Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy
Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy
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DOI：
10.1016/s0735-1097(00)00748-8
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发表时间：
2000-08-01
影响因子：
24
通讯作者：
Fiorentini, C
中科院分区：
文献类型：
--
作者：
Cardinale, D;Sandri, MT;Fiorentini, C
目的探讨心肌肌钙蛋白I(CTnI)在大剂量化疗(HDC)治疗侵袭性恶性肿瘤中的作用。考虑到心脏功能障碍可能在HDC后几周或几个月变得临床明显，目前需要一种早期的心肌损伤标记物，能够预测晚期室性损伤。方法我们测量了204名(45+/-10岁)受HDC耐药影响的癌症患者在HDC每一个周期后的cTnI血浆浓度。根据cTnI<或等于0.4 ng/ml分为肌钙蛋白阳性(cTnI+，n=65)和肌钙蛋白阴性(cTnT-，n=139)组。结果cTnI组HDC后左室射血分数(LVEF)进行性下降，3个月后下降最大，但心肌压低是一过性的，在随后的随访中不再被发现。相比之下，cTnI+组的LVEF下降更明显，在随访结束时仍然明显。在cTnI+的患者中，cTnI的短期升高与最大左心室射血分数下降之间存在密切的关系(r=-0.87，p<0.0001)。结论恶性心肌梗死患者术后cTnI的升高可准确预测未来左心室射血分数下降。在这种情况下，cTnI可以被认为是一个敏感和可靠的急性轻微心肌损害的标志物，具有相关的临床和预后意义。(C)2000年由美国心脏病学会颁发。
OBJECTIVES We investigated the role of cardiac troponin I (cTnI) in patients with aggressive malignancies treated with high-dose chemotherapy (HDC).BACKGROUND High dose chemotherapy is potentially limited by cardiac toxicity. Considering the fact that cardiac dysfunction may become clinically evident weeks or months after HDC, the availability of an early marker of myocardial injury, able to predict late ventricular impairment, is a current need.METHODS We measured, in 204 patients (45 +/- 10 years) affected by cancer resistant to conventional treatment, the cTnI plasma concentration after every single cycle of HDC. According to the cTnI value (less than or equal to or >0.4 ng/ml), patients were divided into a troponin positive (cTnI+, n = 65) and a troponin negative (cTnT-, n = 139) group. All patients underwent echocardiographic examination during the following seven months.RESULTS In the cTnI- group, left Ventricular ejection fraction (LVEF) progressively decreased after HDC, reaching a maximal reduction after three months; however, myocardial depression was transient and no longer detectable at later follow-up. By contrast, in the cTnI+ group LVEF reduction was more marked and still evident at the end of the follow-up. In cTnI+ patients, a close relationship between the short-term cTnI increment and the greatest LVEF reduction was found (r = -0.87, p < 0.0001).CONCLUSIONS The elevation of cTnI in patients undergoing HDC for aggressive malignancies accurately predicts the development of future LVEF depression. In this setting, cTnI can be considered a sensitive and reliable marker of acute minor myocardial damage with relevant clinical and prognostic implications. (C) 2000 by the American College of Cardiology.