1
|
Ali EA, Patel N, Khalid M, Kaddoura R, Kalavar M, Shani J, Yassin M. Myocardial Infarction in Chronic Myeloid Leukemia: Results from the Nationwide Readmission Database. Oncology 2024:1-8. [PMID: 38705141 DOI: 10.1159/000539149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is a hematological malignancy with an excellent prognostic outcome. After the advancements in CML treatment and the introduction of different tyrosine kinase inhibitors (TKIs), the life expectancy of CML patients has become equivalent to that of the general population. As a result, coronary artery disease is anticipated to be the leading cause of death among CML patients. Moreover, TKI use is associated with a risk of endothelial dysfunction, thrombosis, and cardiovascular events, including myocardial infarction. In this study, we compare the outcomes of percutaneous coronary intervention (PCI) in patients with CML to their matched non-CML counterparts. METHOD This is a retrospective cohort study using the Nationwide Readmission Database from January 2016 to December 2020. Adults with or without CML hospitalized for acute myocardial infarction and underwent PCI were included. The patients were identified using ICD-10 codes. The primary outcomes were in-hospital mortality and 30-day readmission rates. The secondary outcomes were PCI complications rates. RESULTS Out of 2,727,619 patients with myocardial infarction, 2,124 CML patients were identified. A total of 888 CML patients underwent PCI. CML patients were significantly older (mean age: 68.34 ± 11.14 vs. 64.40 ± 12.61 years, p < 0.001) than non-CML patients without a difference in sex distribution. Hypertension (85.45% vs. 78.64%), diabetes (45.48% vs. 37.29), stroke (11.84% vs. 7.78) at baseline were significantly higher in the CML group. Prior myocardial infarction events (20.51% vs. 15.17%) and prior PCI procedure (24.47% vs. 16.89%) were significantly higher in the CML group. CML patients had a significantly longer hospital stay (4.66 ± 4.40 vs. 3.75 ± 4.62 days, p = 0.001). The primary outcomes did not differ between the comparison groups. The risk of post-PCI complications did not differ between the comparison groups in the propensity matched analysis except for coronary artery dissection (odds ratio [OR]: 0.10; 95% confidence interval [CI]: 0.02-0.65, p = 0.016) and ischemic stroke (OR: 0.35; 95% CI: 0.14-0.93, p = 0.034) which were lower in the CML group. CONCLUSION This analysis showed no statistically significant difference in mortality, 30-day readmission, and post PCI complications rates between CML and non-CML patients. However, interestingly, CML patients may experience lower coronary artery dissection and ischemic stroke events than those without CML diagnosis.
Collapse
Affiliation(s)
- Elrazi A Ali
- Interfaith Medical Center, One Brooklyn Health, New York, New York, USA
| | - Neel Patel
- Maimonides Medical Center, Brooklyn, New York, USA
| | - Mazin Khalid
- Engelwood Health, Englewood, New Jersey, USA
- Chairman of Brooklyn Cardiovascular Institute, Maimonides Medical Center, Brooklyn, New York, USA
| | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Jacob Shani
- Maimonides Medical Center, Brooklyn, New York, USA
| | - Mohamed Yassin
- Hematology-BMT National Centre for Cancer Care and Research, Doha, Qatar
| |
Collapse
|
2
|
Romero-Becera R, Santamans AM, Arcones AC, Sabio G. From Beats to Metabolism: the Heart at the Core of Interorgan Metabolic Cross Talk. Physiology (Bethesda) 2024; 39:98-125. [PMID: 38051123 DOI: 10.1152/physiol.00018.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023] Open
Abstract
The heart, once considered a mere blood pump, is now recognized as a multifunctional metabolic and endocrine organ. Its function is tightly regulated by various metabolic processes, at the same time it serves as an endocrine organ, secreting bioactive molecules that impact systemic metabolism. In recent years, research has shed light on the intricate interplay between the heart and other metabolic organs, such as adipose tissue, liver, and skeletal muscle. The metabolic flexibility of the heart and its ability to switch between different energy substrates play a crucial role in maintaining cardiac function and overall metabolic homeostasis. Gaining a comprehensive understanding of how metabolic disorders disrupt cardiac metabolism is crucial, as it plays a pivotal role in the development and progression of cardiac diseases. The emerging understanding of the heart as a metabolic and endocrine organ highlights its essential contribution to whole body metabolic regulation and offers new insights into the pathogenesis of metabolic diseases, such as obesity, diabetes, and cardiovascular disorders. In this review, we provide an in-depth exploration of the heart's metabolic and endocrine functions, emphasizing its role in systemic metabolism and the interplay between the heart and other metabolic organs. Furthermore, emerging evidence suggests a correlation between heart disease and other conditions such as aging and cancer, indicating that the metabolic dysfunction observed in these conditions may share common underlying mechanisms. By unraveling the complex mechanisms underlying cardiac metabolism, we aim to contribute to the development of novel therapeutic strategies for metabolic diseases and improve overall cardiovascular health.
