心脏再同步治疗在癌症治疗相关心功能障碍中的有效性：一项系统评价与荟萃分析。
完整摘要 · 中文译文
引言：癌症治疗的进展增加了幸存者数量，使得癌症治疗相关心功能障碍（CTRCD）成为一个重要关注点。虽然心脏再同步治疗（CRT）已确立用于射血分数降低的心力衰竭和传导障碍，但其在CTRCD中的作用仍不明确。我们进行了一项荟萃分析，以评估CRT在CTRCD患者中的获益。 方法：我们对显示CRT在CTRCD患者这一特定群体中结局的研究进行了文献检索。关注的结局为左心室射血分数（LVEF）和左心室容积改善。采用随机效应荟萃分析估计95%置信区间（CI）。 结果：本分析纳入四项研究（一项前瞻性研究和三项回顾性研究），共包括110例CTRCD患者，其中大多数（91%，n = 100）为乳腺癌或淋巴瘤/白血病幸存者。基线LVEF范围为18.6% ± 7.6%至28.5% ± 3.8%（均值24% ± 7%）。在平均9 ± 5个月的随访后，LVEF增加9.95%（95% CI 7.79-12.11），收缩末期容积减少39.17 mL（95% CI 24.99-53.35）。三项研究纳入了接受CRT植入的其他形式非缺血性心肌病患者作为对照组，显示两组之间LVEF改善无显著差异。 结论：本荟萃分析提示，CRT可改善选定CTRCD患者的LVEF和左心室容积，其逆向重构的程度似乎与其他病因的非缺血性心肌病中观察到的相似。然而， 证据仅限于小型观察性研究，因此关于临床结局的结论仍不确定。因此，对于符合心脏再同步治疗（CRT）植入标准标准的癌症患者，可考虑CRT，但决策应个体化，并以多学科评估、癌症预后和相互竞争的临床风险为指导。
完整摘要 · 英文原文
INTRODUCTION: Advances in cancer treatment have increased the number of survivors, making cancer therapy-related cardiac dysfunction (CTRCD) an important concern. While cardiac resynchronization therapy (CRT) is established for heart failure with reduced ejection fraction and conduction disorders, its role in CTRCD remains unclear. We conducted a meta-analysis to assess the benefit of CRT in patients with CTRCD. METHODS: We performed a literature search of studies showing CRT outcomes in the specific group of CTRCD patients. The outcomes of interest were left ventricular ejection fraction (LVEF) and LV volume improvement. A random effects meta-analysis was done to estimate 95% confidence intervals (CI). RESULTS: This analysis included four studies (one prospective and three retrospective) comprising 110 patients with CTRCD, the majority (91%, n = 100) being survivors of breast cancer or lymphoma/leukemia. Baseline LVEF ranged from 18.6% ± 7.6% to 28.5% ± 3.8% (mean 24% ± 7%). After a mean follow-up of 9 ± 5 months, LVEF increased by 9.95% (95% CI 7.79-12.11) and end-systolic volume decreased by 39.17 mL (95% CI 24.99-53.35). Three studies included a control group of patients with other forms of non-ischemic cardiomyopathy who underwent CRT implantation, showing no significant difference in LVEF improvement between the two groups. CONCLUSION: This meta-analysis suggests that CRT improves LVEF and LV volumes in selected patients with CTRCD, with a magnitude of reverse remodeling that appears similar to that observed in other etiologies of non-ischemic cardiomyopathy. However, the evidence is limited to small observational studies, so conclusions about clinical outcomes remain uncertain. Thus, CRT may be considered in cancer patients who meet standard criteria for CRT implantation, but the decision should be individualized and guided by multidisciplinary assessment, cancer prognosis, and competing clinical risks.