接受蒽环类药物治疗的淋巴瘤患者发生治疗相关心血管事件的预测因素

A. López-García, Ester Macia, Sandra Gómez-Talavera, Eva Castillo, D. Morillo, Jose Tuñon, Borja Ibañez, R. Córdoba
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摘要

背景:由于诊断和治疗方法的进步,血液恶性肿瘤患者的存活率有所提高,因此癌症治疗相关心功能不全(CTRCD)的发病率也在不断上升。识别有 CTRCD 风险的患者对于制定预防策略至关重要。方法:在 2017 年 1 月 1 日至 2023 年 2 月 15 日期间开展了一项单中心回顾性队列研究。研究人员查阅了接受一线蒽环类药物治疗的淋巴瘤患者的病历。收集了人口统计学数据、心血管风险因素、心肌损伤生物标志物和超声心动图信息。研究结果共纳入 200 名患者。CTRCD的发病率为17.4%(35/200)。CTRCD 患者的年龄大于非 CTRCD 患者,平均年龄为 65.17 岁对 56.77 岁(P = 0.008)。血脂异常(DL)(31.4% 对 13.4%,P = 0.017)和既往患有心血管疾病(40% 对 13.3%,P < 0.001)在发生事件的组别中更为常见。发生心血管事件亚组的平均基线 NT-proBNP 水平为 388.73 kg/L ± 101.02,未发生心血管事件亚组的平均基线 NT-proBNP 水平为 251.518 kg/L ± 26.22(P = 0.004)。在治疗期间和治疗后,发现肌钙蛋白 I 水平存在差异,但未超过实验室参考上限。患者的随访时间中位数为 51.83 个月(0.76-73.49 个月)。出现 CTCRD 事件对任何原因导致的总死亡率均有负面影响(HR = 2.23(95% CI:1.08-2.93);P = 0.031)。结论早期识别风险因素对于管理有 CTRCD 风险的患者至关重要。
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Predictive Factors of Therapy-Related Cardiovascular Events in Patients with Lymphoma Receiving Anthracyclines
Background: Cancer-therapy-related cardiac dysfunction (CTRCD) is a growing concern for public health, with a growing incidence due to improved survival rates of patients with hematological malignancies due to diagnostic and therapeutic advances. The identification of patients at risk for CTRCD is vital to developing preventive strategies. Methods: A single-center retrospective cohort study was conducted between 1 January 2017 and 15 February 2023. Medical records of patients with lymphoma treated with first-line anthracyclines were reviewed. Demographic data, cardiovascular risk factors, biomarkers of myocardial damage, and echocardiographic information were collected. Results: A total of 200 patients were included. The incidence of CTRCD was 17.4% (35/200). Patients with CTRCD were older than those without CTRCD, with a mean age of 65.17 years vs. 56.77 (p = 0.008). Dyslipidemia (DL) (31.4% vs. 13.4% p = 0.017) and previous cardiovascular disease (40% vs. 13.3%; p < 0.001) were more frequent in the group who developed an event. Mean baseline NT-proBNP levels in the subgroup with cardiovascular events were 388.73 kg/L ± 101.02, and they were 251.518 kg/L ± 26.22 in those who did not (p = 0.004). Differences in Troponin I levels were identified during and after treatment without exceeding the laboratory’s upper reference limit. Patients were followed for a median of 51.83 months (0.76–73.49). The presence of a CTCRD event had a negative impact on overall mortality from any cause (HR = 2.23 (95% CI: 1.08–2.93); p = 0.031). Conclusions: Early identification of risk factors is crucial to manage patients at risk for CTRCD.
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