Collapse
Affiliation(s)
| | | | - Alba C Arcones
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Guadalupe Sabio
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| |
Collapse
|
3
|
de Moraes FCA, Dal Moro L, Pessoa FR, Passos ESDR, Campos RALS, de Souza DDSM, Feio D, Rodríguez Burbano RM, Fernandes MR, dos Santos NPC. Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review. Cancers (Basel) 2023; 15:5206. [PMID: 37958380 PMCID: PMC10647525 DOI: 10.3390/cancers15215206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence in males (76.9%, n = 10). The average time for neoplasm development was 4.4 years (54.07 months). The most prevalent model was Medtronic (38.4%, n = 5), with titanium (83.3%) being the most common metal composition. Chemotherapy was the most performed procedure among patients (38.4%), followed by radiation therapy (38.4%) and surgical tumor resection (30.7%). Six analyzed cases (46.1%) resulted in death, and four patients (30.7%) achieved a cure. Patients with pacemakers should be routinely evaluated for the occurrence of malignant tumors at the site of device implantation.
Collapse
Affiliation(s)
- Francisco Cezar Aquino de Moraes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Lucca Dal Moro
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Fernando Rocha Pessoa
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Ellen Sabrinna dos Remédios Passos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Raul Antônio Lopes Silva Campos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Dilma do Socorro Moraes de Souza
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
- Gaspar Vianna State Public Hospital of Clinical Foundation, Belém 66083-106, PA, Brazil
| | - Danielle Feio
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | | | - Marianne Rodrigues Fernandes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Ney Pereira Carneiro dos Santos
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| |
Collapse
|
4
|
Triantafyllou A, Elia SA, Park C, Climie RE, Mayer CC, Mozos I, Pucci G, Weber T, Panayiotou AG. Developing a Questionnaire on Knowledge, Perceptions and Application of Vascular-Aging Measurements. J Cardiovasc Dev Dis 2023; 10:jcdd10020080. [PMID: 36826576 PMCID: PMC9965266 DOI: 10.3390/jcdd10020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Vascular age (VA) is independent and chronological age for assessing cardiovascular disease (CVD) risk. However, tools for the implementation of VA are currently lacking. We aimed to develop a questionnaire to assess the current knowledge gaps related to VA and barriers to its implementation in routine practice. METHODS Using a stepwise mixed-method approach, a quantitative questionnaire was constructed in four phases: (1) basic item generation and the development of a semi-qualitative questionnaire (SQQ); (2) dissemination to the VascAgeNet extended network and an analysis of the semi-qualitative questionnaire responses; (3) the development of a quantitative questionnaire (QQ); and (4) an assessment of the content and face validity and internal reliability in an additional sample. RESULTS Based on six main topics initially identified through an expert panel, a SQQ was developed and disseminated. Finally, a 22-item QQ was developed, with questions grouped around three main themes: knowledge of VA and its risk factors; perceptions and beliefs regarding the importance and contribution of VA to risk classification; and the application of VA measurements in clinical and research practice and its potential limitations (Cronbach's alpha between 0.920 and 0.982 for all three categories). CONCLUSION We report the development of a QQ on VA addressed to both clinicians and non-clinicians aiming to assess their knowledge, perceptions and application of VA measurements.
