UNLABELLED:Decreased left ventricular ejection fraction (LVEF) is a relative contraindication for the use of potentially cardiotoxic chemotherapy. A resting LVEF of 50% is usually used as the lower limit of normal values. The decision to change chemotherapy, however, is complex and is affected by many factors, including ejection fraction.

METHODS:To determine how LVEF data were used by clinical oncologists in clinical decision making, we performed a retrospective analysis of patients referred for ejection fraction measurements from the hematology/oncology divisionS of Stanford University from March 1992 through March 1995. The records of 565 patients treated with potentially cardiotoxic chemotherapy were evaluated.

RESULTS:LVEFs < 50% were found in 153 patients. The charts of patients with reduced ejection fractions were reviewed to determine if the radionuclide measurement resulted in either discontinuation of the cardiotoxic agent or substitution of a less cardiotoxic drug or mode of administration. These specific changes in therapy occurred in only 43 of the 153 (28%) patients with ejection fractions below 50%; 24 of the 43 (57%) had ejection fractions < or = 40%. Patients with lower ejection fraction values were more likely to have their therapy changed than those with LVEFs close to normal. Patients with ejection fractions < or = 30 generally had cardiotoxic agents discontinued. Of patients who had a resting LVEF < 50% and whose therapy was not changed, 81% had a normal increase in LVEF with exercise.

CONCLUSION:In clinical practice at our institution, ejection fraction < 50% is not used as an absolute contraindication to cardiotoxic chemotherapy. When the LVEF is less than 40%, potentially cardiotoxic therapy is most often discontinued or omitted. Radionuclide evidence of cardiac reserve may account for decisions to continue cardiotoxic agents despite ejection fractions < 50% in the majority of patients. Further study will be needed to establish standard criteria. Reserve function, as measured by the change in ejection fraction from rest to stress may be an important parameter used by oncologists to help select patients for continued therapy in spite of a reduced ejection fraction. Our results argue that use of fixed criteria may be too restrictive.

译文

未加标签:左心室射血分数(LVEF)降低是使用潜在心脏毒性化学疗法的相对禁忌症。通常将50%的静态LVEF用作正常值的下限。但是,更改化学疗法的决定是复杂的,并且受射血分数等许多因素影响。

方法:确定临床肿瘤学家在临床决策中如何使用LVEF数据从1992年3月至1995年3月,我们对斯坦福大学血液/肿瘤科S进行射血分数测量的患者进行了回顾性分析。评估了565例接受潜在心脏毒性化疗的患者的记录。

结果:在153例患者中发现LVEF <50%。回顾射血分数降低的患者病历表,以确定放射性核素测量是否导致心脏毒性药物的中止或心脏毒性较小的药物的替代或给药方式。在153例(28%)射血分数低于50%的患者中,只有43例发生了这些特定的治疗变化; 43个中的24个(57%)的射血分数<或= 40%。与左室射血分数接近正常的患者相比,射血分数较低的患者更有可能改变治疗方法。射血分数小于或等于30的患者通常停用心脏毒性药物。在静息LVEF <50%且治疗方法未改变的患者中,有81%的LVEF随运动而正常增加。

结论:在我们机构的临床实践中,射血分数<50%不能用作心脏毒性化疗的绝对禁忌症。当LVEF低于40%时,最有可能停止或省略潜在的心脏毒性治疗。尽管大多数患者的射血分数<50%,但心脏储备的放射性核素证据可能决定了继续使用心脏毒性药物的决定。需要进一步研究以建立标准。尽管射血分数降低,但由射血分数从静止状态变化到压力状态所测得的储备功能可能是肿瘤学家用来帮助选择患者进行继续治疗的重要参数。我们的研究结果表明,使用固定标准可能过于严格。

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