1
|
Sousa Silva M, Lima Rocha CH, Aguiar Dos Santos A, da Silva MTB. Moderately intense physical exercise alleviates electrocardiographic changes induced by cisplatin in rats. Rev Port Cardiol 2024:S0870-2551(24)00222-1. [PMID: 38992427 DOI: 10.1016/j.repc.2024.03.006] [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: 08/31/2023] [Revised: 01/23/2024] [Accepted: 03/29/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION AND OBJECTIVE Cisplatin induces many collateral effects such as gastrointestinal disorders, nephrotoxicity, and dysautonomia. Recently our group showed that cisplatin treatment induces gastric emptying delay and that physical exercise and treatment with pyridostigmine prevent this change. In the current study, we investigated the role of moderate exercise on cardiac activity and autonomic balance in rats treated with cisplatin. METHODS Male Wistar rats were divided into saline, cisplatin, exercise, and exercise+cisplatin groups. Cardiac and autonomic disorders were induced by (cisplatin - 3 mg/kg, i.p. once a week/per 5 weeks). Exercise consists of swimming (1 hour per day/5× day per week/per 5 weeks without overload). Forty-eight hours after the last session of the training or treatment, we assessed the cardiac activity and HRV via electrocardiogram analysis in DII derivation. RESULTS Cisplatin increase (p<0.05) R-R' interval and decrease (p<0.05) heart rate vs. saline. Exercise+cisplatin prevented (p<0.05) changes in R-R' interval. Exercise per se induced bradycardia vs. saline group. We observed an increase in LF (nu) and a decrease in HF (nu) in the cisplatin group vs. saline. These changes were not significant. Moreover, cisplatin treatment increased (p<0.05) QT, QTc, and JT intervals compared with the saline group. In the exercise+cisplatin groups these increases were prevented significantly (p<0.05). CONCLUSION In the current study, chronic use of cisplatin induced electrocardiographic changes without altering autonomic balance. Moderate physical exercise prevented this phenomenon indicating that exercise can be beneficial in patients in chemotherapy.
Collapse
Affiliation(s)
- Mariana Sousa Silva
- Graduate Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Exercise and Gastrointestinal Tract - Department of Physical Education, Federal University of Piauí, Teresina, PI, Brazil
| | - Cláudio Henrique Lima Rocha
- Oncoclinics and Oncology Sector at the University Hospital, Federal University of Piauí, Teresina, PI, Brazil
| | - Arménio Aguiar Dos Santos
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Moisés Tolentino Bento da Silva
- Graduate Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Exercise and Gastrointestinal Tract - Department of Physical Education, Federal University of Piauí, Teresina, PI, Brazil; Laboratory of Physiology, Department of Immuno-Physiology and Pharmacology, School of Medicine and Biomedical Sciences, Institute of the Biomedical Science Abel Salazar, ICBAS, Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Porto, Portugal.
| |
Collapse
|
2
|
Albsheer K, Fadul A, Khalafalla A, Abdalla EM, Al-Dubai H. Cytarabine-Induced Bradycardia: A Case Report. Cureus 2022; 14:e30624. [PMID: 36426323 PMCID: PMC9681701 DOI: 10.7759/cureus.30624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/16/2023] Open
Abstract
Cardiotoxicity is damage to the heart muscle, which affects its function. Chemotherapy is known to cause cardiotoxicity along with many other medications and etiologies. Many chemotherapeutic cocktails are known to be associated with cardiotoxicities, such as taxane and cisplatin. Patients might have arrhythmias, severe bradycardia, cardiomyopathy, and even cardiac arrest, so precautions are taken when such medications are started. This report presents a patient who developed severe symptomatic bradycardia after receiving idarubicin and cytarabine and was managed conservatively, along with a literature review of this entity.
Collapse
Affiliation(s)
| | - Abdalla Fadul
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | | |
Collapse
|
3
|
Abstract
Cardiac remodelling is characterized by abnormal changes in the function and morphological properties such as diameter, mass, normal diameter of cavities, heart shape, fibrosis, thickening of vessels and heart layers, cardiomyopathy, infiltration of inflammatory cells, and some others. These damages are associated with damage to systolic and diastolic abnormalities, damage to ventricular function, and vascular remodelling, which may lead to heart failure and death. Exposure of the heart to radiation or anti-cancer drugs including chemotherapy drugs such as doxorubicin, receptor tyrosine kinase inhibitors (RTKIs) such as imatinib, and immune checkpoint inhibitors (ICIs) can induce several abnormal changes in the heart structure and function through the induction of inflammation and fibrosis, vascular remodelling, hypertrophy, and some others. This review aims to explain the basic mechanisms behind cardiac remodelling following cancer therapy by different anti-cancer modalities.