Collapse
Affiliation(s)
- Areti Triantafyllou
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
| | - Stavria-Artemis Elia
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 3041 Limassol, Cyprus
| | - Chloe Park
- MRC Unit for Lifelong Health and Aging, UCL, London WC1E 6BT, UK
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Christopher C. Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, 05100 Terni, Italy
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Andrie G. Panayiotou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 3041 Limassol, Cyprus
- Correspondence: ; Tel.: +357-25002131
| |
Collapse
|
5
|
Hubbert L, Mallios P, Karlström P, Papakonstantinou A, Bergh J, Hedayati E. Long-term and real-life incidence of cancer therapy-related cardiovascular toxicity in patients with breast cancer: a Swedish cohort study. Front Oncol 2023; 13:1095251. [PMID: 37152049 PMCID: PMC10154463 DOI: 10.3389/fonc.2023.1095251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The administration of anticancer drugs in females with comorbidity increases the risk for cancer therapy-related cardiovascular toxicity (CTR-CVT), which in turn contributes to cardiovascular disease (CVD). Furthermore, a pathophysiological connection between cancer and cardiovascular disease may exist. Objective To assess the long-term risks and predictors of CTR-CVT, including clinical hypertension (HT), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), as well as all-cause mortality in women diagnosed with early breast cancer (BC) and eligible for adjuvant chemotherapy in Sweden. Methods Data were extracted from Swedish registers and medical records on 433 women, 18-60 years of age, diagnosed 1998-2002 with lymph node-positive BC, and considered for adjuvant chemotherapy. CTR-CVT was defined as HT, CAD, HF, or AF after the diagnosis of BC. Follow-up was from the date of BC diagnosis until November 30, 2021, or death. Prevalence of CTR-CVT and all-cause mortality were calculated. Hazard ratios (HR) were determined for factors associated with CTR-CVT. Results The median age was 50 (interquartile range (IQR) 32) years. 910 CTR-CVT events were diagnosed in 311 women with a median of 19.3 (IQR 15,3) years follow-up. The proportions of CTR-CVT events were: HT 281 (64%); CAD 198 (46%); HF 206 (47%); and AF 225 (51%). The cumulative incidence of CTR-CVT was 71.8%, and 50% of all 433 patients developed CTR-CVT within 11.7 years of BC diagnosis (standard deviation (SD) 0.57, 95% confidence interval (CI) 10.6-12.9). Age was a risk factor for CTR-CVT. Anthracycline increased the risk for HF (p=0,001; HR 2,0; 95%CI 1,4-2,8), CAD (p= 0,002; HR 1,7; 95% CI 1,2-2,4), and AF (p=0,013; HR 1,5; 95% CI 1,0-2,0). At the end of the 24-year study period, 227 of the 433 women were alive, and the total cumulative mortality was 47,6%. Conclusion The prevalence of CTR-CVT and all-cause mortality is high after BC diagnosis and treatment, particularly in older patients and those receiving anthracyclines. These findings and the onset of CTR-CVT support cardio-oncology guidelines recommending initial risk stratification and cardiovascular monitoring during treatment, followed by long-term annual screening for cardiovascular risk factors and CTR-CVT among BC survivors.
Collapse
Affiliation(s)
- Laila Hubbert
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Panagiotis Mallios
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Patric Karlström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Andri Papakonstantinou
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
| | - Elham Hedayati
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Medical Unit: Breast, Endocrine Tumors, and Sarcoma, Theme Cancer, Karolinska University Hospital and Comprehensive Cancer Center, Stockholm, Sweden
- *Correspondence: Elham Hedayati,
| |
Collapse
|