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Chu J, Tung L, Atallah I, Wei C, Cobleigh M, Rao R, Feinstein SB, Usha L, Banach K, Reiser J, Okwuosa TM. Soluble urokinase plasminogen activator receptor and cardiotoxicity in doxorubicin-treated breast cancer patients: a prospective exploratory study. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:3. [PMID: 38225669 PMCID: PMC10788987 DOI: 10.1186/s40959-023-00191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/23/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor is an inflammatory biomarker that may prognosticate cardiovascular outcomes. We sought to determine the associations between soluble urokinase plasminogen activator receptor and established markers of cardiotoxicity in breast cancer patients receiving doxorubicin. METHODS We conducted a prospective cohort study of women with newly diagnosed breast cancer receiving standard-dose doxorubicin (240 mg/m2) at Rush University Medical Center and Rush Oak Park Hospital (Chicago, IL) between January 2017 and May 2019. Left ventricular ejection fraction, global longitudinal strain, and cardiac biomarkers (N-terminal prohormone B-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein) were measured at baseline and at intervals up to 12-month follow-up after end of treatment. The associations between soluble urokinase plasminogen activator receptor and these endpoints were evaluated using multivariable mixed effects linear regression. RESULTS Our study included 37 women (mean age 47.0 ± 9.3 years, 60% white) with a median baseline soluble urokinase plasminogen activator receptor level of 2.83 ng/dL. No participant developed cardiomyopathy based on serial echocardiography by one-year follow-up. The median percent change in left ventricular strain was -4.3% at 6-month follow-up and absolute changes in cardiac biomarkers were clinically insignificant. There were no significant associations between soluble urokinase plasminogen activator receptor and these markers of cardiotoxicity (all p > 0.05). CONCLUSIONS In this breast cancer cohort, doxorubicin treatment was associated with a very low risk for cardiotoxicity. Across this narrow range of clinical endpoints, soluble urokinase plasminogen activator receptor was not associated with markers of subclinical cardiotoxicity. Further studies are needed to clarify the prognostic utility of soluble urokinase plasminogen activator receptor in doxorubicin-associated cardiomyopathy and should include a larger cohort of leukemia and lymphoma patients who receive higher doses of doxorubicin.
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Affiliation(s)
- Jian Chu
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Lillian Tung
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Issam Atallah
- Department of Internal Medicine, Division of Cardiology, Saint Louis University Hospital, St. Louis, MO, USA
| | - Changli Wei
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Melody Cobleigh
- Department of Internal Medicine, Section of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Ruta Rao
- Department of Internal Medicine, Section of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Steven B Feinstein
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway | Kellogg Bldg, Suite 328, Chicago, IL, 60612, USA
| | - Lydia Usha
- Department of Internal Medicine, Section of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Kathrin Banach
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway | Kellogg Bldg, Suite 328, Chicago, IL, 60612, USA
| | - Jochen Reiser
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tochukwu M Okwuosa
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway | Kellogg Bldg, Suite 328, Chicago, IL, 60612, USA.
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2
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Miller CE, Jordan JH, Thomas A, Friday SR, Meléndez GC, Weis JA. Myocardial Elasticity Imaging Correlates with Histopathology in a Model of Anthracycline-Induced Cardiotoxicity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.11.561881. [PMID: 37904976 PMCID: PMC10614736 DOI: 10.1101/2023.10.11.561881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background There is considerable focus on developing strategies for identifying subclinical cardiac decline prior to cardiac failure. Myocardial tissue elasticity changes may precede irreversible cardiac damage, providing promise for an early biomarker for cardiac decline. Biomarker strategies are of particular interest in cardio-oncology due to cardiotoxic effects of anti-neoplastic therapies, particularly anthracycline-based chemotherapeutics. Current clinical methods for diagnosing cardiotoxicity are too coarse to identify cardiac decline early enough for meaningful therapeutic intervention, or too cumbersome for clinical implementation. Methods Utilizing changes in myocardial elasticity as a biomarker for subclinical cardiac decline, we developed a biomechanical model-based elasticity imaging methodology (BEIM) to estimate spatial maps of left ventricle (LV) myocardial elasticity. In this study, we employ this methodology to assess changes in LV elasticity in a non-human primate model of doxorubicin-induced cardiotoxicity. Cardiac magnetic resonance imaging of five African Green monkeys was acquired at baseline prior to doxorubicin administration, 6-weeks, and 15-weeks after final doxorubicin dose and histopathological samples of the LV were taken at 15-weeks after final doxorubicin dose. Spatial elasticity maps of the mid-short axis plane of the LV were estimated at each image acquisition. Global and regional LV elasticity were calculated and changes between imaging time points was assessed. LV elasticity at baseline and final time point were compared to cardiomyocyte size and collagen volume fraction measurements calculated from histopathological staining of archived tissue bank samples and study endpoint tissue samples utilizing Pearson's correlation coefficients. Results We identify significant changes in LV elasticity between each imaging time point both globally and regionally. We also demonstrate strong correlation between LV elasticity and cardiomyocyte size and collagen volume fraction measurements. Results indicate that LV elasticity estimates calculated using BEIM correlate with histopathological changes that occur due to doxorubicin administration, validating LV elasticity solutions and providing significant promise for use of BEIM to non-invasively elucidate cardiac injury. Conclusions This methodology can show progressive changes in LV elasticity and has potential to be a more sensitive indicator of elasticity changes than current clinical measures of cardiotoxicity. LV elasticity may provide a valuable biomarker for cardiotoxic effects of anthracycline-based chemotherapeutics and cardiac disease detection.
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Affiliation(s)
- Caroline E. Miller
- Wake Forest School of Medicine, Biomedical Engineering
- Virginia Tech – Wake Forest School of Biomedical Engineering and Sciences
| | - Jennifer H. Jordan
- Virginia Commonwealth University, Department of Biomedical Engineering
- Virginia Commonwealth University Health Sciences, Pauley Heart Center
| | - Alexandra Thomas
- Atrium Health Wake Forest Baptist, Internal Medicine-Hematology and Oncology
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center
| | | | - Giselle C. Meléndez
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center
- Atrium Health Wake Forest Baptist, Internal Medicine-Cardiovascular Medicine
- Atrium Health Wake Forest Baptist, Pathology-Comparative Medicine
| | - Jared A. Weis
- Wake Forest School of Medicine, Biomedical Engineering
- Virginia Tech – Wake Forest School of Biomedical Engineering and Sciences
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center
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3
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Cannizzaro MT, Inserra MC, Passaniti G, Celona A, D'Angelo T, Romeo P, Basile A. Role of advanced cardiovascular imaging in chemotherapy-induced cardiotoxicity. Heliyon 2023; 9:e15226. [PMID: 37095987 PMCID: PMC10121465 DOI: 10.1016/j.heliyon.2023.e15226] [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: 01/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The development of cardiotoxicity induced by cancer treatments has emerged as a significant clinical problem, both in the short run, as it may influence drug administration in chemotherapeutic protocols, and in the long run, because it may determine adverse cardiovascular outcomes in survivors of various malignant diseases. Therefore, early detection of anticancer drug-related cardiotoxicity is an important clinical target to improve prevention of adverse effects and patient care. Today, echocardiography is the first-line cardiac imaging techniques used for identifying cardiotoxicity. Cardiac dysfunction, clinical and subclinical, is generally diagnosed by the reduction of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, myocardial injury detected by echocardiography is preceded by other alterations, such as myocardial perfusion and mitochondrial and metabolic dysfunction, that can only be recognized by second-level imaging techniques, like cardiac magnetic resonance (CMR) and nuclear imaging, which, using targeted radiotracers, may help to provide information on the specific mechanisms of cardiotoxicity. In this review, we focus on the current and emerging role of CMR, as a critical diagnostic tool of cardiotoxicity in the very early phase, due to its availability and because it allows the contemporary detection of functional alterations, tissue alterations (mainly performed using T1, T2 mapping with the evaluation of extracellular volume-ECV) and perfusional alteration (evaluated with rest-stress perfusion) and, in the next future, even metabolic changes. Moreover, in the subsequent future, the use of Artificial Intelligence and big data on imaging parameters (CT, CMR) and oncoming molecular imaging datasets, including differences for gender and countries, may help predict cardiovascular toxicity at its earliest stages, avoiding its progression, with precise tailoring of patients' diagnostic and therapeutic pathways.
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Affiliation(s)
| | | | | | | | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Ospital “Policlinico G. Martino”, Messina, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.U.O. Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- University of Catania, Department of Surgical and Medical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Italy
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4
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Barbaroux H, Kunze KP, Neji R, Nazir MS, Pennell DJ, Nielles-Vallespin S, Scott AD, Young AA. Automated segmentation of long and short axis DENSE cardiovascular magnetic resonance for myocardial strain analysis using spatio-temporal convolutional neural networks. J Cardiovasc Magn Reson 2023; 25:16. [PMID: 36991474 PMCID: PMC10061808 DOI: 10.1186/s12968-023-00927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/01/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Cine Displacement Encoding with Stimulated Echoes (DENSE) facilitates the quantification of myocardial deformation, by encoding tissue displacements in the cardiovascular magnetic resonance (CMR) image phase, from which myocardial strain can be estimated with high accuracy and reproducibility. Current methods for analyzing DENSE images still heavily rely on user input, making this process time-consuming and subject to inter-observer variability. The present study sought to develop a spatio-temporal deep learning model for segmentation of the left-ventricular (LV) myocardium, as spatial networks often fail due to contrast-related properties of DENSE images. METHODS 2D + time nnU-Net-based models have been trained to segment the LV myocardium from DENSE magnitude data in short- and long-axis images. A dataset of 360 short-axis and 124 long-axis slices was used to train the networks, from a combination of healthy subjects and patients with various conditions (hypertrophic and dilated cardiomyopathy, myocardial infarction, myocarditis). Segmentation performance was evaluated using ground-truth manual labels, and a strain analysis using conventional methods was performed to assess strain agreement with manual segmentation. Additional validation was performed using an externally acquired dataset to compare the inter- and intra-scanner reproducibility with respect to conventional methods. RESULTS Spatio-temporal models gave consistent segmentation performance throughout the cine sequence, while 2D architectures often failed to segment end-diastolic frames due to the limited blood-to-myocardium contrast. Our models achieved a DICE score of 0.83 ± 0.05 and a Hausdorff distance of 4.0 ± 1.1 mm for short-axis segmentation, and 0.82 ± 0.03 and 7.9 ± 3.9 mm respectively for long-axis segmentations. Strain measurements obtained from automatically estimated myocardial contours showed good to excellent agreement with manual pipelines, and remained within the limits of inter-user variability estimated in previous studies. CONCLUSION Spatio-temporal deep learning shows increased robustness for the segmentation of cine DENSE images. It provides excellent agreement with manual segmentation for strain extraction. Deep learning will facilitate the analysis of DENSE data, bringing it one step closer to clinical routine.
