進行性腎細胞癌に対するスニチニブ治療に伴う左室壁運動異常の出現様式

Variations of left ventricular asynergy after sunitinib treatment in patients with metastatic renal cell carcinoma

　進行性腎細胞癌患者に対するスニチニブ治療後，がん治療関連心機能障害（CTRCD）に至る前の段階で左室壁運動低下が出現するか否か，およびその部位を検討した．スニチニブ治療前後で経胸壁心エコー図検査を施行した進行性腎細胞癌患者16例を対象とし，左室壁運動異常の有無と左室駆出率（LVEF）を評価した．16例中6例（38％）に左室壁運動異常を認めた．そのうちCTRCDは4例で，2例はその定義を満たさなかった．壁運動異常の出現様式はびまん性，心尖部の壁運動低下，後壁と下壁および心尖部の壁運動低下とさまざまであった．CTRCDの定義を満たさない段階でも，左室壁運動異常が出現していた．スニチニブ治療開始後にはLVEFのみではなく左室壁運動異常にも留意する必要があると考えられた．

Abstract

The aim of this study was to examine whether left ventricular (LV) asynergy was appeared before cancer therapy-related cardiac dysfunction (CTRCD) in patients with metastatic renal cell carcinoma (RCC) treated by sunitinib. Transthoracic echocardiography (TTE) was performed in 16 patients with metastatic renal cell carcinoma before and after sunitinib treatment from January 2011 to December 2018. We evaluated presence and pattern of LV asynergy by TTE. A new LV asynergy was found in 6 of 16 patients (38%). CTRCD was recognized 4 of 6 patient. On the other hand, 2 of 6 patients did not meet the definition of CTRCD. LV asynergy pattern were diffuse hypokinesis (n = 3), apical hypokinesis (n = 2) and hypokinesis of both posterior to inferior region and apical region (n = 1). These findings indicate that LV asynergy has been appeared before CTRCD after sunitinib treatment in patients with metastatic RCC. Furthermore, variations of LV asynergy pattern after sunitinib treatment are demonstrated. In clinical situation, we have to notice not only LVEF but also LV asynergy after treatment by sunitinib (Rinsho Hinyokika 75 : 151-156, 2021).