Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy
Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy
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DOI：
10.1007/s10554-020-01976-5
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发表时间：
2020-08-28
影响因子：
2.1
通讯作者：
Hirata, Ken-ichi
中科院分区：
文献类型：
--
作者：
Yamashita, Kentaro;Tanaka, Hidekazu;Hirata, Ken-ichi
连续或同时使用两种不同类型的药物，如蒽环类药物和曲妥珠单抗，可能会增加心肌损伤和癌症治疗相关的心功能障碍(CTRCD)，这通常是两种治疗方法对乳腺癌患者联合不利的结果。然而，此类患者的临床危险因素与左心室(LV)功能之间的关联目前尚不清楚。我们研究了86名左心室射血分数(LVEF)保留的乳腺癌患者，并接受了蒽环类药物、曲妥珠单抗或两者兼用的治疗。分别于化疗前和化疗后16天进行超声心动图检查。根据目前的意见书，CTRCD的临床危险因素被定义为：阿霉素累积剂量240 mg/m(2)，年龄65岁，体重指数30 kg/m(2)，既往放射治疗，B型利钠肽100 pg/ml，既往心血管疾病、心房颤动、高血压、糖尿病和吸烟史。有4个以上危险因素的患者化疗后LVEF的相对下降显著大于无危险因素的患者(-9.3+/-10.8%比-2.2+/-10.2%；P=0.02)。然而，这一发现并不适用于具有超过一个、两个或三个危险因素的患者。有四个以上危险因素的患者也倾向于比没有危险因素的患者表现出更高的CTRCD患病率(14.3%比2.8%；p=0.12)。而且，随着危险因素的增多，LVEF的相对降幅也越来越大。这项研究发现，多种危险因素与化疗后左心功能不全有关。因此，我们的发现有望对转诊为化疗的乳腺癌患者进行更好的治疗具有临床意义。
The sequential or concurrent use of two different types of agents such as anthracyclines and trastuzumab may increase myocardial injury and cancer therapeutics-related cardiac dysfunction (CTRCD), which is often the result of the combined detrimental effect of the two therapies for breast cancer patients. However, the association between clinical risk factors and left ventricular (LV) function in such patients is currently unclear. We studied 86 breast cancer patients with preserved LV ejection fraction (LVEF) and treated with anthracyclines, trastuzumab, or both. Echocardiography was performed before and 16 days after chemotherapy. In accordance with the current position paper, clinical risk factors for CTRCD were defined as: cumulative dose of doxorubicin > 240 mg/m(2), age > 65-year-old, body mass index > 30 kg/m(2), previous radiation therapy, B-type natriuretic peptide > 100 pg/mL, previous history of cardiovascular disease, atrial fibrillation, hypertension, diabetes, and smoking. The relative decrease in LVEF after chemotherapy for patients with more than four risk factors was significantly greater than that for patients without (- 9.3 +/- 10.8% vs. - 2.2 +/- 10.2%; p = 0.02). However, this finding did not apply to patients with more than one, two or three risk factors. Patients with more than four risk factors also tended to show a higher prevalence of CTRCD than those without (14.3% vs. 2.8%; p = 0.12). Moreover, the relative decrease in LVEF became greater as the number of risk factors increased. This study found multiple risk factors were associated with LV dysfunction following chemotherapy. Our findings can thus be expected to have clinical implications for better management of patients with breast cancer referred for chemotherapy.