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Affiliation(s)
- Hugo Barbaroux
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK.
| | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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5
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Global longitudinal strain: an early marker for cardiotoxicity in patients treated for breast cancer. Neth Heart J 2023; 31:103-108. [PMID: 36434383 PMCID: PMC9950304 DOI: 10.1007/s12471-022-01734-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients treated with anthracyclines and trastuzumab are at increased risk of developing heart failure. Early diagnosis and treatment may prevent irreversible left ventricular (LV) dysfunction. This study investigates whether subclinical deterioration of global longitudinal strain (GLS) is a more reliable early predictor for LV dysfunction than three-dimensional (3D) LV ejection fraction (LVEF). METHODS Adult patients receiving anthracyclines and trastuzumab for breast cancer who had serial echocardiographic follow-up were included in this retrospective study. The primary endpoint was the necessity to temporarily pause chemo- or immunotherapy due to declining LVEF (decline in 3D LVEF of > 10 percentage points to < 53%). Linear mixed-effects models were used to assess the longitudinal evolution of 3D LVEF and GLS over time. RESULTS Fifty-one women were included, mean age 54 (50.5-57.6) years, with a total of 216 follow-up echocardiograms (mean follow-up 1.1 ± 0.45 years). GLS and 3D LVEF were significantly correlated (Spearman's rho: -0.36, p < 0.001). A decrease in GLS significantly predicted a lower LVEF on the subsequent echocardiogram [ß -0.6, 95% confidence interval (CI) (-1.0 to -0.2), p < 0.006]. Conversely, prior LVEF did not significantly predict GLS on the subsequent echocardiogram [ß -0.04, 95% CI -0.1 to -0.01, p = 0.12]. Nine patients reached the primary endpoint. On average, patients who reached the primary endpoint had a relative decrease of 15% GLS at day 205 and an absolute 10% decrease of LVEF to LVEF < 53% at day 235. DISCUSSION GLS is able to identify subclinical LV dysfunction earlier than 3D LVEF measurement in women undergoing treatment for breast cancer with anthracyclines followed by trastuzumab.
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6
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Cocco LD, Chiaparini AF, Dutra AS, Saffi MAL, Leiria TLL. Global Longitudinal Strain for the Early Detection of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis. Clin Oncol (R Coll Radiol) 2022; 34:514-525. [PMID: 35637075 DOI: 10.1016/j.clon.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
AIMS Left ventricular ejection fraction is used to monitor patients undergoing cardiotoxic chemotherapy. A decrease in left ventricular ejection fraction represents a relatively late stage of systolic involvement. Global longitudinal strain has been studied to detect early changes in left ventricular myocardial contractile function. The aim of the present study was to evaluate the global longitudinal strain measurement in the early detection of cardiotoxicity induced by cardiotoxic chemotherapeutic agents. MATERIALS AND METHODS A study search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was carried out to report systematic reviews. A search on PubMed, EMBASE, Web of Science and SCOPUS was carried out using the following keywords: 'echocardiography' and 'cardiotoxicity' and their variations, without language or date restrictions (until March 2021). RESULTS In total, 4873 articles were identified for title and abstract analysis. The systematic review included 10 studies comprising 661 patients with cancer, including mainly breast cancer and haematological malignancies, mainly treated with anthracyclines. The meta-analysis included four studies: patients with cardiotoxicity showed a reduction in strain, compared with baseline, 14.13% greater than patients without cardiotoxicity (95% confidence interval 5.07-23.19; P < 0.01). No heterogeneity was observed between studies (I2 = 0). CONCLUSION The meta-analysis showed that strain is a tool with proper predictive capacity for the detection of cardiotoxicity.
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Affiliation(s)
- L D Cocco
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil.
| | - A F Chiaparini
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil
| | - A S Dutra
- Santa Casa de Misericórdia Complex of Porto Alegre, Porto Alegre, Brazil
| | - M A L Saffi
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - T L L Leiria
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil
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7
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Harbo MB, Stokke MK, Sjaastad I, Espe EKS. One step closer to myocardial physiology: From PV loop analysis to state-of-the-art myocardial imaging. Acta Physiol (Oxf) 2022; 234:e13759. [PMID: 34978759 DOI: 10.1111/apha.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
Recent advances in cardiac imaging have revitalized the assessment of fundamental physiological concepts. In the field of cardiac physiology, invasive measurements with pressure-volume (PV) loops have served as the gold standard methodology for the characterization of left ventricular (LV) function. From PV loop data, fundamental aspects of LV chamber function are derived such as work, efficiency, stiffness and contractility. However, the parametrization of these aspects is limited because of the need for invasive procedures. Through the utilization of recent advances in echocardiography, magnetic resonance imaging and positron emission tomography, it has become increasingly feasible to quantify these fundamental aspects of LV function non-invasively. Importantly, state-of-the-art imaging technology enables direct assessment of myocardial performance, thereby extending functional assessment from the net function of the LV chamber, as is done with PV loops, to the myocardium itself. With a strong coupling to underlying myocardial physiology, imaging measurements of myocardial work, efficiency, stiffness and contractility could represent the next generation of functional parameters. The purpose of this review is to discuss how the new imaging parameters of myocardial work, efficiency, stiffness and contractility can bring cardiac physiologists, researchers and clinicians alike one step closer to underlying myocardial physiology.
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Affiliation(s)
- Markus Borge Harbo
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
- Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Emil Knut Stenersen Espe
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
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8
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Bloomfield GS, Alenezi F, Chiswell K, Dunning A, Okeke NL, Velazquez EJ. Progression of cardiac structure and function in people with human immunodeficiency virus. Echocardiography 2022; 39:268-277. [PMID: 35048419 PMCID: PMC11196839 DOI: 10.1111/echo.15302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE People living with HIV (PLWH) are at increased risk for cardiac dysfunction. It is unknown how their global longitudinal cardiac function, cardiac structure, and other indices of function progress over time. We aimed to characterize the longitudinal trend in cardiac structure and function in PLWH. DESIGN Retrospective study of PLWH with clinically obtained echocardiograms at an academic medical center. METHODS We reviewed archived transthoracic echocardiograms (TTEs) performed between 2001 and 2012 on PLWH. The primary outcome measures were progression of global longitudinal strain (GLS, left and right ventricles), LV mass, E/e' ratio, LV end-systolic, and -diastolic volumes using hierarchical mixed model analysis as a function of CD4+ T cell count and HIV RNA suppression. Models were adjusted for clinical and demographic characteristics. RESULTS We analyzed 469 TTEs from 150 individuals (median age 46 years, 58% male). Median CD4+ T cell counts at nadir and proximal to first echocardiogram were 85 and 222 cells/mm3 , respectively. Over a median of 5 years, LV mass index increased regardless of nadir or proximal CD4+ T cell count or viral suppression status. PLWH with viral suppression at baseline had more normal GLS throughout the follow-up period. There were no significant trends in LV end-systolic volume index or E/e'. CONCLUSIONS In PLWH, HIV viral suppression is associated with early gains in echocardiographic indices of cardiac function that persist for up to >5 years. HIV disease control impacts routine echocardiographic measures with known impacts on long-term prognosis.
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Affiliation(s)
- Gerald S. Bloomfield
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Allison Dunning
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Eric J. Velazquez
- Division of Cardiology, Yale University, New Haven, Connecticut, USA
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9
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Yu C, Pathan F, Tan TC, Negishi K. The Utility of Advanced Cardiovascular Imaging in Cancer Patients-When, Why, How, and the Latest Developments. Front Cardiovasc Med 2021; 8:728215. [PMID: 34540922 PMCID: PMC8446374 DOI: 10.3389/fcvm.2021.728215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023] Open
Abstract
Cardio-oncology encompasses the risk stratification, prognostication, identification and management of cancer therapeutics related cardiac dysfunction (CTRCD). Cardiovascular imaging (CVI) plays a significant role in each of these scenarios and has broadened from predominantly quantifying left ventricular function (specifically ejection fraction) to the identification of earlier bio-signatures of CTRCD. Recent data also demonstrate the impact of chemotherapy on the right ventricle, left atrium and pericardium and highlight a possible role for CVI in the identification of CTRCD through tissue characterization and assessment of these cardiac chambers. This review aims to provide a contemporary perspective on the role of multi-modal advanced cardiac imaging in cardio-oncology.
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Affiliation(s)
- Christopher Yu
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Faraz Pathan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
| | - Timothy C Tan
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Blacktown Hospital, Sydney, NSW, Australia
| | - Kazuaki Negishi
- Nepean Clinical School, University of Sydney, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, NSW, Australia
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10
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Banke A, Schou M, Ewertz M, Dahl J, Frederiksen PH, Videbaek L, Cold S, Møller JE. Immediate evaluation of global longitudinal strain at initiation of trastuzumab treatment in breast cancer patients. Echocardiography 2021; 38:1702-1710. [PMID: 34510537 DOI: 10.1111/echo.15190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Global longitudinal strain (GLS) is recommended to detect subclinical changes preceding reduced left ventricular ejection fraction (LVEF) in trastuzumab related cardiotoxicity. Since the possibility to detect signs of acute myocardial deterioration at treatment initiation is not clarified, the objective of this study was to assess changes in GLS and biomarkers within the first 2 weeks of trastuzumab treatment. METHODS In a prospective cohort study, 45 patients with non-metastatic breast cancer (age 54, LVEF 62.8%, GLS -19.9%, 40% hypertension) scheduled for trastuzumab treatment were included. Echocardiography and measurement of troponin and NT-proBrain-Natriuretic-Peptide were conducted before initiation of trastuzumab, at days 3, 7, and 14 and after 3, 6, and 9 months. RESULTS A significant deterioration in LVEF from 62.8% (SD±3.6) to 58.4% (SD±4.1) (p < 0.0001), GLS from -19.9 (SD±2.1) to -18.1 (SD±2.5) (p = 0.004), s' (p < 0.0001), e' septal (p = 0.008), and s' RV (p < 0.0001) occurred at 9 months and was preceded by significant changes in these parameters within the first 14 days. After 14 days, 12 patients (27%) had a ≥10% deterioration in GLS, which was associated with significantly lower LVEF at 55.2% (SD±4.1) at 9 months compared to patients with < 10% early deterioration in GLS (LVEF = 59.5% (SD±3.5) (p = 0.001)). No difference in plasma concentrations of biomarkers was observed between the two groups. CONCLUSION In this study deteriorations in key echocardiographic parameters within normal limits were detected during the first 2 weeks of trastuzumab treatment, and an early ≥10% deterioration in GLS was associated with a lower LVEF at 9 months.
