evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2018-3-50-61evrazkar-299Research ArticleОБЗОРREVIEWСОВРЕМЕННЫЕ ПОДХОДЫ К ВЫЯВЛЕНИЮ РАННЕЙ СУБКЛИНИЧЕСКОЙ КАРДИОТОКСИЧНОСТИ, ИНДУЦИРОВАННОЙ ХИМИОТЕРАПИЕЙ, У БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫMODERN APPROACHES TO DETECTING EARLY SUBCLINICAL CARDIOTOXICITY INDUCED BY CHEMOTHERAPY IN PATIENTS WITH BREAST CANCERАвалянА. А.AvalyanA. A.

Аспирант отдела ультразвуковых методов исследования

121552, Россия, Москва, ул. 3-я Черепковская, д.15А.

Postgraduate Student of the Department of Ultrasound Methods of Diagnostic

121552, Russia, Moscow, 3-rd Cherepkovskaya Street, 15A.

ani_avalian@mail.ruСаидоваМ. А.SaidovaM. A.

Руководитель отдела ультразвуковых методов исследования, д.м.н., профессор

 

The Head of Department of Ultrasound Methods of Diagnostic. Professor, Doctor of Medical Sciences

noemail@neicon.ruОщепковаЕ. В.OshchepkovaE. V.

Руководитель Отдела Регистров сердечно-сосудистых заболеваний и координации и мониторинга научных программ, д.м.н., профессор

The Head of Department of Registers of Cardiovascular Diseases and Coordination and Monitoring of Scientific Programs. Professor, Doctor of Medical Sciences

noemail@neicon.ruЧазоваИ. Е.ChazovaI. Ye.

Директор института клинической кардиологии, академик РАН, профессор, д.м.н.

Director of the Institute of Clinical Cardiology. Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences

noemail@neicon.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Center of Cardiology of the Ministry of Health of RussiaRussian Federation201830092018035061Copyright © Авалян А.А., Саидова М.А., Ощепкова Е.В., Чазова И.Е., 20182018Авалян А.А., Саидова М.А., Ощепкова Е.В., Чазова И.Е.Avalyan A.A., Saidova M.A., Oshchepkova E.V., Chazova I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/299

В последние десятилетия в развитых странах мира были достигнуты успехи в лечении рака молочной железы (РМЖ), как в силу раннего выявления рака, так и благодаря использованию современных методов лечения (таргетная и химиотерапия, лучевая терапия и хирургическое лечение). В связи с этим, увеличилось время безрецидивного течения онкозаболевания и продолжительность жизни больных. Однако ряд противоопухолевых препаратов, применяемых при лечении РМЖ, обладает кардиотоксичностью [1]. Показано, что сердечно-сосудистые заболевания являются второй ведущей причиной смертности среди женщин, перенесших РМЖ [27]. Снижение систолической функции сердца является наиболее распространенным проявлением кардиотоксичности противоопухолевой терапии [7]. К другим проявлениям кардиотоксичности относятся артериальная гипертония (АГ), острый коронарный синдром, аритмии и тромбозы. В последние годы для выявления кардиотоксичности противоопухолевой терапии применяются такие методы, как электрокардиография (ЭКГ); эхокардиогра-фии (ЭхоКГ) с классическим определением фракции выброса левого желудочка (ФВ ЛЖ) по методу Simpson’s biplane и показателя глобальной продольной деформации ЛЖ (GLS) по данным технологии недопплеровского изображения миокарда в двумерном режиме (2D Speckle Tracking Imaging); определение уровня биомаркеров повреждения миокарда и магнитнорезонансная томография (МРТ) сердца. Таким образом, ранняя диагностика и своевременное выявление кардиотоксических эффектов противоопухолевых препаратов при лечении женщин РМЖ являются одними из задач сформировавшегося в последние годы направления в медицине - кардиоонкологии [1].

