肿瘤治疗相关心血管损伤与冠状动脉微循环障碍

Cancer therapy-related cardiovascular dysfunction and coronary microvascular dysfunction:research progress

许多接受化学治疗或放射治疗的肿瘤患者心血管疾病发生风险明显增加。研究发现,肿瘤治疗引起心功能障碍及随后的心力衰竭主要由于血管毒性所致,而非心肌毒性。然而,并不是所有肿瘤治疗的血管毒性都可以用阻塞性冠状动脉疾病解释。在过去的几十年里,已经发现心肌缺血可能是由于冠状动脉造影所不能看到的复杂血管网络结构或功能障碍所致,即冠状动脉微循环障碍(CMD)。越来越多的证据表明,肿瘤治疗相关心血管损伤(CTRCD)和CMD存在许多共同的病理生理机制。本文从病理生理学角度阐述CTRCD与CMD的联系,为探索心血管疾病新的诊断方法和治疗策略提供思路。

The risk of cardiovascular diseases is significantly increased in cancer patients receiving chemotherapy or radiotherapy.Recent evidences suggested that cardiac dysfunction and subsequent heart failure are mainly caused by vascular toxicity rather than myocardial toxicity.However,not all of the vascular toxicity of cancer therapies can be explained by obstructive coronary artery disease.In the past few decades,it has been found that myocardial ischemia may be caused by structural or functional disorders of the complex vascular network that cannot be seen by coronary angiography,known as coronary microvascular dysfunction(CMD).There is growing evidences that cancer therapy-related cardiovascular dysfunction(CTRCD)and CMD have many common pathophysiological mechanisms.This paper elucidates the relationship between CTRCD and CMD from the pathophysiological perspective,providing reference for exploring new diagnostic methods and treatment strategies of cardiovascular diseases.