Santiago Luna-Alcala, Adrián Espejel-Guzmán, Claudia Lerma, Paula Leon, Enrique C Guerra, Jose Rodrigo Espinosa Fernández, Pavel Martinez-Dominguez, Javier Serrano-Roman, Aldo Cabello-Ganem, Alexis D Aparicio-Ortiz, Candace Keirns, Abel Lerma, Maria Jose Santa Ana-Bayona, Nilda Espinola-Zavaleta
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引用次数: 0
Abstract
Background: Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown.
Methods: Fifty BC patients underwent TTE assessment before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant.
Results: TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%).
Conclusions: BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.
背景:乳腺癌(BC)患者在接受蒽环类药物联合或不联合曲妥珠单抗化疗时,心脏毒性是一种公认的并发症。然而,心率变异性(HRV)指标对早期心脏毒性发展的预后价值仍然未知:方法:50 名 BC 患者在化疗前和化疗后三个月接受了 TTE 评估。方法:50 名 BC 患者在化疗前和化疗后三个月接受了 TTE 评估,心率变异性指数是通过仰卧位自主呼吸、主动站立和仰卧位控制呼吸时的连续心电图获得的。计算仰卧站立与仰卧控制呼吸之间的变化幅度(Δ)。采用 t 检验或方差分析对变量进行比较。通过 ROC 曲线分析评估心脏毒性预测值。结果TTE 显示心脏毒性组的左心房导管应变降低。随访期间,所有操作中的平均心率均有所增加,有无心脏毒性患者的心率变异指数无差异。然而,在仰卧控制呼吸时,几项心率变异指标的Δ越低,超声心动图检查就越能预测早期心脏毒性(例如,SDNN≤-8.44 ms:敏感性=75%,特异性=69%):结论:接受化疗的 BC 患者在化疗 3 个月后仍能保持对生理刺激的心脏自主神经反应。结论:接受化疗的 BC 患者在化疗 3 个月后仍能保持对生理刺激的心脏自主神经反应,然而,化疗前主动站立和控制呼吸时较低的Δ可预测早期心脏毒性。