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Affiliation(s)
- Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, 5000, Denmark.,OPEN, OPEN Patient data Explorative Network, University of Southern Denmark, Odense, 5000, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, 2730, Denmark
| | - Marianne Ewertz
- Institute of Clinical Research, University of Southern Denmark, Odense, 5000, Denmark
| | - Jordi Dahl
- Department of Cardiology, Odense University Hospital, Odense, 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, 5000, Denmark
| | - Peter Hartmund Frederiksen
- Department of Cardiology, Odense University Hospital, Odense, 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, 5000, Denmark
| | - Lars Videbaek
- Department of Cardiology Svendborg, Odense University Hospital, Svendborg, 5700, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, 5000, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, 5000, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen 2100, Denmark
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11
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de Baat EC, Naaktgeboren WR, Leiner T, Teske AJ, Habets J, Grotenhuis HB. Update in imaging of cancer therapy-related cardiac toxicity in adults. Open Heart 2021; 8:openhrt-2020-001506. [PMID: 33863836 PMCID: PMC8055139 DOI: 10.1136/openhrt-2020-001506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
Over the past decades, prognosis of patients with cancer has strongly improved and the number of cancer survivors is rapidly growing. Despite this success, cancer treatment is associated with development of serious cardiovascular diseases including left ventricular (LV) systolic dysfunction, heart failure, valvular disease, myocardial infarction, arrhythmias or pericardial diseases. Serial non-invasive cardiac imaging is an important tool to detect early signs of cardiotoxicity, to allow for timely intervention and provide optimal circumstances for long-term prognosis. Currently, echocardiographic imaging is the method of choice for the evaluation of myocardial function during and after cancer therapy. However, 2D echocardiography may fail to detect subtle changes in myocardial function, potentially resulting in a significant delay of therapeutic intervention to impede advanced cardiac disease states with more overt systolic dysfunction. Strain imaging is a promising method for early detection of myocardial dysfunction and may predict future changes in LV ejection fraction. The use of three-dimensional echocardiography may overcome the limitations of 2D echocardiography with more precise and reproducible measurements of LV performance. Cardiac MRI is the gold standard for volumetric assessment and can also be used to perform myocardial tissue characterisation. Visualisation of oedema and fibrosis may provide insights into the degree and disease course of cardiotoxicity and underlying pathophysiological mechanisms. There is growing body of literature regarding the promising role of these advanced imaging modalities in early detection of cardiotoxicity. With this overview paper, new insights and recent results in literature regarding echocardiographic and cardiac magnetic resonance imaging of cancer therapy-related cardiac dysfunction in post-cancer therapy adults will be highlighted.
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Affiliation(s)
- Esmée C de Baat
- Pediatric Oncology, Princess Maxima Center, Utrecht, The Netherlands
| | - Willeke R Naaktgeboren
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Radiology, University Medical Center Utrecht Imaging Division, Utrecht, The Netherlands
| | - Arco J Teske
- Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jesse Habets
- Radiology, University Medical Center Utrecht Imaging Division, Utrecht, The Netherlands
- Radiology, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Heynric B Grotenhuis
- Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
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12
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Assessment and Management of Cardiotoxicity in Hematologic Malignancies. DISEASE MARKERS 2021; 2021:6616265. [PMID: 33613788 PMCID: PMC7875649 DOI: 10.1155/2021/6616265] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
With the increasing overall survival of cancer patients due to recent discoveries in oncology, the incidence of side effects is also rising, and along with secondary malignancies, cardiotoxicity is one of the most concerning side effects, affecting the quality of life of cancer survivors. There are two types of cardiotoxicity associated with chemotherapy; the first one is acute, life-threatening but, fortunately, in most of the cases, reversible; and the second one is with late onset and mostly irreversible. The most studied drugs associated with cardiotoxicity are anthracyclines, but many new agents have demonstrated unexpected cardiotoxic effect, including those currently used in multiple myeloma treatment (proteasome inhibitors and immunomodulatory agents), tyrosine kinase inhibitors used in the treatment of chronic myeloid leukemia and some forms of acute leukemia, and immune checkpoint inhibitors recently introduced in treatment of refractory lymphoma patients. To prevent irreversible myocardial damage, early recognition of cardiac toxicity is mandatory. Traditional methods like echocardiography and magnetic resonance imaging are capable of detecting structural and functional changings, but unable to detect early myocardial damage; therefore, more sensible biomarkers like troponins and natriuretic peptides have to be introduced into the current practice. Baseline assessment of patients allows the identification of those with high risk for cardiotoxicity, while monitoring during and after treatment is important for early detection of cardiotoxicity and prompt intervention.
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13
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The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients-Is There More Than Just Left Ventricle Global Longitudinal Strain? J Clin Med 2021; 10:jcm10010154. [PMID: 33466260 PMCID: PMC7795612 DOI: 10.3390/jcm10010154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
With the improvement in survival rate, cardiotoxicity has emerged as a significant adverse effect of cancer therapy. Early diagnosis of subclinical cardiac injury may allow the initiation of cardioprotective therapy and preventing the interruption of optimal cancer therapy and the development of irreversible cardiac dysfunction. In this article, we review the role of two-dimensional speckle tracking echocardiography (2D-STE), beyond the common left ventricle global longitudinal strain in the diagnosis of early subclinical cardiac injury in patients treated with cancer therapies.
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14
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Alaika O, Jamai S, Doghmi N, Cherti M. Diagnostic Accuracy of Global Longitudinal Strain for Detecting Significant Coronary Artery Disease in Diabetic Patients without Regional Wall Motion Abnormality. J Saudi Heart Assoc 2020; 32:425-433. [PMID: 33299787 PMCID: PMC7721456 DOI: 10.37616/2212-5043.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022] Open
Abstract
AIMS Speckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this prospective study was to assess the diagnostic accuracy of global longitudinal strain (GLS) and regional longitudinal strain (RLS) parameters at rest in comparison to stress echocardiography findings for detecting significant coronary artery disease (CAD) in patients with diabetes mellitus (DM). METHODS We prospectively studied echocardiographic characteristics at rest with Speckle tracking echocardiography (2D STE) measures; then stress echocardiography and coronary angiography data in 34 diabetic patients without regional wall motion abnormality (RWMA) at rest. Patients were grouped according to coronary angiography and stress echocardiography results into two groups CAD (+) vs control group CAD (-). RESULTS GLS at rest was lower in the CAD (+) group ((-14.2 % ± 3.1 vs -17.8 % ± 3.1 in the control group CAD (-), P=0.004). GLS at rest had the highest area under the ROC curve (AUC) (AUC 0.78, sensitivity 61%, specificity 91%,P=0.009) with the cut-off of -14.5% which is equal to predictive power of wall motion scoring index (WMSI) at peak stress to detect significant CAD (AUC=0.76 (95% CI 0.58-0.94, P= 0.016) with the cut-off value of 1.21). CONCLUSIONS Global longitudinal strain at rest by STE showed excellent specificity (>90%) and good sensitivity (60%) for the diagnosis of severe CAD among the diabetic population with unknown CAD. This is the first study showing that GLS at rest with cutoff value at -14.5% had good and equal diagnostic accuracy as WMSI at peak stress to detect significant CAD among the diabetic population.
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Affiliation(s)
- Oumaima Alaika
- Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Souad Jamai
- Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Nawal Doghmi
- Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Cherti
- Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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15
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Hochstadt A, Arnold J, Rosen R, Sherez C, Sherez J, Mor L, Derakhshesh M, Moshkovits Y, Merdler I, Arbel Y, Kapusta L, Rozenbaum Z, Topilsky Y, Laufer-Perl M. Diastolic strain time as predictor for systolic dysfunction among patients with active breast cancer. Echocardiography 2020; 37:1890-1896. [PMID: 32686871 DOI: 10.1111/echo.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of diastolic strain time (Dst) with the routine echocardiography diastolic parameters and estimated its role in the early detection of cardiotoxicity among patients with active breast cancer. METHODS Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy, were included. Echocardiography, including global longitudinal systolic strain (GLS) and Dst, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity was determined by GLS relative reduction of ≥15%. Dst was assessed as the time measured (ms) of the myocardium lengthening during diastole. RESULTS Among 69 patients, 67 (97.1%) were females with a mean age of 52 ± 13 years. Dst was significantly associated with the routine diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3. Both in a univariate and a multivariate analyses, the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (P < .04). CONCLUSIONS Among breast cancer patients, Dst showed high correlation to the routine diastolic echocardiography parameters. Change in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.
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Affiliation(s)
- Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Arnold
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rosen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Sherez
- University of Naples, Federico ll, Naples, Italy
| | - Jack Sherez
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Livia Kapusta
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pediatrics Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Park H, Kim KH, Kim HY, Cho JY, Yoon HJ, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG. Left atrial longitudinal strain as a predictor of Cancer therapeutics-related cardiac dysfunction in patients with breast Cancer. Cardiovasc Ultrasound 2020; 18:28. [PMID: 32693802 PMCID: PMC7374848 DOI: 10.1186/s12947-020-00210-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy. Methods A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared. Results CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%). Conclusions PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.