In recent decades, developed countries of the world have made progress in the treatment of breast cancer, both because of the early detection of cancer and the use of modern methods of treatment (target therapy and chemotherapy, radiation therapy and surgical treatment). Due to this, the time of disease-free course of cancer and the duration of life of patients have increased. However, a number of antitumor drugs have cardiotoxicity [1]. It is shown that cardiovascular diseases are the second leading cause of death among women who have undergone breast cancer [27]. Reduction of systolic function of the heart is the most common manifestation of cardiotoxicity of antitumor therapy [7]. Other manifestations of cardiotoxicity include arterial hypertension (AH), acute coronary syndrome, arrhythmias and thromboses. In recent years, methods such as electrocardiography (ECG); echocardiography (EchoCG) with the classical definition of the left ventricular ejection fraction (LVEF) by the method of Simpson's biplane and the global longitudinal strain of the left ventricular (GLS) using data from the 2D Speckle Tracking Imaging; determination of the level of biomarkers of myocardial damage and magnetic resonance imaging (MRI) of the heart have been used to detect the cardiotoxicity of antitumor therapy. Thus, the early diagnosis and timely detection of cardiotoxic effects of antitumor drugs are among the tasks of cardiooncology - an area in medicine formed in recent years [1].

кардиоонкологияартериальная гипертониякардиотоксичностьтехнология спекл трекингхимиотерапиярак молочной железыcardiooncologyarterial hypertensioncardiotoxicitytechnology speckle trackingchemotherapybreast cancerReferencesYuand Jones. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardio-Oncology (2016) 2:1 DOI 10.1186/s40959-016-0011-5Yuand Jones. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardio-Oncology. 2016;2:1 DOI 10.1186/s40959-016-0011-5Чазова И.Е., Ощепкова Е.В., Канторова А.Ю. - Коморбидность сердечно-сосудистых и онкологических заболеваний: проблемы диагностики кардиотоксических эффектов химио- и лучевой терапии. Терапевтический архив. 2015;87(9): 4-10 doi: 10.17116/terarkh20158794-10Chazova I.E., Oshchepkova E.V., Kantorova A.Yu. Comorbidity of cardiovascular diseases and cancers: Problems in the diagnosis of cardiotoxic effects of chemo- and radiation therapy. Terarkh. 2015;87(9): 4-10. doi: 10.17116/terarkh20158794-10 [in Russian]А.А. Авалян, М.Ю. Кириллова, В.Н. Шитов, Е.В. Ощепкова, М.А. Саидова, М.Б. Стенина, И.Е. Чазова. Поиск ранних маркеров кардиотоксичности противоопухолевого лечения у больных раком молочной железы в зависимости от уровня артериального давления. Системные гипертензии 2017; 14 (3): 21-27. DOI: 10.26442/2075-082X_14.3.21-27Avalyan A.A., Kirillova M.Yu., Shitov V.N., Oshchepkova Ye.V., Saidova M.A., Stenina M.B., Chazova I.Ye. Markers of early cardiotoxicity in patients with breast cancer undergoing chemotherapy depending on blood pressure level. Systemic hypertension 2017; 14 (3): 21–27. DOI: 10.26442/2075-082X_14.3.21-27 [in Russian]Fausto Pizzino, Giampiero Vizzari, Charles A. Bomzeretall. Diagnosis of Chemotherapy-Induced Cardiotoxicity. Journal of Patient-Centered Research and Reviews 8-13-2014:121-127Fausto Pizzino, Giampiero Vizzari, Charles A. Bomzeretall. Diagnosis of Chemotherapy-Induced Cardiotoxicity. Journal of Patient-Centered Research and Reviews 8-13-2014: 121-127D. Bovelli, G. Plataniotis, F. Roila. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Annals of Oncology. 21 (Supplement 5): 277-282,2010D. Bovelli, G. Plataniotis, F. Roila. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Annals of Oncology. 