BACKGROUND Cardio-oncology is a recently established discipline that focuses on the management of patients with cancer who are at risk for developing cardiovascular complications as a result of their underlying oncologic treatment. In metastatic colorectal cancer (mCRC) and metastatic renal cell carcinoma (mRCC), vascular endothelial growth factor inhibitor (VEGF-i) therapy is commonly used to improve overall survival. Although these novel anticancer drugs may lead to the development of cardiotoxicity, whether early detection of cardiac dysfunction using serial echocardiography could potentially prevent the development of heart failure in this patient population requires further study. The aim of this study was to investigate the role of two-dimensional speckle-tracking echocardiography in the detection of cardiotoxicity due to VEGF-i therapy in patients with mCRC or mRCC. METHODS Patients with mRCC or mCRC were evaluated using serial echocardiography at baseline and 1, 3, and 6 months following VEGF-i treatment. RESULTS A total of 40 patients (34 men; mean age, 63 ± 9 years) receiving VEGF-i therapy were prospectively recruited at two academic centers: 26 (65%) were receiving sunitinib, eight (20%) pazopanib, and six (15%) bevacizumab. The following observations were made: (1) 8% of patients developed clinically asymptomatic cancer therapeutics-related cardiac dysfunction; (2) 30% of patients developed clinically significant decreases in global longitudinal strain, a marker for early subclinical cardiac dysfunction; (3) baseline abnormalities in global longitudinal strain may identify a subset of patients at higher risk for developing cancer therapeutics-related cardiac dysfunction; and (4) new or worsening hypertension was the most common adverse cardiovascular event, afflicting nearly one third of the study population. CONCLUSIONS Cardiac dysfunction defined by serial changes in myocardial strain assessed using two-dimensional speckle-tracking echocardiography occurs in patients undergoing treatment with VEGF-i for mCRC or mRCC, which may provide an opportunity for preventive interventions.

中文翻译：

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超声心动图评估检测在转移性肾细胞癌和结直肠癌中由于血管内皮生长因子抑制剂治疗而引起的心脏毒性。

背景技术心血管肿瘤学是最近建立的一门学科，其重点是对由于其潜在的肿瘤学治疗而有发展心血管并发症风险的癌症患者的治疗。在转移性大肠癌（mCRC）和转移性肾细胞癌（mRCC）中，血管内皮生长因子抑制剂（VEGF-i）治疗通常用于提高总体生存率。尽管这些新的抗癌药可能导致心脏毒性的发展，但使用连续超声心动图检查早期发现心脏功能障碍是否有可能阻止该患者人群心力衰竭的发展，尚需进一步研究。这项研究的目的是调查二维散斑跟踪超声心动图在检测mCRC或mRCC患者的VEGF-i治疗引起的心脏毒性中的作用。方法在基线，VEGF-i治疗后1、3和6个月使用连续超声心动图对mRCC或mCRC患者进行评估。结果前瞻性地在两个学术中心招募了接受VEGF-i治疗的40例患者（34名男性，平均年龄63±9岁）：26名（65％）接受舒尼替尼，8名（20％）帕唑帕尼和6名（ 15％）贝伐单抗。进行了以下观察：（1）8％的患者出现了与临床无症状的癌症治疗相关的心脏功能障碍；（2）30％的患者在临床上发现总体纵向张力降低，这是早期亚临床心脏功能障碍的标志；（3）总体纵向张力的基线异常可能会识别出一部分患癌症治疗相关的心脏功能障碍的较高风险的患者；（4）新发或恶化的高血压是最常见的不良心血管事件，折磨了近三分之一的研究人群。结论由二维斑点跟踪超声心动图评估的心肌张力的系列变化定义的心脏功能障碍发生在接受VEGF-i治疗mCRC或mRCC的患者中，这可能为预防性干预提供了机会。折磨了将近三分之一的研究人群。结论由二维斑点跟踪超声心动图评估的心肌张力的系列变化定义的心脏功能障碍发生在接受VEGF-i治疗mCRC或mRCC的患者中，这可能为预防性干预提供了机会。折磨了将近三分之一的研究人群。结论由二维斑点跟踪超声心动图评估的心肌张力的系列变化定义的心脏功能障碍发生在接受VEGF-i治疗mCRC或mRCC的患者中，这可能为预防性干预提供了机会。