Collapse
|
4
|
Fonseca M, Cheng E, Do D, Haldar S, Kutty S, Yang EH, Ghosh AK, Guha A. Bradyarrhythmias in Cardio-Oncology. South Asian J Cancer 2021; 10:195-210. [PMID: 34966697 PMCID: PMC8710146 DOI: 10.1055/s-0041-1731907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The relationship between bradyarrhythmias and cancer therapies has not been well described but is increasingly recognized. There have been extensive advances in oncological pharmacotherapy, with several new classes of drugs available including targeted agents, immune checkpoint inhibitors and CAR T cell therapy. This increasing repertoire of available drugs has revolutionized overall prognosis and survival of cancer patients but the true extent of their cardiovascular toxicity is only beginning to be understood. Previous studies and published reviews have traditionally focused on conventional chemotherapies and in arrhythmias in general, particularly tachyarrhythmias. The number of patients with both cancer and cardiovascular problems is increasing globally and oncologists and cardiologists need to be adept at managing arrythmia based scenarios. Greater collaboration between the two specialties including studies with prospective data collection in Cardio-Oncology are much needed to fill in knowledge gaps in this arena. This case-based review summarizes current available evidence of cancer treatment-related bradyarrhythmia incidence (including its different subtypes), possible mechanisms and outcomes. Furthermore, we propose a stepwise surveillance and management protocol for patients with suspected bradyarrhythmia related to cancer treatment.
Collapse
Affiliation(s)
- Marta Fonseca
- Division of Cardiology, Cardiac-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital West Smithfield, London, United Kingdom.,Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom
| | - Evaline Cheng
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Duc Do
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Shouvik Haldar
- Division of Cardiology, Heart Rhythm Centre, The Royal Brompton and Harefield Hospitals, Guys & St Thomas' NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, The Johns Hopkins Hospital and Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Arjun K Ghosh
- Division of Cardiology, Cardiac-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital West Smithfield, London, United Kingdom.,Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, United States.,Division of Cardiology, Department of Medicine, Augusta University, Augusta, Georgia, United States.,Division of Cardiology-Oncology Program, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
5
|
Bin Naeem S, Azhar M, Baloch NU, Abbas M, Waheed M, Masood Sheikh R. Cisplatin-Induced Bradycardia: A Silent Risk Observed in Two Different Clinical Cases. Cureus 2021; 13:e19769. [PMID: 34950548 PMCID: PMC8686342 DOI: 10.7759/cureus.19769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
Cisplatin is a platinum-containing drug that inhibits DNA synthesis by inhibiting cross-linking, denaturing DNA strands. It is used in combination with other chemotherapeutic agents to treat several types of cancers. Numerous adverse effects have been reported with this compound. However, it is considered a safe medication in terms of cardiotoxicity. In this report, we discuss the case of two patients who experienced bradycardia while receiving cisplatin as part of combination therapy. A workup was undertaken to rule out other possible causes of bradycardia, and the diagnosis of cisplatin-induced bradycardia was made.
Collapse
Affiliation(s)
- Sameen Bin Naeem
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Musa Azhar
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Naqib Ullah Baloch
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mansoor Abbas
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Waheed
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Rizwan Masood Sheikh
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|
6
|
Sagcan F, Citak EC, Karpuz D, Alakaya M. A rare entity: Recurrent cisplatin-induced bradycardia. J Cancer Res Ther 2020; 16:699-700. [PMID: 32719297 DOI: 10.4103/jcrt.jcrt_26_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Fatih Sagcan
- Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Elvan Caglar Citak
- Department of Pediatric Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Karpuz
- Department of Pediatric Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care Unit, Mersin University Faculty of Medicine, Mersin, Turkey
| |
Collapse
|
7
|
Bang HJ, Lee HY, Kim HJ, Yoon N, Chung IJ, Bae WK. Cisplatin-induced Atrioventricular Block Requiring a Pacemaker: Two Case Reports and a Literature Review. Electrolyte Blood Press 2020; 18:49-52. [PMID: 33408748 PMCID: PMC7781763 DOI: 10.5049/ebp.2020.18.2.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/21/2022] Open
Abstract
Chemotherapeutic drugs can cause cardiac toxicities such as cardiomyopathy, arrhythmia, and cardiovascular disease. The well-known side effects of cisplatin are nephrotoxicity, nausea, vomiting, and electrolyte imbalance. Cardiotoxicity induced by cisplatin is rare, and its pathophysiology is unknown. Here, we present two cases of complete and high-degree atrioventricular (AV) block that occurred during cisplatin-based chemotherapy and required pacemaker placement. A 64-year-old woman and a 75-year-old man, who had no underlying heart disease, developed dyspnea without chest pain and bradycardia during cisplatin-based chemotherapy. However, there were no significant differences in their serum electrolyte levels, cardiac enzyme levels, and echocardiography results before and after drug administration. The ECGs were confirmed with complete AV block and high-degree AV block, which requiring pacemaker placement. We assume that cisplatin directly caused the complete, high-degree AV block, which required a pacemaker placement in our cases. In such cases, a cumulative dose of cisplatin over 240 mg/m2 is a risk factor for early symptoms of AV block. If patients complain of dyspnea without chest pain during cisplatin-based chemotherapy, arrhythmic complications should be considered. This information may be helpful for clinicians treating patients with cisplatin chemotherapy.
