摘要
本研究旨在利用不同的超声心动图方法观察蒽环类药物对左室收缩和舒张功能的急性影响。对13例计划接受蒽环类药物治疗的儿童进行前瞻性观察。在蒽环类药物(剂量为30～75m g/m2)首次给药前及前三次给药后2h内进行全面的二维和多普勒超声心动图检查,其中包括组织多普勒成像。给予首剂后,可观察到舒张期末室壁厚度增加、收缩期室壁增厚降低以及心肌作功指数增加。舒张期功能参数发生显著改变:二尖瓣E波降低、E/A比值降低和等容舒张时间延长。另外,还观察到舒张早期纵向心肌速率和等容收缩期心肌速率加速的降低,以及纵向和径向收缩期应变率和应变峰值的降低。在随后的给药过程中,这些参数仍维续显著降低。
The aim of this study was to describe the acute effects of anthracyclines on left ventricular systolic and diastolic function using different echocardiographic modalities. Thirteen children scheduled to receive anthracyclines were prospectively studied. They underwent complete 2-dimensional and Doppler echocardiographic evaluations, including tissue Doppler imaging, before the first dose and< 2 hours after each of the first 3 doses of anthracyclines(dose range 30 to 75 mg/m2). After the first dose, increased end-diastolic wall thickness, decreased wall thickening, and a prolonged myocardial performance index were noted. Parameters of diastolic function changed significantly, with a lower mitral E wave, a decreased E/A ratio, and prolonged isovolumic relaxation time. Also, reduced longitudinal early diastolic myocardial velocity and myocardial velocity acceleration during isovolumic contraction as well as reduced peak longitudinal and radial systolic strain rate and strain were noted. All these parameters remained significantly lower after subsequent doses. After the second dose, significant changes in the shortening fraction and the ejection fraction compared with baseline became apparent. After the third dose, further deterioration in radial peak systolic strain was seen. In conclusion, low to moderate doses of anthracyclines acutely induce cardiac diastolic and systolic dysfunction.