21 (Supplement 5): 277–282, 2010Maria Florescu et all. Chemotherapy-inducedCardiotoxicity. A Journal of Clinical Medicine 2013; 8(1): 59-67Maria Florescu et all. Chemotherapy-inducedCardiotoxicity. A Journal of Clinical Medicine 2013; 8(1): 59-67Jose Luis Zamorano, Patrizio Lancellotti, Daniel Rodriguez Mun'oz, Victor Aboyans, Riccardo Asteggiano et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. European Heart Journal. 2016,AugustJose Luis Zamorano, Patrizio Lancellotti, Daniel Rodriguez Mun˜oz, Victor Aboyans, Riccardo Asteggiano et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. European Heart Journal. 2016,August 26.Lenihan DJ, Kowey PR. Overview and management of cardiac adverse events associatedwith tyrosine kinase inhibitors. Oncologist 2013;18:900-908Lenihan DJ, Kowey PR. Overview and management of cardiac adverse events associatedwith tyrosine kinase inhibitors. Oncologist 2013;18:900–908Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am CollCardiol. 2009;53:2231-2247Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am CollCardiol. 2009;53:2231–2247Daher IN, Kim C, Saleh RR, Plana JC, Yusuf SW, Banchs J. Prevalence of abnormal echocardiographic findings in cancer patients: a retrospectiveevaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography. 2011;28:1061-7.Daher IN, Kim C, Saleh RR, Plana JC, Yusuf SW, Banchs J. Prevalence of abnormal echocardiographic findings in cancer patients: a retrospectiveevaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography. 2011;28:1061-7.Juan Carlos Plana et al. Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging J Am SocEchocardiogr. 2014;27:911-39Juan Carlos Plana et al. Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging J Am SocEchocardiogr. 2014;27:911-39Sergio Mondillo, Maurizio Galderisi, Donato Mele, Matteo Cameli, MD et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med. 2011; 30:71-8Sergio Mondillo, Maurizio Galderisi, Donato Mele, Matteo Cameli, MD et al. Speckle-Tracking Echocardiography: A New Technique for Assessing Myocardial Function. J Ultrasound Med. 2011; 30:71–8Cardinale D, Colombo A,Lamantia G. et al. Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am CollCardiol. 2010;55:213-20Cardinale D, Colombo A,Lamantia G. et al. Anthracyclineinduced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am CollCardiol. 2010;55:213–20Stoodley PW, Richards DA, Boyd A, et al. Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging. 2013 Mar;14(3): 228-34Stoodley PW, Richards DA, Boyd A, et al. Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging. 2013 Mar;14(3): 228-34Anita Boyd, Paul Stoodley, David Richards, et al. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study- PLoS One. 2017 Apr 13;12(4):e0175544; 15.Anita Boyd, Paul Stoodley, David Richards, et al. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study- PLoS One. 2017 Apr 13;12(4):e0175544; 15.Moazeni et al. Anthracycline induced cardiotoxicity: biomarkers and “Omics" technology in the era of patient speci c care. Clin Trans Med (2017) 6:17 DOI 10.1186/s40169-017-0148-3Moazeni et al Anthracycline induced cardiotoxicity: biomarkers and “Omics” technology in the era of patient speci c care. Clin Trans Med (2017) 6:17 DOI 10.1186/s40169-017-0148-3Ky B, Putt M, Sawaya H, French B, Januzzi JL Jr, Sebag IA et al. (2014) Early increases in multiple biomarkers predict subsequent cardiotoxicity in patients with breast cancer treated with doxorubicin, taxanes, and trastuzumab. J Am CollCardiol 63(8):809-816Ky B, Putt M, Sawaya H, French B, Januzzi JL Jr, Sebag IA et al (2014) Early increases in multiple biomarkers predict subsequent cardiotoxicity in patients