在化疗期间进行应变监测以改善心血管结果:SUCCOUR-MRI试验
Thomas H Marwick1,2, Elizabeth Dewar1, Mark Nolan1,3
1Imaging Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
癌症患者的心脏保护疗法减少了全球纵向应变 (GLS),但正常的射出分数 (LVEF) 改善了心脏功能. 与常规护理相比,这种方法更好地保持了LVEF,这表明了监测和治疗化疗引起的心脏功能障碍的新策略.
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 心脏瘤学 - 心脏瘤学
背景情况:
- 与癌症治疗相关的心脏功能障碍 (CTRCD) 通常通过左心室喷射率 (LVEF) 的减少来检测.
- 早期发现心脏应变可能允许及时干预.
- 仅基于全球纵向应变 (GLS) 减轻的干预的作用还不清楚.
研究的目的:
- 为了研究心脏保护疗法的有效性,在没有LVEF下降的化学疗法诱导的GLS减少的患者.
- 为了比较接受心脏保护和常规护理的患者的心血管结果.
主要方法:
- 一个前性的多中心随机受控试验 (SUCCOUR-MRI) 涉及333名接受 antracyclines 的患者.
- 患有GLS减少 (>12%的相对减少),但LVEF正常的患者随机分配到心脏保护或常规护理.
- 通过心磁共振成像 (MRI) 和心声谱,在12个月内评估心血管结果.
主要成果:
- 与常规护理相比,心脏保护与LVEF的显著较小下降有关 (-2.5%与-5.6%,P = .009).
- 随访 LVEF 在心脏保护组中较高 (59%对55%,P < .0001).
- 在心脏保护组中,较少的患者出现了LVEF-CTRCD (1/49 vs 6/56,P = .075).
结论:
- 在抗环素化疗期间单独减少GLS的患者中,使用神经激素抗剂进行心脏保护,与通常护理相比,可以保持LVEF.
- 这表明GLS监测可以识别那些可能受益于早期心脏保护干预的患者.
- 进一步的研究可能会完善CTRCD的监测和治疗策略.
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