ABSTRACT
Objective To investigate the value of echocardiographic Tei index combined with serum high-sensitivity cardiac troponin T(hs-cTnT) on monitoring cardiac toxicity associated with anthracycline chemotherapy drug in patients with diffuse large B-cell lymphoma(DLBCL).Methods PW-Tei index,TDI-Tei index of left/right ventricles and radionuclide cardiac measurement were acquired from 56 patients with DLBCL before,after the completion of 2-4 cycle(100-200 mg/m2) and 6-8 cycle(300-400 mg/m2) of the regimen,part of them received serum hs-cTnT detection at the same time.Cardiac toxicity event was defined as a relative reduction of radionuclide left ventricular ejection fraction(LVEF) of ≥10％ during the regime or an absolute radionuclide LVEF≤50％ after the complete chemotherapy.Results Compared with baseline,left ventricular PW-Tei index significantly increased after whole cures [(0.36-± 0.12) vs (0.44 ±0.13) vs (0.40 ± 0.13),P =0.002].After complete regimen,serum hs-cTnT level elevated significantly [(0.006 ± 0.006)tg/L vs (0.012 ± 0.007) μg/L vs (0.020±0.013)tμg/L,P =0.001].The sensitivity,specificity and area under ROC curve of early diagnosis of anthracycline-induced cardiotoxicity with elevated serum hs-cTnT in 2-4 cycle and increased left ventricular PW-Tei index in 6-8cycle detected together were 75％,85％,0.736 and 92％,50％,0.675,respectively(all P ＜0.05).Conclusions Echocardiographic PW-Tei index combined with serum hs-cTnT is a simple method and can be easily obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.
ABSTRACT
El dolor torácico agudo es uno de los motivos más frecuentes de consulta en servicios de urgencia. Una de sus causas más relevantes son los síndromes coronarios agudos. Sin embargo, existen muchas otras etiologías de dolor torácico agudo dentro de los diagnósticos diferenciales, algunas de ellas igualmente graves. En esta revisión se presentan las características clínicas que ayudan a diferenciar estos diversos cuadros, como también sus características electrocardiográficas y radiológicas. Se hace mención a los biomarcadores de daño miocárdico, de especial importancia dada su alta sensibilidad y especificidad. Debido a que este número de la Revista Médica CLC tiene como tema central trauma y urgencia, se han incluido aspectos habitualmente ausentes en revisiones de este tipo, como son commotio cordis (conmoción cardíaca) y el traumatismo torácico cerrado. Finalmente, se tocan tópicos referentes a las pruebas de provocación de isquemia sin y con imágenes y la tomografía computada de coronarias en la evaluación de pacientes con este síndrome.
Acute chest pain is one of the most common reasons for presentation to the emergency department. One of its most relevant causes is acute coronary syndrome. However, there are many other etiologies for acute chest pain among the differential diagnoses, some of them being severe too. In this review, we present the clinical features that help to differentiate these several clinical conditions, as well as their electrocardiographic and radiological characteristics. We address biomarkers of myocardial injury that have particular importance due to their high sensitivity and specificity. Because this issue of the Journal has as central subject trauma and urgency, we included topics commonly not considered in other reviews like this, such as commotio cordis and blunt thoracic trauma. Finally, we devoted some paragraphs to stress testing (with electrocardiography and imaging) and coronary multi detector computed tomography in the evaluation of patients with this syndrome.