Abstract
Chronic heart failure following chemotherapy for cancer is a relevant issue of an adverse cardiovascular prognosis and premature death in cancer patients. This category of patients requires thorough and chronic monitoring of the cardiovascular system, prevention and treatment of cardiovascular complications of chemotherapy, such as IHD, systolic or diastolic myocardial dysfunction, arterial or pulmonary hypertension, pulmonary thromboembolism, pericarditis, stroke, and peripheral vascular disease. However, many aspects of this important interdisciplinary issue presently remain understudied. For instance, it is still impossible to predict long-term consequences of chemotherapy for cancer and development of the associated cardiovascular complications listed above. Baseline evaluation of the risk for cardiovascular complications is a major component in management of such patients. High-risk patients need an individual, detailed schedule of cardiovascular treatment throughout and after the course of chemotherapy. Furthermore, early detection of subclinical myocardial dysfunction is critical for prevention of the most threatening cardiovascular complications of chemotherapy, CHF. Detecting impaired LV EF following chemotherapy is, unfortunately, only a late predictor of irreversible changes, such as toxic cardiomyopathy and clinically pronounced, rapidly progressing CHF. Markers of myocardial injury, high-sensitivity troponins and natriuretic peptides, in combination with up-to-date EchoCG technologies have been recently used. Their use, for instance, for evaluation of LV myocardial global longitudinal strain to detect early, reversible changes in structure and mechanics of the myocardium is promising for ultimate improvement of prediction for such patients.
Highlights
Chronic heart failure following chemotherapy for cancer is a relevant issue of an adverse cardiovascular prognosis and premature death in cancer patients
Baseline evaluation of the risk for cardiovascular complications is a major component in management of such patients
Early detection of subclinical myocardial dysfunction is critical for prevention of the most threatening cardiovascular complications of chemotherapy, CHF
Summary
Chronic heart failure following chemotherapy for cancer is a relevant issue of an adverse cardiovascular prognosis and premature death in cancer patients. Sawaya с соавт., опублико‐ ванном в 2012 г., в которое были включены пациентки с раком молочной железы, было показано, что снижение глобальной продольной деформации ЛЖ менее –19 % после терапии антрациклинами является независимым предиктором развития систолической дисфункции у пациенток, которым был назначен трастузумаб [31]. В 2017 г., у 13 % больных раком молочной железы пациенток про‐ изошло достоверное уменьшение показателя глобальной продольной деформации на 15 % от исходных значений, в то время как ФВ ЛЖ достоверно не менялась [34]. В нашем исследовании также было показано снижение глобальной продольной деформации ЛЖ на 5 % у паци‐ енток с раком молочной железы на фоне химиотерапев‐ тического лечения, а ФВ ЛЖ у них практически не меня‐ лась.
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