是时候采用一种新的标准方法来评估乳腺癌化疗引起的心脏毒性心功能了？系统回顾和荟萃分析。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2026-05-01 Epub Date: 2026-01-28 DOI:10.1016/j.cpcardiol.2026.103289

Bruno Gama Linhares , Diego Gama Linhares , Rodrigo Gomes de Souza Vale , Daniel Moreira Gonçalves

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引用次数: 0

摘要

背景：蒽环类药物引起的心脏毒性是乳腺癌幸存者发病的主要原因。虽然左室射血分数（LVEF）是监测心功能的金标准，但它通常被认为是心肌损伤的一个晚期和不敏感的标志物。新的方法已经出现：全局纵向应变（GLS）和心脏磁共振（CMR）衍生参数作为检测亚临床功能障碍的潜在优越工具。本研究旨在系统比较GLS、LVEF和CMR índices在化疗引起的心脏毒性早期检测中的诊断准确性和时间敏感性。方法：使用PubMed、Web of Science和Scopus数据库，对临床研究进行系统回顾和荟萃分析，以评估评估乳腺癌化疗患者心功能的主要方法的结果和技术准确性。29项研究被纳入系统评价和荟萃分析。结果：荟萃分析揭示了不同方法之间明显的时间分离。GLS检测到早在治疗开始后1-3个月，绝对降低1.81% （95% CI: 1.14 - 2.49; z = 5.25,p < .001）。相比之下，LVEF仅在中期随访（4-6个月）时显着下降3.59%，通常保持在临床正常范围内（约50%）。对GLS的HSROC分析（10项研究）显示出可靠的诊断性能，曲线下面积（AUC）为0.818，合并敏感性为74.6% (95% CI: 64.8%-82.4%)，特异性为76.3% （95% CI: 68.2%-82.9%）。结论：我们荟萃分析数据的比较分析支持全局纵向应变（GLS）作为筛选心脏毒性的首选方法，而不是左心室射血分数（LVEF）单独评估。

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Time to adopt a new standard method for assessing cardiac function in chemotherapy-induced cardiotoxicity in breast cancer? A systematic review and meta-analysis

Background

Anthracycline-induced cardiotoxicity is a major cause of morbidity in breast cancer survivors. Although left ventricular ejection fraction (LVEF) is the gold standard for monitoring cardiac function, it is often considered a late and insensitive marker of myocardial damage. New methods have emerged: global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) derived parameters as potentially superior tools for detecting subclinical dysfunction. This study aimed to systematically compare the diagnostic accuracy and temporal sensitivity of GLS, LVEF, and CMR índices in the early detection of chemotherapy-induced cardiotoxicity.

Methods

A systematic review and meta-analysis of clinical studies was conducted to evaluate the outcomes and technical accuracy of the main methods for assessing cardiac function in breast cancer patients undergoing chemotherapy, using the PubMed, Web of Science, and Scopus databases. Twenty-nine studies were included in the systematic review and meta-analysis.

Results

The meta-analysis revealed a distinct temporal dissociation between methods. GLS detected a significant absolute reduction of 1.81% (95% CI: 1.14 – 2.49; z = 5.25, p < .001) as early as 1–3 months after treatment initiation. In contrast, LVEF showed a significant reduction of 3.59% only at mid-term follow-up (4–6 months), typically remaining within the range of clinical normality (>50%). The HSROC analysis for GLS (10 studies) demonstrated robust diagnostic performance, with an Area Under the Curve (AUC) of 0.818, a pooled sensitivity of 74.6% (95% CI: 64.8%–82.4%), and a specificity of 76.3% (95% CI: 68.2%–82.9%).

Conclusion

Comparative analysis of data from our meta-analyses supports the recommendation of Global Longitudinal Strain (GLS) as the preferred method for screening for cardiotoxicity, over isolated assessment by Left Ventricular Ejection Fraction (LVEF).

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.