with breast cancer treated with doxorubicin, taxanes, and trastuzumab. J Am CollCardiol 63(8):809–816Ciro Santoro1 et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. European Heart Journal - Cardiovascular Imaging, Volume 18, Issue 8, 2017, Pages 930-936, doi. org/10.1093/ehjci/jex033Ciro Santoro1 et al. 2D and 3D strain for detection of subclinical anthracycline cardiotoxicity in breast cancerpatients: a balance with feasibility. European Heart Journal – Cardiovascular Imaging, Volume 18, Issue 8, 2017, Pages 930–936, doi.org/10.1093/ehjci/jex033Paaladinesh Thavendiranathan et al. Cardiac MRI in the Assessment of Cardiac Injury and Toxicity From Cancer Chemotherapy. A Systematic Review. CircCircCardiovasc Imaging. 2013;6:1080-1091, DOI:10.1161/ CIRCIMAGING.113.000899Paaladinesh Thavendiranathan et al. Cardiac MRI in the Assessment of Cardiac Injury and ToxicityPiccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291(20):2441-7.From Cancer Chemotherapy. A Systematic Review. CircCircCardiovasc Imaging. 2013;6:1080-1091, DOI:10.1161/CIRCIMAGING.113.000899Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10:4-12.Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291(20):2441-7.Pedro Veronese, Denise Tessariol Hachul, Mauricio Ibrahim Scanavacca et al. Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer. PLoS ONE. 2018; 2-10. doi.org/10.1371/ journal.pone.0196763Chazova I.Ye., Zhernakova Yu.V., Oshchepkova E.V. The prevalence of risk factors for cardiovascular diseases in the Russian population of patients with arterial hypertension. Cardiology. 2014; 10: 4-12 [in Russian]Ranpura V, Pulipati B, Chu D, Zhu X, Whu S. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens. 2010;23(5):460-8.Pedro Veronese, Denise Tessariol Hachul, Mauricio Ibrahim Scanavacca et al. Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer. PLOS ONE. 2018; 2-10. doi.org/10.1371/journal.pone.0196763Feola M, Garrone O, Occelli M et al. Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide. Int J Cardiol. 2011;148(2):194-198. doi: 10.1016/j. ijcard.2009.09.564Ranpura V, Pulipati B, Chu D, Zhu X, Whu S. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens. 2010;23(5):460-8.Чазова И.Е,.Тюляндин С.А, Виценя М.В. и др. Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Часть: Системные гипертензии. 2017;14(3); 6-20Feola M, Garrone O, Occelli M et al. Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide. Int J Cardiol. 2011;148(2):194–198. doi: 10.1016/j.ijcard.2009.09.564Seidman A, Hudis C, Pierri MK, Shak S, Paton V, Ashby Metal. Cardiac dysfunction in the trastuzumab clinical trials experience. J ClinOncol. 2002 Mar 1;20 (5):1215-21Chazova I.Ye. Tyulyandin S.A., Vitsenya M.V. et al. A guide to the diagnosis, prevention and treatment of cardiovascular complications of antitumor therapy. Part I. Systemic hypertension. 2017; 14 (3); 6-20 [in Russian]M.A. Nicolazzi, A. Carnicelli, M. Fuorlo et al. Anthracycline and trastuzumab-induced cardiotoxicity in breast cancer. European Review for Medical and Pharmacological Sciences 2018; 22:2175-2185Seidman A, Hudis C, Pierri MK, Shak S, Paton V, Ashby Metal. Cardiac dysfunction in the trastuzumab clinical trials experience. J ClinOncol. 2002 Mar 1;20 (5):1215–21M.A. Nicolazzi, A. Carnicelli, M. Fuorlo et al. Anthracycline and trastuzumab-induced cardiotoxicity in breast cancer. European Review for Medical and Pharmacological Sciences 2018; 22: 2175-2185M.A. Nicolazzi, A. Carnicelli, M. Fuorlo et al. Anthracycline and trastuzumab-induced cardiotoxicity in breast cancer. European Review for Medical and Pharmacological Sciences 2018; 22: 2175-2185

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