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Affiliation(s)
- Hyukjin Park
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea.
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
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17
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Oikonomou EK, Kokkinidis DG, Kampaktsis PN, Amir EA, Marwick TH, Gupta D, Thavendiranathan P. Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis. JAMA Cardiol 2020; 4:1007-1018. [PMID: 31433450 DOI: 10.1001/jamacardio.2019.2952] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. A meta-analysis of the prognostic value of GLS for cancer therapy-related cardiac dysfunction (CTRCD) has not been performed, to our knowledge. Objective To explore the prognostic value of GLS for the prediction of CTRCD. Data Sources Systematic search of the MEDLINE, Embase, Scopus, and the Cochrane Library databases from database inception to June 1, 2018. Study Selection Cohort studies assessing the prognostic or discriminatory performance of GLS before or during chemotherapy for subsequent CTRCD. Data Extraction and Synthesis Random-effects meta-analysis and hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the prognostic and discriminatory performance of different GLS indices. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. Main Outcomes and Measures The primary outcome was CTRCD, defined as a clinically significant change in left ventricular ejection fraction with or without new-onset heart failure symptoms. Results Analysis included 21 studies comprising 1782 patients with cancer, including breast cancer, hematologic malignancies, or sarcomas, treated with anthracyclines with or without trastuzumab. The incidence of CTRCD ranged from 9.3% to 43.8% over a mean follow-up of 4.2 to 23.0 months (pooled incidence, 21.0%). For active treatment absolute GLS (9 studies), the high-risk cutoff values ranged from -21.0% to -13.8%, with worse GLS associated with a higher CTRCD risk (odds ratio, 12.27; 95% CI, 7.73-19.47; area under the HSROC, 0.86; 95% CI, 0.83-0.89). For relative changes vs a baseline value (9 studies), cutoff values ranged from 2.3% to 15.9%, with a greater decrease linked to a 16-fold higher risk of CTRCD (odds ratio, 15.82; 95% CI, 5.84-42.85; area under the HSROC, 0.86; 95% CI, 0.83-0.89). Both indices showed significant publication bias. Meta-regression identified differences in sample size and CTRCD definition but not GLS cutoff value as significant sources of interstudy heterogeneity. Conclusions and Relevance In this meta-analysis, measurement of GLS after initiation of potentially cardiotoxic chemotherapy with anthracyclines with or without trastuzumab had good prognostic performance for subsequent CTRCD. However, risk of bias in the original studies, publication bias, and limited data on the incremental value of GLS and its optimal cutoff values highlight the need for larger prospective multicenter studies.
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Affiliation(s)
- Evangelos K Oikonomou
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Damianos G Kokkinidis
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Polydoros N Kampaktsis
- Department of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York
| | - Eitan A Amir
- Division of Medical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paaladinesh Thavendiranathan
- Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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18
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Clinical and Research Tools for the Study of Cardiovascular Effects of Cancer Therapy. J Cardiovasc Transl Res 2020; 13:417-430. [PMID: 32472498 DOI: 10.1007/s12265-020-10030-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
The expansion of cancer therapeutics has paved the way for improved cancer-related outcomes. Cardiotoxicity from cancer therapy occurs in a small but significant subset of patients, is often poorly understood, and contributes to adverse outcomes at all stages of cancer treatment. Given the often-idiopathic occurrence of cardiotoxicity, novel strategies are needed for risk-stratification and early identification of cancer patients experiencing cardiotoxicity. Clinical and research tools extending from imaging to blood-based biomarkers and pluripotent stem cells are being explored as methods to study the cardiovascular impact of various cancer treatments. Here we provide an overview of tools currently available for evaluation of cardiotoxicity and highlight novel techniques in development aimed at understanding underlying pathophysiologic mechanisms.
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19
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Zacchigna S, Paldino A, Falcão-Pires I, Daskalopoulos EP, Dal Ferro M, Vodret S, Lesizza P, Cannatà A, Miranda-Silva D, Lourenço AP, Pinamonti B, Sinagra G, Weinberger F, Eschenhagen T, Carrier L, Kehat I, Tocchetti CG, Russo M, Ghigo A, Cimino J, Hirsch E, Dawson D, Ciccarelli M, Oliveti M, Linke WA, Cuijpers I, Heymans S, Hamdani N, de Boer M, Duncker DJ, Kuster D, van der Velden J, Beauloye C, Bertrand L, Mayr M, Giacca M, Leuschner F, Backs J, Thum T. Towards standardization of echocardiography for the evaluation of left ventricular function in adult rodents: a position paper of the ESC Working Group on Myocardial Function. Cardiovasc Res 2020; 117:43-59. [PMID: 32365197 DOI: 10.1093/cvr/cvaa110] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/28/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Echocardiography is a reliable and reproducible method to assess non-invasively cardiac function in clinical and experimental research. Significant progress in the development of echocardiographic equipment and transducers has led to the successful translation of this methodology from humans to rodents, allowing for the scoring of disease severity and progression, testing of new drugs, and monitoring cardiac function in genetically modified or pharmacologically treated animals. However, as yet, there is no standardization in the procedure to acquire echocardiographic measurements in small animals. This position paper focuses on the appropriate acquisition and analysis of echocardiographic parameters in adult mice and rats, and provides reference values, representative images, and videos for the accurate and reproducible quantification of left ventricular function in healthy and pathological conditions.
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Affiliation(s)
- Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Alessia Paldino
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Evangelos P Daskalopoulos
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Matteo Dal Ferro
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Simone Vodret
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Pierluigi Lesizza
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Antonio Cannatà
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Daniela Miranda-Silva
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bruno Pinamonti
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Gianfranco Sinagra
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Florian Weinberger
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Izhak Kehat
- Department of Physiology, Biophysics and System Biology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Michele Russo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | | | | | - Wolfgang A Linke
- Institute of Physiology 2, University of Muenster, Muenster, Germany
| | - Ilona Cuijpers
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Stephane Heymans
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Nazha Hamdani
- Department of Molecular and Experimental Cardiology, Division Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Martine de Boer
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Christophe Beauloye
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luc Bertrand
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Manuel Mayr
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Mauro Giacca
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy.,King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Florian Leuschner
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Thomas Thum
- Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
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20
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Wang B, Yu Y, Zhang Y, Hao X, Zhao H, Yang S, Sun Q, Wang Y. Speckle tracking echocardiography in the early detection and prediction of anthracycline cardiotoxicity in diffuse large B-cell lymphoma treated with (R)-CHOP regimen. Echocardiography 2020; 37:421-428. [PMID: 32112477 DOI: 10.1111/echo.14622] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite speckle tracking echocardiography (STE) has emerged as a sensitive technique for identifying myocardial dysfunction, there are little data available on the appropriate timing to perform STE in the serial assessment after anthracycline administration. Moreover, further uncertainty is increased in the context of STE application in diffuse large B-cell lymphoma (DLBCL) research, as most recommendations are inferred by studies conducted primarily in breast cancer. OBJECTIVE This study aimed to determine whether early measurement of strain parameters derived by STE could predict the development of cardiotoxicity. METHODS Sixty-five patients were included in the final analysis. The patients were evaluated at baseline, after the third cycle and sixth-eighth cycle, and during follow-up. Global longitudinal strain (GLS) was analyzed using STE, and left ventricular ejection fraction (LVEF) was calculated by real time 3D echocardiography (RT3DE). RESULTS There was a significant decrease in GLS after the third cycle of chemotherapy and remained decreased during subsequent follow-up, whereas LVEF decreased only at follow-up. A percentage reduction in GLS of 13.8% between baseline and the third cycle of chemotherapy was the best predictor of further LVEF reduction. CONCLUSION Earlier monitoring timing and more accurate assessment methods might be helpful in the prevention of irreversible heart failure.
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Affiliation(s)
- Baozhen Wang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Yang Yu
- Medical Imaging Center, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Zhang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Xiaoyi Hao
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Hong Zhao
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Shan Yang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Qianqian Sun
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Wang
- Medical Imaging Center, Cangzhou People's Hospital, Cangzhou, China
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21
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Global longitudinal strain is a better metric than left ventricular ejection fraction: lessons learned from cancer therapeutic-related cardiac dysfunction. Curr Opin Cardiol 2019; 35:170-177. [PMID: 31850935 DOI: 10.1097/hco.0000000000000716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW This review aims to highlight the utility of global longitudinal strain (GLS) in cancer therapeutic-related cardiac dysfunction (CTRCD), with an attempt to stipulate that GLS might be a better measure than left ventricular ejection fraction (LVEF). RECENT FINDINGS Increasingly, GLS quantification has been employed in various cardiovascular diseases especially with its ability to detect left ventricular dysfunction subclinically, even before a change in LVEF is visualized. In fact, several studies reveal that GLS may be a superior predictor of mortality and morbidity than LVEF in this context. A recent metaanalysis supported the prognosticating value of GLS in CTRCD, however, endorsed the need for larger multicenter studies to establish the value of this metric. Studies in other cardiovascular disease processes showed GLS as a better metric than LVEF. SUMMARY GLS has been heralded as a new echocardiographic measure that can detect subclinical cardiac disease. At a minimum, GLS can provide incremental value in prognosticating, diagnosing, and predicting LVEF recovery and at best, a better measure of left ventricular dysfunction.
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22
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Rodrigues RC, de Azevedo KML, Moscavitch SD, Setubal S, Mesquita CT. The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls. Arq Bras Cardiol 2019; 113:737-745. [PMID: 31482986 PMCID: PMC7020862 DOI: 10.5935/abc.20190169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. OBJECTIVES To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. METHODS Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. RESULTS The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. CONCLUSION The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.
