with a low cardiotoxic threshold. These patients had a significantly higher age, but were otherwise similar to the remaining part of the study population. Conclusion Decreases in MPR after initial doxorubicin exposure in lymphoma patients may represent an early marker of doxorubicin-induced cardiotoxicity. The prognostic value of acute doxorubicin-induced changes in MPR remains to be investigated.