Кардиоонкология, часть 2. Методы диагностики в кардиоонкологии


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Ранняя диагностика и появление новых методов лечения рака привели к улучшению выживаемости пациентов с онкологическими заболеваниями. Однако, агрессивная терапия, направленная против злокачественного процесса, нередко приводит к новым заболеваниям. К ним, в первую очередь, следует отнести сердечно-сосудистые заболевания (ССЗ). В результате прямого воздействия лучевой терапии и химиотерапии на структуру сердца и сосудов происходит акселерация атеросклероза, поражение кардиомиоцитов и эндотелия, увеличивается склонность к тромбообразованию. Влияние противоопухолевого лечения на сердце разнообразно и наиболее часто определяется как кардиотоксичность.

Своевременная диагностика и выявление пациентов с высоким риском кардиотоксичности является первым шагом на пути к успешной профилактике ССЗ у онкобольных, не ставя под угрозу лечение рака, что в конечном итоге приводит к снижению общей смертности. К основным методам диагностики кардиотоксичности до и после лечения относят двухмерную эхокардиографию. Новые методы визуализации – трехмерная эхокардиография, speckle-tracking эхокардиография и магнитно-резонансная томография, показывают еще более высокую чувствительность при выявлении ранних изменений функции миокарда на фоне проводимой терапии рака. В данной статье рассматриваются основные диагностические алгоритмы и подходы, применяемые в кардиоонкологии.

Об авторах

Екатерина Владимировна Плохова

ФГБУ " Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России" 

Автор, ответственный за переписку.
Email: evplokhova@gmail.com

к.м.н, врач-кардиолог кардиологического отделения ФНКЦ ФМБА России

Россия, 115682, Москва, Ореховый бульвар, 28

Александр Вячеславович Сорокин

ФГБУ " Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России" 

Email: drav40in@gmail.com

врач отделения рентгенхирургических методов диагностики и лечения ФНКЦ ФМБА России

Россия, 115682, Москва, Ореховый бульвар, 28

Антон Валерьевич Стаферов

ФГБУ " Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России" 

Email: avstaferov@mail.ru

к.м.н., заведующий отделением рентгенхирургических методов диагностики и лечения ФНКЦ ФМБА России

Россия, 115682, Москва, Ореховый бульвар, 28

Давид Петрович Дундуа

ФГБУ " Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России" 

Email: david.doundoua@gmail.com

д.м.н., руководитель кардиологического центра ФНКЦ ФМБА России

Россия, 115682, Москва, Ореховый бульвар, 28

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2. Рис.1. Определение продольной деформации (А), радиальной деформации (В)и циркулярной (С)методом speckle-tracking ЭхоКГ [14]. В левой части рисунка стрелки указывают направление деформаций. В средней части – значения деформаций по сегментам (кроме циркулярной). В правой части – кривые деформаций. Нормальные значения для продольной деформации -19,7% (95% ДИ: от -20,4% до-18,9%), для радиальной 47,3% (95% ДИ: от 43,6% до 51,0%)и циркулярной -23,3% (95 % ДИ: от -24,6% до -22,1%)[20]. AVC – время закрытия аортального клапана.

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© Плохова Е.В., Сорокин А.В., Стаферов А.В., Дундуа Д.П., 2018

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