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Affiliation(s)
| | | | | | - Sergio Setubal
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
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23
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Scott JM, Dillon EL, Kinsky M, Chamberlain A, McCammon S, Jupiter D, Willis M, Hatch S, Richardson G, Danesi C, Randolph K, Durham W, Wright T, Urban R, Sheffield-Moore M. Effects of adjunct testosterone on cardiac morphology and function in advanced cancers: an ancillary analysis of a randomized controlled trial. BMC Cancer 2019; 19:778. [PMID: 31391011 PMCID: PMC6686390 DOI: 10.1186/s12885-019-6006-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adjunct testosterone therapy improves lean body mass, quality of life, and physical activity in patients with advanced cancers; however, the effects of testosterone on cardiac morphology and function are unknown. Accordingly, as an ancillary analysis of a randomized, placebo-controlled trial investigating the efficacy of testosterone supplementation on body composition in men and women with advanced cancers, we explored whether testosterone supplementation could prevent or reverse left ventricular (LV) atrophy and dysfunction. METHODS Men and women recently diagnosed with late stage (≥IIB) or recurrent head and neck or cervical cancer who were scheduled to receive standard of care chemotherapy or concurrent chemoradiation were administered an adjunct 7 week treatment of weekly intramuscular injections of either 100 mg testosterone (T, n = 1 M/5F) or placebo (P, n = 6 M/4F) in a double-blinded randomized fashion. LV morphology (wall thickness), systolic function (ejection fraction, EF), diastolic function (E/A; E'/E), arterial elastance (Ea), end-systolic elastance (Ees), and ventricular-arterial coupling (Ea/Ees) were assessed. RESULTS No significant differences were observed in LV posterior wall thickness in placebo (pre: 1.10 ± 0.1 cm; post: 1.16 ± 0.2 cm; p = 0.11) or testosterone groups (pre: 0.99 ± 0.1 cm; post: 1.14 ± 0.20 cm; p = 0.22). Compared with placebo, testosterone significantly improved LVEF (placebo: - 1.8 ± 4.3%; testosterone: + 6.2 ± 4.3%; p < 0.05), Ea (placebo: 0.0 ± 0.2 mmHg/mL; testosterone: - 0.3 ± 0.2 mmHg/mL; p < 0.05), and Ea/Ees (placebo: 0.0 ± 0.1; testosterone: - 0.2 ± 0.1; p < 0.05). CONCLUSIONS In patients with advanced cancers, testosterone was associated with favorable changes in left ventricular systolic function, arterial elastance, and ventricular-arterial coupling. Given the small sample size, the promising multisystem benefits of testosterone warrants further evaluation in a definitive randomized trial. TRIAL REGISTRATION This study was prospectively registered on ClinicalTrials.gov (NCT00878995; date of registration: April 9, 2009).
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Affiliation(s)
- Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Lichar Dillon
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael Kinsky
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Albert Chamberlain
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Susan McCammon
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - Maurice Willis
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sandra Hatch
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Gwyn Richardson
- Department of Gynecologic Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher Danesi
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Kathleen Randolph
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Health and Kinesiology, Texas A&M University, 155 Ireland St., College Station, TX, TX 77845, USA
| | - William Durham
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Traver Wright
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Health and Kinesiology, Texas A&M University, 155 Ireland St., College Station, TX, TX 77845, USA
| | - Randall Urban
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Melinda Sheffield-Moore
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
- Department of Health and Kinesiology, Texas A&M University, 155 Ireland St., College Station, TX, TX 77845, USA.
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Levine LD, Lewey J, Koelper N, Downes KL, Arany Z, Elovitz MA, Sammel MD, Ky B. Persistent cardiac dysfunction on echocardiography in African American women with severe preeclampsia. Pregnancy Hypertens 2019; 17:127-132. [PMID: 31487629 PMCID: PMC6858847 DOI: 10.1016/j.preghy.2019.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and preeclampsia both disproportionally affect African American women. Evidence continues to grow linking a history of preeclampsia to future CVD. Therefore, we sought to determine whether abnormalities in cardiac function, as determined by echocardiography, could be identified at the time of preeclampsia diagnosis in African American women, and if they persist into the early postpartum period. STUDY DESIGN This prospective blinded longitudinal cohort study was performed from April 2015 to May 2017. We identified African American women diagnosed with preterm (<37 weeks) preeclampsia with severe features and compared them to control normotensive pregnant women matched on race, gestational age, maternal age, and body mass index. We obtained transthoracic echocardiograms on cases and controls at time of diagnosis and again 4-12 weeks postpartum. We quantified the systolic function with longitudinal strain, ventricular-arterial coupling parameters and diastolic function. RESULTS There were 29 matched (case-control) pairs of African American women for a total of 58 women. At time of preeclampsia diagnosis, there was more abnormal cardiac function as evidenced by worse cardiac systolic function (longitudinal strain), increased chamber stiffness (end systolic elastance), and worse diastolic function (E/e') in preeclampsia cases compared to controls. These findings persisted 4-12 weeks postpartum. There were additional notable abnormalities in E/A, and Ea (arterial load) postpartum, indicative of potentially worse diastolic function and increased arterial stiffness in the postpartum period. CONCLUSIONS Among African American women, we found notable cardiac function differences between women with severe preeclampsia and healthy pregnant controls that persist postpartum.
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Affiliation(s)
- Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathanael Koelper
- Center for Research on Reproduction and Women's Health, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Zolt Arany
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mary D Sammel
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, and Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bonnie Ky
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, and Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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25
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Kar J, Cohen MV, McQuiston SA, Figarola MS, Malozzi CM. Can post-chemotherapy cardiotoxicity be detected in long-term survivors of breast cancer via comprehensive 3D left-ventricular contractility (strain) analysis? Magn Reson Imaging 2019; 62:94-103. [PMID: 31254595 DOI: 10.1016/j.mri.2019.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE This study applied a novel and automated contractility analysis tool to investigate possible cardiotoxicity-related left-ventricular (LV) dysfunction in breast cancer patients following treatment with anti-neoplastic chemotherapy agents (CTA). Subclinical dysfunction otherwise undetected via LV ejection fraction (LVEF) was determined. METHODS Deformation data were acquired with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence on 16 female patients who had CTA-based treatment. The contractility analysis tool consisting of image quantization-based boundary detection and the meshfree Radial Point Interpolation Method was used to compare chamber quantifications, 3D regional strains and torsion between patients and healthy subjects (N = 26 females with N = 14 age-matched). Quantifications of patient LVEFs from DENSE and Steady-State Free Precession (SSFP) acquisitions were compared, Bland-Altman interobserver agreements measured on their strain results and differences in contractile parameters with healthy subjects determined via Student's t-tests. RESULTS A significant difference was not found between DENSE and SSFP-based patient LVEFs at 58 ± 7% vs 57 ± 9%, p = 0.6. Bland-Altman agreements were - 0.01 ± 0.05 for longitudinal strain and 0.1 ± 1.3° for torsion. Differences in basal diameter indicating enlargement, 5.2 ± 0.5 cm vs 4.5 ± 0.5 cm, p < 0.01, and torsion, 4.7 ± 1.0° vs 8.1 ± 1.1°, p < 0.001 in the mid-ventricle and 5.9 ± 1.2° vs 10.2 ± 0.9°, p < 0.001 apically, were seen between patients and age-matched healthy subjects and similarly in longitudinal strain, but not in LVEF. CONCLUSIONS Results from the statistical analysis reveal the likelihood of LV remodeling in this patient subpopulation otherwise not indicated by LVEF measurements.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, 150 Jaguar Drive, Mobile, AL 36688, United States of America.
| | - Michael V Cohen
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
| | - Samuel A McQuiston
- Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, United States of America
| | - Maria S Figarola
- Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, United States of America
| | - Christopher M Malozzi
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
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Tocchetti CG, Cadeddu C, Di Lisi D, Femminò S, Madonna R, Mele D, Monte I, Novo G, Penna C, Pepe A, Spallarossa P, Varricchi G, Zito C, Pagliaro P, Mercuro G. From Molecular Mechanisms to Clinical Management of Antineoplastic Drug-Induced Cardiovascular Toxicity: A Translational Overview. Antioxid Redox Signal 2019; 30:2110-2153. [PMID: 28398124 PMCID: PMC6529857 DOI: 10.1089/ars.2016.6930] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Significance: Antineoplastic therapies have significantly improved the prognosis of oncology patients. However, these treatments can bring to a higher incidence of side-effects, including the worrying cardiovascular toxicity (CTX). Recent Advances: Substantial evidence indicates multiple mechanisms of CTX, with redox mechanisms playing a key role. Recent data singled out mitochondria as key targets for antineoplastic drug-induced CTX; understanding the underlying mechanisms is, therefore, crucial for effective cardioprotection, without compromising the efficacy of anti-cancer treatments. Critical Issues: CTX can occur within a few days or many years after treatment. Type I CTX is associated with irreversible cardiac cell injury, and it is typically caused by anthracyclines and traditional chemotherapeutics. Type II CTX is generally caused by novel biologics and more targeted drugs, and it is associated with reversible myocardial dysfunction. Therefore, patients undergoing anti-cancer treatments should be closely monitored, and patients at risk of CTX should be identified before beginning treatment to reduce CTX-related morbidity. Future Directions: Genetic profiling of clinical risk factors and an integrated approach using molecular, imaging, and clinical data may allow the recognition of patients who are at a high risk of developing chemotherapy-related CTX, and it may suggest methodologies to limit damage in a wider range of patients. The involvement of redox mechanisms in cancer biology and anticancer treatments is a very active field of research. Further investigations will be necessary to uncover the hallmarks of cancer from a redox perspective and to develop more efficacious antineoplastic therapies that also spare the cardiovascular system.
