Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
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DOI：
10.1016/j.echo.2014.07.012
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发表时间：
2014-09-01
影响因子：
6.5
通讯作者：
Lancellotti, Patrizio
中科院分区：
文献类型：
--
作者：
Plana, Juan Carlos;Galderisi, Maurizio;Lancellotti, Patrizio
20世纪60年代，随着蒽环类药物在肿瘤治疗领域的广泛应用，暴露于癌症治疗药物导致的心功能障碍首次被认识到。与蒽环类药物相关的心力衰竭（HF）被认为是一个重要的副作用。因此，医生学会了限制剂量以避免心功能障碍。在过去的几十年里，人们使用了几种策略来检测它。随着时间的推移，其中两种方法逐渐变得非常有用：心内膜肌活组织检查和心脏成像监测左心室射血分数（LVEF）。心肌膜活检检查被证明是鉴别蒽环类药物引起的左室功能障碍最敏感和特异的参数，并在20世纪70年代成为金标准。然而，随着时间的推移，由于用于治疗恶性肿瘤的累积剂量的减少，手术的侵入性，以及在无创心脏成像方面取得的显着进展，对心内膜活检的兴趣已经减弱。LVEF的非侵入性评估变得越来越重要，尽管其计算技术存在局限性，但它已成为监测心功能变化的最广泛使用的策略，无论是在潜在的心脏毒性癌症治疗期间还是之后。3-5不同药物的左室功能障碍时间不同。就蒽环类药物而言，在接触后立即发生损害；对其他人来说，从给药到检测到心功能障碍之间的时间间隔似乎变化更大。然而，心脏有明显的心脏储备，并且
Cardiac dysfunction resulting from exposure to cancer therapeutics was first recognized in the 1960s, with the widespread introduction of anthracyclines into the oncological therapeutic armamentarium. 1 Heart failure (HF) associated with anthracyclines was then recognized as an important side effect. As a result, physicians learned to limit their doses to avoid cardiac dysfunction. 2 Several strategies have been used over the past decades to detect it. Two of them evolved over time to be very useful: endomyocardial biopsies and monitoring of left ventricular (LV) ejection fraction (LVEF) by cardiac imaging. Examination of endomyocardial biopsies proved to be the most sensitive and specific parameter for the identification of anthracycline-induced LV dysfunction and became the gold standard in the 1970s. However, the interest in endomyocardial biopsy has diminished over time because of the reduction in the cumulative dosages used to treat malignancies, the invasive nature of the procedure, and the remarkable progress made in non-invasive cardiac imaging. The non-invasive evaluation of LVEF has gained importance, and notwithstanding the limitations of the techniques used for its calculation, has emerged as the most widely used strategy for monitoring the changes in cardiac function, both during and after the administration of potentially cardiotoxic cancer treatment. 3–5 The timing of LV dysfunction can vary among agents. In the case of anthracyclines, the damage occurs immediately after the exposure; 6 for others, the time frame between drug administration and detectable cardiac dysfunction appears to be more variable. Nevertheless, the heart has significant cardiac reserve, and the expression of