犬隻接受阿黴素化療後規律心臟評估之必要性

Abstract

阿黴素(doxorubicin)是一種廣泛用於治療癌症病患的細胞毒殺性藥物，然而其造成之心臟毒性作用，也在人醫及獸醫犬隻病患上廣為人知。過去的研究指出，給予阿黴素治療之療程中可能產生的相關不良反應如心肌收縮力下降、心律不整和發生心衰竭之風險上升等；目前已知此心臟毒性為劑量相關性及具有累積效應，因此在化療過程中對此執行監控以及盡早執行醫療介入更顯得重要。本研究的目的是調查台灣中小型犬隻族群，在接受最多四劑阿黴素治療的化療方案下，其心臟毒性的可能表型、發生率以及心電圖與心臟超音波的追蹤變化。 本研究共納入20隻自2021年9月至2023年4月至台大動物醫院接受腫瘤疾病治療的犬隻，每隻狗皆至少接受一劑阿黴素治療；心臟功能評估之進行包含心電圖與心臟超音波，初始評估會在第一劑阿黴素治療前進行，而在隨後每劑阿黴素給予後皆會進行追蹤，總共進行五次的心臟功能評估。 本研究結果顯示，在我們納入的犬隻病患中沒有任何臨床心臟毒性的表現，顯示心臟毒性之發生率極低；此外，心臟超音波之監控結果顯示無任何顯著之收縮及舒張功能異常。研究中觀察到四犬隻表現心電圖結果異常，包含一犬隻發生插入性心室早期收縮、兩犬隻發生竇性停搏，以及另一犬隻發生上心室心搏過速，然而這類心律不整常為自限性，且表現低度惡性心律特徵，因此被認為屬於較良性的心律異常。本研究指出，使用四劑阿黴素做為化療方案對於這類犬隻族群而言安全性高，因此本篇提出使用阿黴素化療的犬隻建議執行之監控計畫：在給予第一劑阿黴素治療前進行首次心臟評估，以建立初始紀錄，並在完成化療療程後進行最終評估，以比較其對心臟功能之影響。

Doxorubicin is a cytotoxic agent that is widely used in treating cancer patients. It is well-known that it can have a cardiotoxic effect when administered to humans and dogs. The previous studies indicated some adverse effects associated with doxorubicin administration, such as impaired cardiac contractility, arrhythmia, and an increased risk of developing heart failure. The cardiotoxicity induced by doxorubicin is known to be dose-dependent and cumulative. Therefore, it is important to monitor and intervene medically during the course of chemotherapy treatment. The aim of this study is to investigate the phenotype, incidence, and changes in echocardiographic (systolic and diastolic function) and electrocardiographic measures in small and medium-sized canine populations in Taiwan following a four-dose protocol of doxorubicin. We included 20 dogs referred to the National Taiwan University Veterinary Hospital (NTUVH) for neoplastic diseases between September 2021 and April 2023. Each dog received at least one dose of doxorubicin. The cardiac evaluation included an electrocardiogram (ECG) and an echocardiogram. The initial evaluation was conducted before the first administration of doxorubicin, and subsequent evaluations were performed after each subsequent administration. In our study, we did not observe any clinical cardiotoxicity in our patients, indicating a very low incidence. Furthermore, the echocardiogram did not reveal any significant systolic or diastolic dysfunction. ECG abnormalities were observed in four dogs, including one interpolated ventricular premature complex (VPC), two sinus arrests, and one supraventricular tachycardia (SVT). However, they were self-limiting and showed less malignancy in their rhythmic changes, which are generally considered benign. The results of our study suggest that the treatment protocol, which includes four doses of doxorubicin, is safe for these dogs. Therefore, we suggest that the cardiac evaluation be performed prior to the first administration of doxorubicin as a baseline recording and that the final recording be conducted after completing the entire treatment course.