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Affiliation(s)
| | - Christian Cadeddu
- 2 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Di Lisi
- 3 Biomedical Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Saveria Femminò
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Rosalinda Madonna
- 5 Center of Aging Sciences and Translational Medicine - CESI-MeT, "G. d'Annunzio" University, Chieti, Italy.,6 Department of Internal Medicine, The Texas Heart Institute and Center for Cardiovascular Biology and Atherosclerosis Research, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Donato Mele
- 7 Cardiology Unit, Emergency Department, University Hospital of Ferrara, Ferrara, Italy
| | - Ines Monte
- 8 Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
| | - Giuseppina Novo
- 3 Biomedical Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Claudia Penna
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessia Pepe
- 9 U.O.C. Magnetic Resonance Imaging, Fondazione Toscana G. Monasterio C.N.R., Pisa, Italy
| | - Paolo Spallarossa
- 10 Clinic of Cardiovascular Diseases, IRCCS San Martino IST, Genova, Italy
| | - Gilda Varricchi
- 1 Department of Translational Medical Sciences, Federico II University, Naples, Italy.,11 Center for Basic and Clinical Immunology Research (CISI) - Federico II University, Naples, Italy
| | - Concetta Zito
- 12 Division of Cardiology, Clinical and Experimental Department of Medicine and Pharmacology, Policlinico "G. Martino" University of Messina, Messina, Italy
| | - Pasquale Pagliaro
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Mercuro
- 2 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Abstract
Doxorubicin-induced cardiotoxicity in childhood cancer survivors is a growing problem. The population of patients at risk for cardiovascular disease is steadily increasing, as five-year survival rates for all types of childhood cancers continue to improve. Doxorubicin affects the developing heart differently from the adult heart and in a subset of exposed patients, childhood exposure leads to late, irreversible cardiomyopathy. Notably, the prevalence of late-onset toxicity is increasing in parallel with improved survival. By the year 2020, it is estimated that there will be 500,000 childhood cancer survivors and over 50,000 of them will suffer from doxorubicin-induced cardiotoxicity. The majority of the research to-date, concentrated on childhood cancer survivors, has focused mostly on clinical outcomes through well-designed epidemiological and retrospective cohort studies. Preclinical studies have elucidated many of the cellular mechanisms that elicit acute toxicity in cardiomyocytes. However, more research is needed in the areas of early- and late-onset cardiotoxicity and more importantly improving the scientific understanding of how other cells present in the cardiac milieu are impacted by doxorubicin exposure. The overall goal of this review is to succinctly summarize the major clinical and preclinical studies focused on doxorubicin-induced cardiotoxicity. As the prevalence of patients affected by doxorubicin exposure continues to increase, it is imperative that the major gaps in existing research are identified and subsequently utilized to develop appropriate research priorities for the coming years. Well-designed preclinical research models will enhance our understanding of the pathophysiology of doxorubicin-induced cardiotoxicity and directly lead to better diagnosis, treatment, and prevention. © 2019 American Physiological Society. Compr Physiol 9:905-931, 2019.
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Affiliation(s)
- Trevi R. Mancilla
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Brian Iskra
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Gregory J. Aune
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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28
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Bergamini C, Dolci G, Truong S, Zanolla L, Benfari G, Fiorio E, Rossi A, Ribichini FL. Role of Speckle Tracking Echocardiography in the Evaluation of Breast Cancer Patients Undergoing Chemotherapy: Review and Meta-analysis of the Literature. Cardiovasc Toxicol 2019; 19:485-492. [DOI: 10.1007/s12012-019-09523-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Scott JM, Martin D, Ploutz-Snyder R, Downs M, Dillon EL, Sheffield-Moore M, Urban RJ, Ploutz-Snyder LL. Efficacy of Exercise and Testosterone to Mitigate Atrophic Cardiovascular Remodeling. Med Sci Sports Exerc 2019; 50:1940-1949. [PMID: 29570536 DOI: 10.1249/mss.0000000000001619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Early and consistent evaluation of cardiac morphology and function throughout an atrophic stimulus is critically important for the design and optimization of interventions. This randomized controlled trial was designed 1) to characterize the time course of unloading-induced morphofunctional remodeling and 2) to examine the effects of exercise with and without low-dose testosterone supplementation on cardiac biomarker, structural, and functional parameters during unloading. METHODS Twenty-six subjects completed 70 d of head-down tilt bed rest (BR): 9 were randomized to exercise training (Ex), 8 to EX and low-dose testosterone (ExT), and 9 remained sedentary (CONT). Exercise consisted of high-intensity, continuous, and resistance exercise. Cardiac morphology (left ventricular mass [LVM]) and mechanics (longitudinal, radial, and circumferential strain and twist), cardiovascular biomarkers, and cardiorespiratory fitness (V˙O2peak) were assessed before, during, and after BR. RESULTS Sedentary BR resulted in a progressive decline in LVM, longitudinal, radial, and circumferential strain in CONT, whereas Ex and ExT mitigated decreases in LVM and function. Twist was increased throughout BR in sedentary BR, whereas after an initial increase at BR7, there were no further changes in twist in Ex and ExT. HDL cholesterol was significantly decreased in all groups compared with pre-BR (P < 0.007). There were no significant changes in other cardiovascular biomarkers. Change in twist was significantly related to change in V˙O2max (R = 0.68, P < 0.01). CONCLUSION An integrated approach with evaluation of cardiac morphology, mechanics, V˙O2peak, and biomarkers provides extensive phenotyping of cardiovascular atrophic remodeling. Exercise training and exercise training with low-dose testosterone supplementation abrogates atrophic remodeling.
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Chuzi S, Rangarajan V, Jafari L, Vaitenas I, Akhter N. Subcostal View-Based Longitudinal Strain in Patients With Breast Cancer Is an Alternative to Conventional Apical View-Based Longitudinal Strain. J Am Soc Echocardiogr 2019; 32:514-520.e1. [DOI: 10.1016/j.echo.2018.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 01/08/2023]
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31
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Treatment exposures stratify need for echocardiographic screening in asymptomatic long-term survivors of hematopoietic stem cell transplantation. Cardiol Young 2019; 29:338-343. [PMID: 30744727 DOI: 10.1017/s104795111800238x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽-2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score -2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3-99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.
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Gong IY, Ong G, Brezden-Masley C, Dhir V, Deva DP, Chan KKW, Graham JJ, Chow CM, Thavendiranathan P, Dai D, Ng MY, Barfett JJ, Connelly KA, Yan AT. Early diastolic strain rate measurements by cardiac MRI in breast cancer patients treated with trastuzumab: a longitudinal study. Int J Cardiovasc Imaging 2018; 35:653-662. [PMID: 30390170 DOI: 10.1007/s10554-018-1482-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/20/2018] [Indexed: 01/03/2023]
Abstract
We evaluated temporal changes in early diastolic strain rates by cardiovascular magnetic resonance (CMR) as an early detector of trastuzumab-induced ventricular dysfunction. We conducted a prospective, multi-centre, longitudinal observational study of 41 trastuzumab-treated breast cancer women who underwent serial CMR (baseline, 6, 12, and 18 months). Two blinded readers independently measured left ventricular ejection fraction (LVEF), peak systolic strain parameters (global longitudinal strain [GLS] and global circumferential strain [GCS]), and early diastolic strain rate parameters (global longitudinal diastolic strain rate [GLSR-E], global circumferential diastolic strain rate [GCSR-E], and global radial diastolic strain rate [GRSR-E]), by feature tracking (FT-CMR) using CMR42. There was a significant decline in peak systolic strain GLS and GCS at 6 months (p = 0.024 and p < 0.001, respectively) and 12 months (p = 0.002 and p < 0.001, respectively), followed by recovery at 18 months, which paralleled decline in LVEF at 6 months (p = 0.034) and 12 months (p = 0.012). Conversely, early diastolic strain rates GLSR-E and GCSR-E did not significantly change over 18 months (p > 0.10), while GRSR-E was marginally significant at 12 months (p = 0.021). There was no significant correlation between changes at 6 months in LVEF and GLSR-E or GRSR-E (p > 0.10), and a marginally significant weak correlation between LVEF and GCSR-E (p = 0.046). Among trastuzumab-treated patients without overt cardiotoxicity, there was no consistent temporal change in FT-CMR-derived diastolic strain rate parameters up to 18 months, in contrast to decline in systolic strain and LVEF. Systolic strains by FT-CMR are likely more useful than diastolic strain rates for monitoring subclinical trastuzumab-related myocardial dysfunction.ClinicalTrials.gov identifier NCT01022086.
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Affiliation(s)
| | - Geraldine Ong
- Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Christine Brezden-Masley
- University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, St Michael's Hospital, Toronto, Canada
| | - Vinita Dhir
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, Canada
| | - Djeven P Deva
- University of Toronto, Toronto, Canada.,Department of Medical Imaging, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Kelvin K W Chan
- University of Toronto, Toronto, Canada.,Sunnybrook Odette Cancer Centre, Canadian Center for Applied Research in Cancer Control, Toronto, Canada
| | - John J Graham
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Chi-Ming Chow
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | | | - Day Dai
- University of Toronto, Toronto, Canada
| | - Ming-Yen Ng
- The University of Hong Kong, Hong Kong, China
| | - Joseph J Barfett
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Kim A Connelly
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Andrew T Yan
- University of Toronto, Toronto, Canada. .,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada. .,Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Rm 6-030 Donnelly, Toronto, M5B 1W8, Canada.
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Heitner SB, Minnier J, Naher A, Van Woerkom RC, Ritts A, Ferencik M, Broberg C, Medvedova E, Silbermann R, Scott EC. Bortezomib-based Chemotherapy for Multiple Myeloma Patients Without Comorbid Cardiovascular Disease Shows No Cardiotoxicity. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:796-802. [PMID: 30217616 DOI: 10.1016/j.clml.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Proteasome inhibitors used in the treatment of multiple myeloma act primarily through the disruption of intrinsic cellular protein quality maintenance, resulting in proteotoxic stress, cellular dysfunction, and, ultimately, cell death. We assessed whether evidence has shown off-target myocardial dysfunction related to the administration of bortezomib-based chemotherapy for multiple myeloma. PATIENTS AND METHODS Patients aged 18 to 70 years who were free of significant cardiovascular disease were included. They underwent evaluations before and after each dose of bortezomib to assess for clinical, subclinical, and transient cardiotoxicity using echocardiography and serum biomarker measurement. Cardiac magnetic resonance imaging was performed at 3 separately defined intervals. The primary modality for determining subclinical myocardial dysfunction was echocardiographic assessment of the global longitudinal strain (GLS). RESULTS Eleven patients (7 men) with an average age of 55 years were included. No evidence of cumulative myocardial dysfunction was found using echocardiographic markers, primarily GLS (average change in absolute GLS, -1.17; P = .064). Additionally, no echocardiographic evidence of transient cardiotoxicity was found. The left ventricular ejection fraction (LVEF) also did not show any significant changes (ΔLVEF, -2.17%; P = .15). Magnetic resonance imaging confirmed no changes in structure or function (ΔLVEF, -2.6%; P = .54) and extracellular volume fraction (Δ = 2%; P = .46). The serum biomarker levels also did not change significantly over time. CONCLUSION We did not observe cardiotoxicity from bortezomib-based chemotherapy despite very intensive evaluation with multiple modalities. Neither cumulative nor transient alterations were found in our metrics, suggesting that bortezomib is safe from a cardiovascular standpoint for patients free of cardiovascular disease.
