cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2020.3.n952cardio-952Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESРемоделирование сердца у больных с тяжелой систолической дисфункцией, возникшей на фоне противоопухолевой терапии.Heart reHeart remodeling in patients with severe systolic dysfunction due tocancer chemotherapymodeling in patients with severe systolic dysfunction due tocancer chemotherapy.https://orcid.org/0000-0002-3100-8342ЕмелинаЕ. И.EmelinaE. I.eei1210@mail.ruhttps://orcid.org/0000-0002-8576-3159ИбрагимоваА. А.IbragimovaA. A.onistella@mail.ruhttps://orcid.org/0000-0002-2429-1629ГаниеваИ. И.GanievaI. I.ganievaii@mail.ruhttps://orcid.org/0000-0002-7846-1611ГендлинГ. Е.GendlinG. E.rgmugt2@mail.ruhttps://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.igor.nikitin.64@mail.ruhttps://orcid.org/0000-0002-8869-8655КууларА. А.KuularA. A.

врач-кардиолог

char_ai_al_91@mail.ruhttps://orcid.org/0000-0002-0139-5177СитниковаМ. Ю.SitnikovaM. Yu.

д.м.н., профессор

drsitnikova@mail.ruРНИМУ имени Н.И. ПироговаРоссияN. I. Pirogov Russian National Research Medical University”; 117997, Moscow, Russian Federation.Russian FederationГБУЗ "Городская клиническая больница имени В.М. Буянова" ДЗМ, 115516, г. МоскваРоссияCity Clinical Hospital named after V.M. Buyanov of the Moscow Healthcare Department, 115516, Moscow.Russian FederationФГБУ «НМИЦ им. В. А. Алмазова» Минздрава России, 197341, Санкт-ПетербургРоссияNational Medical Research Center named after V.A. Almazov, 197341, St. PetersburgRussian Federation2020200120206035158Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/952

Цель Сравнительный анализ структурно-функциональных особенностей сердца у пациентов с токсической кардиомиопатией (ТКМП) с низкой фракцией левого желудочка (ФВ ЛЖ) и тяжелой хронической сердечной недостаточностью (ХСН) с таковыми у пациентов с идиопатической дилатационной кардиомиопатией (ДКМП) с аналогичными ФВ ЛЖ и тяжестью ХСН.Материал и методы В наблюдательное одноцентровое исследование были включены 15 пациентов с ТКМП (12 из них получали схемы, содержащие антрациклиновые антибиотики, 3 – таргетные препараты) и 26 пациентов с идиопатической ДКМП. Сравнивались показатели эхокардиографии пациентов с ТКМП и ДКМП с сопоставимой низкой ФВ ЛЖ менее 40 %.Результаты У больных с тяжелым поражением сердца на фоне лечения противоопухолевыми препаратами с низкой ФВ ЛЖ объемные и линейные показатели левого и правого желудочков сердца, левого предсердия (индекс объема левого предсердия (иОЛП) – 33,7 (21,5–36,9) мл / м2, конечно-диастолический размер правого желудочка (КДРпж) – 2,49 (1,77–3,53) cм, индексированный конечно-диастолический объем (иКДО) – 78,0 (58,7–90,0) мл / м2) оказались значительно меньше таковых в группе ДКМП (иОЛП- 67,1 (51,1–85,0) мл / м2, КДРпж – 4,05 (3,6–4,4) см, иКДО – 117,85 (100,6–138,5) мл / м2, p<0,0001). При этом в сравниваемых группах не отличались толщина стенок ЛЖ, значения систолического давления в легочной артерии. И у мужчин, и у женщин с ТКМП показатели иОЛП и индексированный конечно-диастолический объем оказались значительно меньше, чем у мужчин и женщин с ДКМП.Заключение Результаты исследования выявили значительные различия в показателях ремоделирования сердца. У больных с ТКМП, в отличие от пациентов с ДКМП, несмотря на выраженное снижение ФВ ЛЖ, наблюдалось отсутствие дилатации ЛЖ сердца или умеренное увеличение его объемных показателей при более тяжелом соматическом статусе.

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.

