美国哈佛医学院Jagmeet P. Singh联合罗切斯特大学医学中心Valentina Kutyifa课题组在研究中取得进展。他们的最新研究发现心脏再同步化治疗可有效改善化疗性心肌病患者的左室射血分数。相关论文于2019年11月12日发表于国际顶尖学术期刊《美国医学会杂志》上。

据悉，化疗引起的心肌病发病率正不断增加，且与不良临床预后相关。

2014年11月21日至2018年6月21日，研究组在美国12个有心脏肿瘤项目的三级中心进行了一项非对照、前瞻性的队列研究，招募了30例因左心室射血分数降低（LVEF≤35%）、纽约心脏病协会II-IV级心衰和宽QRS波群而形成的化疗性心肌病患者，所有患者均接受植入心脏再同步化治疗（CRT），术后随访6个月。

30例患者的平均年龄为64岁，女性占87%，73%有乳腺癌史，20%有淋巴瘤或白血病史。非缺血性心肌病伴左束支传导阻滞的患者，中位LVEF为29%，QRS平均持续时间为152ms。植入CRT6个月后，患者的平均LVEF从28%提高至39%。同时左室收缩末期容积从122.7mL减少到89.0mL，左室舒张末期容积从171.0mL减少到143.2mL。不良事件包括1例手术相关的气胸、1例器械袋感染和1例随访期间需住院治疗的心力衰竭。

综上，对于化疗性心肌病患者，植入CRT6个月后可显著改善LVEF。但该研究样本量小、随访时间短、缺乏对照组，仍需进一步验证。

附：英文原文

Title: Association of Cardiac Resynchronization Therapy With Change in Left Ventricular Ejection Fraction in Patients With Chemotherapy-Induced Cardiomyopathy

Author: Jagmeet P. Singh, Scott D. Solomon, Michael G. Fradley, Ana Barac, Kristina A. Kremer, Christopher A. Beck, Mary W. Brown, Scott McNitt, Susan Schleede, Wojciech Zareba, Ilan Goldenberg, Valentina Kutyifa

Issue&Volume: 2019/11/12

Abstract:

Importance  The incidence of chemotherapy-induced cardiomyopathy is increasing and is associated with poor clinical outcomes.

Objective  To assess the association of cardiac resynchronization therapy (CRT) with improvement in cardiac function, as well as clinical improvement in patients with chemotherapy-induced cardiomyopathy.

Design, Setting, and Participants  The Multicenter Automatic Defibrillator Implantation Trial–Chemotherapy-Induced Cardiomyopathy was an uncontrolled, prospective, cohort study conducted between November 21, 2014, and June 21, 2018, at 12 tertiary centers with cardio-oncology programs in the United States. Thirty patients were implanted with CRT owing to reduced left ventricular ejection fraction (LVEF≤35%), New York Heart Association class II-IV heart failure symptoms, and wide QRS complex, with established chemotherapy-induced cardiomyopathy and were followed up for 6 months after CRT implantation. The date of final follow-up was February 6, 2019.

Exposures  CRT implantation according to standard of care.

Main Outcomes and Measures  The primary end point was change in LVEF from baseline to 6 months after initiating CRT. Secondary outcomes included all-cause mortality and change in left ventricular end-systolic volume and end-diastolic volume.

Results  Among 30 patients who were enrolled (mean [SD] age, 64 [11] years; 26 women [87%]; 73% had a history of breast cancer; 20% had a history of lymphoma or leukemia), primary end point data were available for 26 patients and secondary end point data were available for 23 patients. Patients had nonischemic cardiomyopathy with left bundle branch block, median LVEF of 29%, and a mean QRS duration of 152 ms. Patients with CRT experienced a statistically significant improvement in mean LVEF at 6 months from 28% to 39% (difference, 10.6% [95% CI, 8.0%-13.3%]; P < .001). This was accompanied by a reduction in LV end-systolic volume from 122.7 to 89.0 mL (difference, 37.0 mL [95% CI, 28.2-45.8]) and reduction in LV end-diastolic volume from 171.0 to 143.2 mL (difference, 31.9 mL [95% CI, 22.1-41.6]) (both P < .001). Adverse events included a procedure-related pneumothorax (1 patient), a device pocket infection (1 patient), and heart failure requiring hospitalization during follow-up (1 patient).

Conclusions and Relevance  In this preliminary study of patients with chemotherapy-induced cardiomyopathy, CRT was associated with improvement in LVEF after 6 months. The findings are limited by the small sample size, short follow-up, and absence of a control group.

DOI: 10.1001/jama.2019.16658

Source: https://jamanetwork.com/journals/jama/article-abstract/2754793