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Affiliation(s)
- Stephen B Heitner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR.
| | - Jessica Minnier
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| | - Aynun Naher
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Ryan C Van Woerkom
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Alexandra Ritts
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Eva Medvedova
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| | - Rebecca Silbermann
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| | - Emma C Scott
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
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El-Sherbeny WS, Sabry NM, Sharbay RM. Prediction of trastuzumab-induced cardiotoxicity in breast cancer patients receiving anthracycline-based chemotherapy. J Echocardiogr 2018; 17:76-83. [PMID: 30099714 DOI: 10.1007/s12574-018-0394-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adjuvant trastuzumab improved overall survival and reduced the risk for disease recurrence in women with breast cancers, because of its potential cardiotoxicity, careful monitoring of left ventricular (LV) function during treatment is required. METHODS This study investigates, whether myocardial strain imaging and level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) could predict subsequent reduction in LVEF in breast cancer patients received adjuvant trastuzumab. 61 women with pathologically proven breast cancer HER-2 positive received AC (Doxorubicin-Cyclophosphamide) for 4 cycles, followed by paclitaxel with Trastuzumab were enrolled. Clinical, conventional echocardiographic parameters, myocardial strain imaging [global longitudinal peak systolic strain (GLS), radial and circumferential systolic strain] and level of NT pro-BNP were measured at baseline, after 3, 6, 9 and 12 months of trastuzumab therapy. RESULTS Of 61 patients, 18 patients (29.5%) developed trastuzumab-induced cardiomyopathy (CM) at 6 and 9 months of therapy (LVEF declines ≥ 10%), GLS and radial strain significantly decreased in CM group at 3 months of trastuzumab treatment, the value of GLS at 3 months was the strongest predictors of cardiotoxicity its area under the curve (AUC 0.98) with an optimal cut-off for GLS (- 18%) having 92.5% sensitivity and 83% specificity. NT-pro BNP levels were not predictive of later trastuzumab-induced cardiac dysfunction. CONCLUSION Myocardial strain imaging has been able to predict pre-clinical changes in LV systolic function and GLS is an independent early predictor of subsequent reduction in EF in breast cancer patients treated with trastuzumab.
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Affiliation(s)
- Wafaa S El-Sherbeny
- Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Nesreen M Sabry
- Clinical Oncology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Radwa M Sharbay
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Jordan JH, Todd RM, Vasu S, Hundley WG. Cardiovascular Magnetic Resonance in the Oncology Patient. JACC Cardiovasc Imaging 2018; 11:1150-1172. [PMID: 30092971 PMCID: PMC6242266 DOI: 10.1016/j.jcmg.2018.06.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 01/20/2023]
Abstract
Patients with or receiving potentially cardiotoxic treatment for cancer are susceptible to developing decrements in left ventricular mass, diastolic function, or systolic function. They may also experience valvular heart disease, pericardial disease, or intracardiac masses. Cardiovascular magnetic resonance may be used to assess cardiac anatomy, structure, and function and to characterize myocardial tissue. This combination of features facilitates the diagnosis and management of disease processes in patients with or those who have survived cancer. This report outlines and describes prior research involving cardiovascular magnetic resonance for assessing cardiovascular disease in patients with or previously having received treatment for cancer.
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Affiliation(s)
- Jennifer H Jordan
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Ryan M Todd
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sujethra Vasu
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
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Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes. JACC Cardiovasc Imaging 2018; 11:1098-1105. [DOI: 10.1016/j.jcmg.2018.03.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/17/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022]
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Ong G, Brezden-Masley C, Dhir V, Deva DP, Chan KKW, Chow CM, Thavendiranathan D, Haq R, Barfett JJ, Petrella TM, Connelly KA, Yan AT. Myocardial strain imaging by cardiac magnetic resonance for detection of subclinical myocardial dysfunction in breast cancer patients receiving trastuzumab and chemotherapy. Int J Cardiol 2018; 261:228-233. [PMID: 29555336 DOI: 10.1016/j.ijcard.2018.03.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Our objectives were to evaluate the temporal changes in CMR-based strain imaging, and examine their relationship with left ventricular ejection fraction (LVEF), in patients treated with trastuzumab. PATIENTS AND METHODS In this prospective longitudinal observational study, 41 women with HER2+ breast cancer treated with chemotherapy underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab (treatment duration 12 months). LVEF and LV strain (global longitudinal[GLS] and circumferential[GCS]) measurements were independently measured by 2 blinded readers. RESULTS Of the 41 patients, 56% received anthracycline-based chemotherapy. Compared to baseline (60.4%, 95%CI 59.2-61.7%), there was a small but significant reduction in LVEF at 6 months (58.4%, 95%CI 56.7-60.0%, p = 0.034) and 12 months (57.9%, 95%CI 56.4-59.7%, p = 0.012), but not at 18 months (60.2%, 95%CI 58.2-62.2%, p = 0.93). Similarly, compared to baseline, GLS and GCS decreased significantly at 6 months (p = 0.024 and < 0.001, respectively) and 12 months (p = 0.002 and < 0.001, respectively) with an increase in LV end-diastolic volume, but not at 18 months. There were significant correlations between the temporal (6 month-baseline) changes in LVEF, and all global strain measurements (Pearson's r = -0.60 and r = -0.75 for GLS and GCS, respectively, all p < 0.001). CONCLUSION There was a significant reduction in LV strain during trastuzumab treatment, which correlated with a concurrent subtle decline in LVEF and was associated with an increase in LV end-diastolic volume. LV strain assessment by CMR may be a promising method to monitor for subclinical myocardial dysfunction in breast cancer patients receiving chemotherapy. Future studies are needed to determine its prognostic and therapeutic implications.
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Affiliation(s)
- Geraldine Ong
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Christine Brezden-Masley
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada.
| | - Vinita Dhir
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada.
| | - Djeven P Deva
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Kelvin K W Chan
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Cancer Care Ontario, Canadian Center for Applied Research in Cancer Control, Toronto, ON, Canada.
| | - Chi-Ming Chow
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Dinesh Thavendiranathan
- University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Rashida Haq
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Joseph J Barfett
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Kim A Connelly
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Moudgil R, Hassan S, Palaskas N, Lopez-Mattei J, Banchs J, Yusuf SW. Evolution of echocardiography in subclinical detection of cancer therapy-related cardiac dysfunction. Echocardiography 2018; 35:860-868. [DOI: 10.1111/echo.14012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Rohit Moudgil
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Saamir Hassan
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Nicolas Palaskas
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Juan Lopez-Mattei
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Jose Banchs
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Syed Wamique Yusuf
- Department of Cardiology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
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Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e30-e66. [PMID: 29437116 PMCID: PMC6722327 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.
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Charbonnel C, Convers-Domart R, Rigaudeau S, Taksin AL, Baron N, Lambert J, Ghez S, Georges JL, Farhat H, Lambert J, Rousselot P, Livarek B. Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity. Eur Heart J Cardiovasc Imaging 2018; 18:392-401. [PMID: 28064155 DOI: 10.1093/ehjci/jew223] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/25/2016] [Indexed: 01/30/2023] Open
Abstract
Aims We sought to assess whether global longitudinal strain (GLS) measured early during treatment with anthracyclines (at a cumulative dose of 150 mg/m2) can predict subsequent alterations in left ventricular ejection fraction. Methods and results Eighty-six patients with Hodgkin's disease, non-Hodgkin's lymphoma, or acute leukaemia and receiving anthracyclines were prospectively included. Patients underwent complete echocardiography on four occasions: baseline (V1); after reaching a cumulative dose of 150 mg/m2 (V2); end of treatment (V3); and 1 year follow-up (V4). Six patients developed cardiotoxicity, defined as a decrease in left ventricular ejection fraction of >10 percentage points, to a value <53%, at V4. GLS measured at V1 and V2 was significantly lower in the cardiotoxicity group vs. the controls (P = 0.042 and P = 0.01, respectively). Compared with GLS at V1, GLS obtained at V2 provided incremental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver-operating-characteristic curve, 0.82). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95% confidence interval 33-100) and 97% (95% confidence interval 94-100), respectively. Conclusion GLS greater than -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is an independent predictor of future anthracycline-induced cardiotoxicity. These findings should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.
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Affiliation(s)
- Clément Charbonnel
- Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Raphaele Convers-Domart
- Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Sophie Rigaudeau
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Anne Laure Taksin
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Nicolas Baron
- Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Juliette Lambert
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Stéphanie Ghez
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Jean-Louis Georges
- Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Hassan Farhat
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Jérôme Lambert
- Department of Biostatistics, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Philippe Rousselot
- Department of Hematology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
| | - Bernard Livarek
- Department of Cardiology, Versailles Hospital, 177 rue de Versailles, 78150 Le Chesnay, France
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Plana JC. Cardio-Oncology. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Paraskevaidis IA, Makavos G, Tsirigotis P, Psarogiannakopoulos P, Parissis J, Gkirkas K, Pessach I, Ikonomidis I. Deformation Analysis of Myocardial Layers Detects Early Cardiac Dysfunction after Chemotherapy in Bone Marrow Transplantation Patients: A Continuous and Additive Cardiotoxicity Process. J Am Soc Echocardiogr 2017; 30:1091-1102. [DOI: 10.1016/j.echo.2017.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 01/09/2023]
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Abstract
Modern advanced imaging techniques have allowed increasingly more rigorous assessment of the cardiac structure and function of several types of cardiomyopathies. In contemporary cardiology practice, echocardiography and cardiac magnetic resonance imaging are widely used to provide a basic framework in the evaluation and management of cardiomyopathies. Echocardiography is the quintessential imaging technique owing to its unique ability to provide real-time images of the beating heart with good temporal resolution, combined with its noninvasive nature, cost-effectiveness, availability, and portability. Cardiac magnetic resonance imaging provides data that are both complementary and uniquely distinct, thus allowing for insights into the disease process that until recently were not possible. The new catchphrase in the evaluation of cardiomyopathies is multimodality imaging, which is purported to be the efficient integration of various methods of cardiovascular imaging to improve the ability to diagnose, guide therapy, or predict outcomes. It usually involves an integrated approach to the use of echocardiography and cardiac magnetic resonance imaging for the assessment of cardiomyopathies, and, on occasion, single-photon emission computed tomography and such specialized techniques as pyrophosphate scanning.