Ремоделирование сердцакардиотоксичностьпротивоопухолевая терапияантрациклиновые антибиотикиCardiac remodelingcardiotoxicityantitumor therapyanthracycline antibioticsАвторы заявляют об отсутствии конфликта интересов.ReferencesMarkman TM, Markman M. Cardio-Oncology: mechanisms of cardiovascular toxicity. F1000Research. 2018;7:113. DOI: 10.12688/f1000research.12598.1Markman TM, Markman M. Cardio-Oncology: mechanisms of cardiovascular toxicity. F1000Research. 2018;7:113. DOI: 10.12688/f1000research.12598.1Perez IE, Taveras Alam S, Hernandez GA, Sancassani R. Cancer The­rapy-Related Cardiac Dysfunction: An Overview for the Clinician. Clinical Medicine Insights: Cardiology. 2019;13:117954681986644. DOI: 10.1177/1179546819866445Perez IE, Taveras Alam S, Hernandez GA, Sancassani R. Cancer The­rapy-Related Cardiac Dysfunction: An Overview for the Clinician. Clinical Medicine Insights: Cardiology. 2019;13:117954681986644. DOI: 10.1177/1179546819866445Lenneman CG, Sawyer DB. Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment. Circulation Research. 2016;118(6):1008–20. DOI: 10.1161/CIRCRESAHA.115.303633Lenneman CG, Sawyer DB. Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment. Circulation Research. 2016;118(6):1008–20. DOI: 10.1161/CIRCRESAHA.115.303633Ballard W, Vader J. Prevention of Cardiotoxicity in the Cancer Patient. Current Cardiovascular Risk Reports. 2017;11(11): 31. DOI: 10.1007/s12170-017-0558-1Ballard W, Vader J. Prevention of Cardiotoxicity in the Cancer Patient. Current Cardiovascular Risk Reports. 2017;11(11): 31. DOI: 10.1007/s12170-017-0558-1Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European Heart Journal. 2016;37(36):2768–801. DOI: 10.1093/eurheartj/ehw211Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European Heart Journal. 2016;37(36):2768–801. DOI: 10.1093/eurheartj/ehw211Varricchi G, Galdiero MR, Marone G, Criscuolo G, Triassi M, Bonaduce D et al. Cardiotoxicity of immune checkpoint inhibitors. ESMO Open. 2017;2(4):e000247. DOI: 10.1136/esmoopen-2017-000247Varricchi G, Galdiero MR, Marone G, Criscuolo G, Triassi M, Bonaduce D et al. Cardiotoxicity of immune checkpoint inhibitors. ESMO Open. 2017;2(4):e000247. DOI: 10.1136/esmoopen-2017-000247Snipelisky D, Park JY, Lerman A, Mulvagh S, Lin G, Pereira N et al. How to Develop a Cardio-Oncology Clinic. Heart Failure Clinics. 2017;13(2):347–59. DOI: 10.1016/j.hfc.2016.12.011Snipelisky D, Park JY, Lerman A, Mulvagh S, Lin G, Pereira N et al. How to Develop a Cardio-Oncology Clinic. Heart Failure Clinics. 2017;13(2):347–59. DOI: 10.1016/j.hfc.2016.12.011Herrmann J, Loprinzi C, Ruddy K. Building a Cardio-Onco-Hematology Program. Current Oncology Reports. 2018;20(10): 81. DOI: 10.1007/s11912-018-0725-7Herrmann J, Loprinzi C, Ruddy K. Building a Cardio-Onco-Hematology Program. Current Oncology Reports. 2018;20(10): 81. DOI: 10.1007/s11912-018-0725-7Larsen CM, Mulvagh SL. Cardio-oncology: what you need to know now for clinical practice and echocardiography. Echo Research and Practice. 2017;4(1):R33–41. DOI: 10.1530/ERP-17-0013Larsen CM, Mulvagh SL. Cardio-oncology: what you need to know now for clinical practice and echocardiography. Echo Research and Practice. 2017;4(1):R33–41. DOI: 10.1530/ERP-17-0013Takami Y, Hoshino N, Kato Y, Sakurai Y, Amano K, Higuchi Y et al. Recovery from anthracycline-induced cardiomyopathy with biventri­cular assist and valve repairs: A case report and literature review. The International Journal of Artificial Organs. 2018;41(7): 413–7. DOI: 10.1177/0391398818772497Takami Y, Hoshino N, Kato Y, Sakurai Y, Amano K, Higuchi Y et al. Recovery from anthracycline-induced cardiomyopathy with biventri­cular assist and valve repairs: A case report and literature review. The International Journal of Artificial Organs. 2018;41(7): 413–7. DOI: 10.1177/0391398818772497Murtagh G, Lyons T, O’Connell E, Ballot J, Geraghty L, Fennelly D et al. Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up. Breast Cancer Research and Treatment. 2016;156(3): 501–6. DOI: 10.1007/s10549-016-3781-4Murtagh G, Lyons T, O’Connell E, Ballot J, Geraghty L, Fennelly D et al. Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up. Breast Cancer Research and Treatment. 2016;156(3): 501–6. DOI: 10.1007/s10549-016-3781-4Lenneman AJ, Wang L, Wigger M, Frangoul H, Harrell FE, Silverstein C et al. Heart Transplant Survival Outcomes for Adriamycin-Dilated Cardiomyopathy. The American Journal of Cardiology. 2013;111(4): 609–12. DOI: 10.1016/j.amjcard.2012.10.048Lenneman AJ, Wang L, Wigger M, Frangoul H, Harrell FE, Silverstein C et al. Heart Transplant Survival Outcomes for Adriamycin-Dilated Cardiomyopathy. The American Journal of Cardiology. 2013;111(4): 609–12. DOI: 10.1016/j.amjcard.2012.10.048Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M et al. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. European Journal of Cancer. 