Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy
Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy
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DOI：
10.1161/circulationaha.114.013777
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发表时间：
2015-06-02
期刊：
影响因子：
37.8
通讯作者：
Cipolla, Carlo M.
中科院分区：
文献类型：
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作者：
Cardinale, Daniela;Colombo, Alessandro;Cipolla, Carlo M.
蒽环类药物引起的心脏毒性有三种类型：急性、早发性慢性和迟发性慢性。然而，缺乏支持这一分类的数据。我们前瞻性地评估发病率，发生的时间，临床相关性，心脏toxicity.Methods和结果，我们评估了左心室射血分数（LVEF），在基线，化疗期间每3个月，并为接下来的一年，每6个月在接下来的4年，每年在一个异质性队列的2625例患者接受蒽环类药物治疗。在心脏毒性（LVEF降低>10个绝对点，和5个绝对点且>50%）或完全（LVEF升高至基线值）的情况下。中位随访时间为5.2（第1四分位数至第3四分位数，2.6-8.0）年。心脏毒性的总体发生率为9%（n=226）。化疗结束与心脏毒性发生之间的中位时间为3.5（第1四分位数至第3四分位数，3-6）个月。98%的病例（n=221）在第一年内发生心脏毒性。25例（11%）患者完全恢复，160例（71%）患者部分恢复。在多变量分析中，化疗结束时LVEF（风险比，1.37; 95%置信区间，1.33-1.42，每单位减量百分比）和累积阿霉素剂量（风险比，1.09; 95%可信区间，1.04-1.15（每增加50 mg/m2））是心脏毒性的独立相关因素。含蒽环类抗生素治疗发生在第一年内，并与治疗结束时的蒽环类药物剂量和LVEF相关。心脏毒性的早期发现和及时治疗对于心脏功能的实质性恢复至关重要。
Background-Three types of anthracycline-induced cardiotoxicities are currently recognized: acute, early-onset chronic, and late-onset chronic. However, data supporting this classification are lacking. We prospectively evaluated incidence, time of occurrence, clinical correlates, and response to heart failure therapy of cardiotoxicity.Methods and Results-We assessed left ventricular ejection fraction (LVEF), at baseline, every 3 months during chemotherapy and for the following year, every 6 months over the following 4 years, and yearly afterward in a heterogeneous cohort of 2625 patients receiving anthracycline-containing therapy. In case of cardiotoxicity (LVEF decrease >10 absolute points, and 5 absolute points and >50%) or full (LVEF increase to the baseline value). The median follow-up was 5.2 (quartile 1 to quartile 3, 2.6-8.0) years. The overall incidence of cardiotoxicity was 9% (n=226). The median time elapsed between the end of chemotherapy and cardiotoxicity development was 3.5 (quartile 1 to quartile 3, 3-6) months. In 98% of cases (n=221), cardiotoxicity occurred within the first year. Twenty-five (11%) patients had full recovery, and 160 (71%) patients had partial recovery. At multivariable analysis, end-chemotherapy LVEF (hazard ratio, 1.37; 95% confidence interval, 1.33-1.42 for each percent unit decrement) and cumulative doxorubicin dose (hazard ratio, 1.09; 95% confidence interval, 1.04-1.15 for each 50 mg/m(2) increment) were independent correlates of cardiotoxicity.Conclusions-Most cardiotoxicity after anthracycline-containing therapy occurs within the first year and is associated with anthracycline dose and LVEF at the end of treatment. Early detection and prompt therapy of cardiotoxicity appear crucial for substantial recovery of cardiac function.