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Affiliation(s)
- M Fuad Jan
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
| | - A Jamil Tajik
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
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Long-term systolic function in children and young adults after hematopoietic stem cell transplant. Bone Marrow Transplant 2017; 52:1443-1447. [PMID: 28714947 DOI: 10.1038/bmt.2017.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023]
Abstract
Congestive heart failure and subclinical left ventricular systolic dysfunction (LVSD) affect long-term survivors of hematopoietic stem cell transplant (HSCT). Echocardiographic measurements of global longitudinal and circumferential strain have shown promise in identifying subclinical LVSD in cancer survivors. We analyzed echocardiograms in 95 children and young adults with malignancies or bone marrow failure syndromes performed before HSCT and 1-6 years after HSCT. We additionally measured the biomarkers soluble suppression of tumorigenicity-2 (sST-2) and cardiac troponin-I (cTn-I) in the same children through 49 days post HSCT. Ejection fraction (EF) after HSCT was unchanged from baseline (baseline: z-score -0.73 vs long-term follow up: -0.44, P=0.11). Global longitudinal strain was unchanged from baseline (-20.66 vs -20.74%, P=0.90) as was global circumferential strain (-24.3 vs -23.5%, P=0.32). Levels of sST-2 were elevated at all time points compared with baseline samples and cTn-I was elevated at days 14 and 28. Cardiac biomarkers at any time point did not correlate with long-term follow-up EF. In children and young adult survivors of HSCT, EF was unchanged in the first years after HSCT. Elevation in cardiac biomarkers occurring after HSCT suggest subclinical cardiac injury occurs in many patients and long-term monitoring for LVSD should continue.
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Anwar S, Negishi K, Borowszki A, Gladding P, Popović ZB, Erenberg F, Thomas JD. Comparison of two-dimensional strain analysis using vendor-independent and vendor-specific software in adult and pediatric patients. JRSM Cardiovasc Dis 2017; 6:2048004017712862. [PMID: 28660071 PMCID: PMC5477995 DOI: 10.1177/2048004017712862] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/08/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Two-dimensional strain analysis is a powerful analysis modality, however, clinical utilization has been limited by variability between different analysis systems and operators. We compared strain in adults and children using vendor-specific and vendor-independent software to evaluate variability. METHODS One hundred and ten subjects (50/110 pediatric, 80/110 normal left ventricular function) had echocardiograms with a General Electric ultrasound scanner between September 2010 and January 2012. Left ventricular longitudinal strain was derived with EchoPAC (General Electric, v10.8.1), a vendor-specific software, and Velocity Vector Imaging (Siemens, v3.5), which is vendor-independent. Three independent readers analyzed all the echocardiograms yielding 330 datasets. RESULTS Mean left ventricular global longitudinal Lagrangian strain was -18.1 ± SD 4.4% for EchoPAC and -15.3 ± SD 4.1% for Velocity Vector Imaging. Velocity Vector Imaging yielded lower absolute global longitudinal Lagrangian strain by mean 2.9 (±SD 2.7, p < 0.0001), and lower regional longitudinal strain. These differences persisted in normal subjects versus those with cardiomyopathy. Longitudinal strain differences were slightly higher in the pediatric cohort. There was no significant difference in inter-observer longitudinal strain and a small difference in intra-observer strain between analysis systems. On repeat measurements, a significant change in global longitudinal Lagrangian strain occurred after the difference exceeded 3-5 strain points for EchoPAC and Velocity Vector Imaging, respectively. CONCLUSION Velocity Vector Imaging produces lower left ventricular longitudinal strain values versus EchoPAC for the same echo images. Both systems have similar inter-observer variability, Velocity Vector Imaging slightly higher intra-observer variability. A statistically significant change in global longitudinal Lagrangian strain occurs with changes >3-5 strain points on repeat measurements. Strain values between the systems are not interchangeable.
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Affiliation(s)
- Shafkat Anwar
- Division of Pediatric Cardiology, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - Kazuaki Negishi
- Division of Cardiovascular Medicine, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - Allen Borowszki
- Division of Cardiovascular Medicine, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Gladding
- Division of Cardiovascular Medicine, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - Zoran B Popović
- Division of Cardiovascular Medicine, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - Francine Erenberg
- Division of Pediatric Cardiology, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
| | - James D Thomas
- Division of Cardiovascular Medicine, Heart and Vascular Institute. Cleveland Clinic, Cleveland, OH, USA
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Garcia R, Rehman M, Goujeau C, Degand B, Le Gal F, Stordeur B, Labarre Q, Christiaens L, Bouleti C. Left ventricular longitudinal strain impairment predicts cardiovascular events in asymptomatic type 1 myotonic dystrophy. Int J Cardiol 2017; 243:424-430. [PMID: 28550978 DOI: 10.1016/j.ijcard.2017.05.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Type 1 myotonic dystrophy (DM1) patients' prognosis is very poor. Up until now, only a few prognostic factors for cardiovascular events have been identified, and they are predictive of end-stage disease. The aim was to assess the prognostic value of global longitudinal strain (GLS) for cardiovascular events in asymptomatic DM1 patients. METHODS DM1 patients were included between 2011 and 2015 and followed up until January 2016. Patients underwent a transthoracic echocardiography at inclusion. The primary endpoint was a composite of all-cause mortality, type 2 Mobitz 2 and type 3 atrioventricular block, symptomatic sino-atrial block, HV interval≥70ms at invasive electrophysiology exploration, left ventricular ejection fraction (LVEF) ≤45% and newly developed atrial fibrillation. RESULTS Forty-six patients (25 males, mean age 40years old) were included. The primary outcome was reached in 14 patients with a mean follow-up of 38months. GLS of patients who reached the primary endpoint was significantly impaired as compared to those who did not (-15.1 [-16.7; -12.7] vs. -18.2 [-19.2; -16.7] respectively; P=0.001). According to ROC curve analysis, probability of primary outcome occurrence was significantly greater in patients with GLS values≥-17.2% (P=0.001). On multivariate analysis, PR electrocardiogram interval and GLS remained significantly and independently associated with the primary endpoint [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.04, P=0.006 for PR interval; HR 1.4, 95% CI 1.1-1.7, P=0.002 for GLS] while LVEF alone was not. CONCLUSION Left ventricular GLS is a powerful marker to predict cardiovascular events in asymptomatic DM1 patients, independently of LVEF.
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Affiliation(s)
- Rodrigue Garcia
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Michaela Rehman
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Cyril Goujeau
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Bruno Degand
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - François Le Gal
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Benjamin Stordeur
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Quentin Labarre
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Luc Christiaens
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France
| | - Claire Bouleti
- Assistance Publique-Hôpitaux de Paris, Hopital Bichat, Service de Cardiologie, F-75018 Paris, France
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48
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Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6582568. [PMID: 28466016 PMCID: PMC5390591 DOI: 10.1155/2017/6582568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/19/2017] [Indexed: 12/31/2022]
Abstract
By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV) global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE) on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r = 0.27, p = 0.083). Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.
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49
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Garcia R, Labarre Q, Degand B, Ingrand P, Le Gal F, Bonnet B, Delaubier A, Guillou C, Gellen B, Coisne D, Bouleti C, Christiaens L. Apical left ventricular myocardial dysfunction is an early feature of cardiac involvement in myotonic dystrophy type 1. Echocardiography 2017; 34:184-190. [PMID: 28191665 DOI: 10.1111/echo.13426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early-stage LV impairment may be useful. The aim of this study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls. METHODS This prospective single-center study included 33 consecutive DM1 patients between February 2014 and February 2015. Mean age was 38.2±12.9 years, and 17 (52%) were males. Exclusion criteria were LVEF <55%, QRS >120 milliseconds, history of atrial fibrillation, and presence of a pacemaker with ventricular pacing. DM1 patients were matched to healthy controls according to sex and age. RESULTS DM1 patients showed significant impairment of global longitudinal strain (GLS) as compared to controls (-18.0±1.9 vs -19.1±2.4; P=.03), characterized by a marked alteration at the apex (-20.0±3.3 vs -22.7±3.1; P<.001). DM1 patients had also global radial strain impairment (20.0±9.8 vs 27.5±14.9; P=.024) compared to controls while global circumferential strain was not statistically different between groups (P=.94). Intra- and inter-observer analysis showed good reproducibility of GLS. CONCLUSION Despite preserved LVEF, DM1 patients exhibited significantly altered LV GLS, particularly at the apex, as compared with controls. The detection of impaired myocardial deformation at early stages of the disease might help to screen high-risk patients who need closer follow-up.
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Affiliation(s)
| | | | - Bruno Degand
- Cardiology Service, CHU Poitiers, Poitiers, France
| | - Pierre Ingrand
- University of Medicine and Pharmacy, Poitiers University, Poitiers, France
| | | | | | - Anne Delaubier
- Rehabilitation Department, CHU Poitiers, Poitiers, France
| | - Claire Guillou
- Rehabilitation Department, CHU Poitiers, Poitiers, France
| | | | | | - Claire Bouleti
- Cardiology Department, Assistance Publique des Hopitaux de Paris, Hôpital Bichat Service de Cardiologie, Paris, France
| | - Luc Christiaens
- Cardiology Service, CHU Poitiers, Poitiers, France.,University of Medicine and Pharmacy, Poitiers University, Poitiers, France
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50
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Kim AS, Bergmann SR. Anthracycline-induced cardiomyopathy: The search continues. J Nucl Cardiol 2017; 24:265-267. [PMID: 26645603 DOI: 10.1007/s12350-015-0352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Agnes S Kim
- Department of Medicine, The Pat and Jim Calhoun Cardiology Center, Farmington, CT, 06032, USA
| | - Steven R Bergmann
- Department of Medicine, The Pat and Jim Calhoun Cardiology Center, Farmington, CT, 06032, USA.
- Department of Diagnostic Imaging and Therapeutics, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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