2018;94:126–37. DOI: 10.1016/j.ejca.2018.02.005Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M et al. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. European Journal of Cancer. 2018;94:126–37. DOI: 10.1016/j.ejca.2018.02.005Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC et al. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation. 2016;134(23):e579–646. DOI: 10.1161/CIR.0000000000000455Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC et al. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation. 2016;134(23):e579–646. DOI: 10.1161/CIR.0000000000000455McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovascular Drugs and Therapy. 2017;31(1):63–75. DOI: 10.1007/s10557-016-6711-0McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovascular Drugs and Therapy. 2017;31(1):63–75. DOI: 10.1007/s10557-016-6711-0Santos DS dos, Goldenberg RC dos S. Doxorubicin-Induced Cardiotoxicity: From Mechanisms to Development of Efficient Therapy. In: Cardiotoxicity Tan W, editor InTech;2018. [Av. at: https://www.intechopen.com/books/cardiotoxicity/doxorubicin-induced-cardiotoxicity-from-mechanisms-to-development-of-efficient-therapy. DOI: 10.5772/intechopen.79588]Santos DS dos, Goldenberg RC dos S. Doxorubicin-Induced Cardiotoxicity: From Mechanisms to Development of Efficient Therapy. In: Cardiotoxicity Tan W, editor InTech;2018. [Av. at: https://www.intechopen.com/books/cardiotoxicity/doxorubicin-induced-cardiotoxicity-from-mechanisms-to-development-of-efficient-therapy. DOI: 10.5772/intechopen.79588]Groarke JD, Nguyen PL, Nohria A, Ferrari R, Cheng S, Moslehi J. Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease. European Heart Journal. 2014;35(10):612–23. DOI: 10.1093/eurheartj/eht114Groarke JD, Nguyen PL, Nohria A, Ferrari R, Cheng S, Moslehi J. Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease. European Heart Journal. 2014;35(10):612–23. DOI: 10.1093/eurheartj/eht114Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medi­cine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58 (6S): 8–164. [Russian: Мареев В. Ю., Фомин И. В., Агеев Ф. Т., Беграмбекова Ю. Л., Васюк Ю. А., Гарганеева А. А. и др. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(6S): 8-164]. DOI: 10.18087/cardio.2475Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medi­cine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58 (6S): 8–164. [Russian: Мареев В. Ю., Фомин И. В., Агеев Ф. Т., Беграмбекова Ю. Л., Васюк Ю. А., Гарганеева А. А. и др. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(6S): 8-164]. DOI: 10.18087/cardio.2475Nepomnyashchikh L.M., Lushnikova E.L., Klinnikova M.G., Molodykh O.P. Influence of doxorubicin on dilated myocardial remodeling during progressive growth. Siberian Medical Journal (Tomsk). 2011;26 (4–1):147–51. [Russian: Непомнящих Л. М., Лушникова Е. Л., Клинникова М. Г., Молодых О. П. Влияние доксорубицина на дилатационное ремоделирование миокарда в период прогрессивного роста. Сибирский медицинский журнал (Томск). 2011;26(4-1):147-51]Nepomnyashchikh L.M., Lushnikova E.L., Klinnikova M.G., Molodykh O.P. Influence of doxorubicin on dilated myocardial remodeling during progressive growth. Siberian Medical Journal (Tomsk). 2011;26 (4–1):147–51. [Russian: Непомнящих Л. М., Лушникова Е. Л., Клинникова М. Г., Молодых О. П. Влияние доксорубицина на дилатационное ремоделирование миокарда в период прогрессивного роста. Сибирский медицинский журнал (Томск). 2011;26(4-1):147-51]Oliveira GH, Qattan MY, Al-Kindi S, Park SJ. Advanced Heart Failure Therapies for Patients With Chemotherapy-Induced Cardiomyo­pathy. Circulation: Heart Failure. 2014;7(6):1050–8. DOI: 10.1161/CIRCHEARTFAILURE.114.001292Oliveira GH, Qattan MY, Al-Kindi S, Park SJ. Advanced Heart Failure Therapies for Patients With Chemotherapy-Induced Cardiomyo­pathy. Circulation: Heart Failure. 2014;7(6):1050–8. DOI: 10.1161/CIRCHEARTFAILURE.114.001292Pinto YM, Elliott PM, Arbustini E, Adler Y, Anastasakis A, Böhm M et al. Proposal for a revised definition of dilated cardiomyo­pathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. European Heart Journal. 2016;37(23):1850–8. DOI: 10.1093/eurheartj/ehv727Pinto YM, Elliott PM, Arbustini E, Adler Y, Anastasakis A, Böhm M et al. Proposal for a revised definition of dilated cardiomyo­pathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. European Heart Journal. 2016;37(23):1850–8. DOI: 10.1093/eurheartj/ehv727Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A et al. Update on Myocarditis. Journal of the American College of Cardiology. 2012;59(9):779–92. DOI: 10.1016/j.jacc.2011.09.074Kindermann I, Barth C, Mahfoud F, Ukena C, Lenski M, Yilmaz A et al. Update on Myocarditis. Journal of the American College of Cardiology. 2012;59(9):779–92. DOI: 10.1016/j.jacc.2011.09.074

The authors declare that there are no conflicts of interest present.