Abstract：
BACKGROUND: The cardiotoxic effects of anthracyclines therapy are well recognized, both in the short and long term. Echocardiography allows monitoring of cancer patients treated with this class of drugs by serial assessment of left ventricle ejection fraction (LVEF) as a surrogate of systolic function. However, changes in myocardial function may occur late in the process when cardiac damage is already established. Novel cardiac magnetic resonance (CMR) parametric techniques, like native T1 mapping and extra-cellular volume (ECV), may detect subclinical myocardial damage in these patients, recognizing early signs of cardiotoxicity before development of overt cancer therapy-related cardiac dysfunction (CTRCD) and prompting tailored therapeutic and follow-up strategies to improve outcome.
RESULTS: We conducted a systematic review and a meta-analysis to investigate the difference in CMR derived native T1 relaxation time and ECV values, respectively, in anthracyclines-treated cancer patients with preserved EF versus healthy controls. PubMed, Embase, Web of Science and Cochrane Central were searched for relevant studies. A total of 6 studies were retrieved from 1057 publications, of which, four studies with 547 patients were included in the systematic review on T1 mapping and five studies with 481 patients were included in the meta-analysis on ECV. Three out of the four included studies in the systematic review showed higher T1 mapping values in anthracyclines treated patients compared to healthy controls. The meta-analysis demonstrated no statistically significant difference in ECV values between the two groups in the main analysis (Hedges´s g =3.20, 95% CI -0.72-7.12, p =0.11, I2 =99%), while ECV was significantly higher in the anthracyclines-treated group when sensitivity analysis was performed.
CONCLUSIONS: Higher T1 mapping and ECV values in patients exposed to anthracyclines could represent early biomarkers of CTRCD, able to detect subclinical myocardial changes present before the development of overt myocardial dysfunction. Our results highlight the need for further studies to investigate the correlation between anthracyclines-based chemotherapy and changes in CMR mapping parameters that may guide future tailored follow-up strategies in this group of patients.
RESULTS: We conducted a systematic review and a meta-analysis to investigate the difference in CMR derived native T1 relaxation time and ECV values, respectively, in anthracyclines-treated cancer patients with preserved EF versus healthy controls. PubMed, Embase, Web of Science and Cochrane Central were searched for relevant studies. A total of 6 studies were retrieved from 1057 publications, of which, four studies with 547 patients were included in the systematic review on T1 mapping and five studies with 481 patients were included in the meta-analysis on ECV. Three out of the four included studies in the systematic review showed higher T1 mapping values in anthracyclines treated patients compared to healthy controls. The meta-analysis demonstrated no statistically significant difference in ECV values between the two groups in the main analysis (Hedges´s g =3.20, 95% CI -0.72-7.12, p =0.11, I2 =99%), while ECV was significantly higher in the anthracyclines-treated group when sensitivity analysis was performed.
CONCLUSIONS: Higher T1 mapping and ECV values in patients exposed to anthracyclines could represent early biomarkers of CTRCD, able to detect subclinical myocardial changes present before the development of overt myocardial dysfunction. Our results highlight the need for further studies to investigate the correlation between anthracyclines-based chemotherapy and changes in CMR mapping parameters that may guide future tailored follow-up strategies in this group of patients.
摘要：
背景：蒽环类药物治疗的心脏毒性作用已被公认，无论是短期还是长期。超声心动图可以通过连续评估左心室射血分数（LVEF）作为收缩功能的替代来监测接受此类药物治疗的癌症患者。然而,当心脏损伤已经确定时，心肌功能的变化可能在该过程的后期发生。新型心脏磁共振（CMR）参数化技术，比如原生T1映射和细胞外体积(ECV)，可能会发现这些患者的亚临床心肌损伤，在发生明显的癌症治疗相关的心功能不全(CTRCD)之前识别心脏毒性的早期迹象,并提示量身定制的治疗和随访策略以改善预后。
结果：我们进行了系统综述和荟萃分析，以研究CMR衍生的天然T1弛豫时间和ECV值的差异，分别,与健康对照相比，蒽环类药物治疗的EF保留的癌症患者。PubMed,Embase,搜索了WebofScience和CochraneCentral进行相关研究。共从1057份出版物中检索到6项研究，其中，4项包含547例患者的研究纳入了T1定位的系统评价,5项包含481例患者的研究纳入了ECV的荟萃分析.系统评价中纳入的四项研究中的三项显示，与健康对照相比，蒽环类药物治疗的患者的T1映射值更高。荟萃分析表明，在主要分析中，两组之间的ECV值无统计学差异（Hedges'sg=3.20，95％CI-0.72-7.12，p=0.11，I2=99％），而在进行敏感性分析时,蒽环类药物治疗组的ECV显著高于对照组.
结论：在接受蒽环类药物治疗的患者中，较高的T1定位和ECV值可能代表CTRCD的早期生物标志物，能够检测到明显心肌功能障碍发展之前存在的亚临床心肌变化。我们的结果强调了需要进一步研究以研究蒽环类药物为基础的化疗与CMR映射参数变化之间的相关性，这可能会指导该组患者未来的定制随访策略。
结果：我们进行了系统综述和荟萃分析，以研究CMR衍生的天然T1弛豫时间和ECV值的差异，分别,与健康对照相比，蒽环类药物治疗的EF保留的癌症患者。PubMed,Embase,搜索了WebofScience和CochraneCentral进行相关研究。共从1057份出版物中检索到6项研究，其中，4项包含547例患者的研究纳入了T1定位的系统评价,5项包含481例患者的研究纳入了ECV的荟萃分析.系统评价中纳入的四项研究中的三项显示，与健康对照相比，蒽环类药物治疗的患者的T1映射值更高。荟萃分析表明，在主要分析中，两组之间的ECV值无统计学差异（Hedges'sg=3.20，95％CI-0.72-7.12，p=0.11，I2=99％），而在进行敏感性分析时,蒽环类药物治疗组的ECV显著高于对照组.
结论：在接受蒽环类药物治疗的患者中，较高的T1定位和ECV值可能代表CTRCD的早期生物标志物，能够检测到明显心肌功能障碍发展之前存在的亚临床心肌变化。我们的结果强调了需要进一步研究以研究蒽环类药物为基础的化疗与CMR映射参数变化之间的相关性，这可能会指导该组患者未来的定制随访策略。