Collapse
Affiliation(s)
- Hyun-Jin Bang
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Ho Young Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Hyeon-Jong Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Namsik Yoon
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Ik-Joo Chung
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| |
Collapse
|
8
|
Oun R, Moussa YE, Wheate NJ. The side effects of platinum-based chemotherapy drugs: a review for chemists. Dalton Trans 2018; 47:6645-6653. [DOI: 10.1039/c8dt00838h] [Citation(s) in RCA: 706] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The platinum chemotherapy drugs cisplatin, carboplatin, and oxaliplatin are known to cause seven different types of side effects in patients.
Collapse
|
9
|
Oun R, Rowan E. Cisplatin induced arrhythmia; electrolyte imbalance or disturbance of the SA node? Eur J Pharmacol 2017; 811:125-128. [PMID: 28599874 DOI: 10.1016/j.ejphar.2017.05.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/23/2017] [Accepted: 05/31/2017] [Indexed: 12/31/2022]
Abstract
Since its approval in 1979 cisplatin has become one of the most extensively used chemotherapeutics in the clinic and although cell resistance and toxicity hinder its efficacy it continues to be a gold standard regimen. Cisplatin's side effects primarily include nephrotoxicity, gastrointestinal toxicity, neurotoxicity and ototoxicity. Cardiotoxicity is generally not defined as a side effect of cisplatin. However, over the past decade there has been a surge in the amount of clinical cases reporting a vast array of cardio-toxic events occurring during or shortly after cisplatin infusion, these range from angina to cardiac ischemia and chronic heart failure. This review intends to discuss the clinical cardiac manifestations of cisplatin specifically tachycardia and bradycardia which can be lethal and the possible mechanisms of action.
Collapse
Affiliation(s)
- Rabbab Oun
- University of Strathclyde, United Kingdom.
| | | |
Collapse
|
10
|
Herradón E, González C, Uranga JA, Abalo R, Martín MI, López-Miranda V. Characterization of Cardiovascular Alterations Induced by Different Chronic Cisplatin Treatments. Front Pharmacol 2017; 8:196. [PMID: 28533750 PMCID: PMC5420557 DOI: 10.3389/fphar.2017.00196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/24/2017] [Indexed: 01/17/2023] Open
Abstract
In the last years, many clinical studies have revealed that some cisplatin-treated cancer survivors have a significantly increased risk of cardiovascular events, being cisplatin-induced cardiovascular toxicity an increasing concern. The aim of the present work was to evaluate the cardiovascular alterations induced by different chronic cisplatin treatments, and to identify some of the mechanisms involved. Direct blood pressure, basal cardiac (left ventricle and coronary arteries) and vascular (aortic and mesenteric) functions were evaluated in chronic (5 weeks) saline- or cisplatin-treated male Wistar rats. Three different doses of cisplatin were tested (1, 2, and 3 mg/kg/week). Alterations in cardiac and vascular tissues were also investigated by immunohistochemistry, Western Blot, and or quantitative RT-PCR analysis. Cisplatin treatment provoked a significant modification of arterial blood pressure, heart rate, and basal cardiac function at the maximum dose tested. However, vascular endothelial dysfunction occurred at lower doses. The expression of collagen fibers and conexin-43 were increased in cardiac tissue in cisplatin-treated rats with doses of 2 and 3 mg/kg/week. The expression of endothelial nitric oxide synthase was also modified in cardiac and vascular tissues after cisplatin treatment. In conclusion, chronic cisplatin treatment provokes cardiac and vascular toxicity in a dose-dependent manner. Besides, vascular endothelial dysfunction occurs at lower doses than cardiac and systemic cardiovascular toxicity. Moreover, some structural changes in cardiac and vascular tissues are also patent even before any systemic cardiovascular alterations.
Collapse
Affiliation(s)
- Esperanza Herradón
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Cristina González
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - José A Uranga
- Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain.,Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain
| | - Raquel Abalo
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Ma I Martín
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| | - Visitacion López-Miranda
- Área de Histología Humana y Anatomía Patológica, Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan CarlosAlcorcón, Spain.,Unidad Asociada ICDCi del Instituto de Química Médica, Consejo Superior de Investigaciones CientíficasMadrid, Spain.,Grupo Interdisciplinar de Investigación en Dolor iCDol, Universidad Rey Juan Carlos-Banco de SantanderAlcorcón, Spain
| |
Collapse
|
11
|
Kounis NG, Cervellin G, Lippi G. Cisplatin-induced bradycardia: Cardiac toxicity or cardiac hypersensitivity and Kounis syndrome? Int J Cardiol 2015; 202:817-8. [PMID: 26476038 DOI: 10.1016/j.ijcard.2015.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, Patras, Achaia, Greece.
| | | | - Giuseppe Lippi
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|