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Shati AA, Eid RA, El-kott AF, Alqahtani YA, Shatoor AS, Ahmed Zaki MS. Curcumin attenuates doxorubicin-induced cardiotoxicity via suppressing oxidative Stress, preventing inflammation and apoptosis: Ultrastructural and computational approaches. Heliyon 2024; 10:e27164. [PMID: 38468941 PMCID: PMC10926088 DOI: 10.1016/j.heliyon.2024.e27164] [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] [Received: 06/12/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Currently, doxorubicin (DOX) is one of the medications commonly used in chemotherapy to treat different types of tumors.Nonetheless, despite being effective in multiple tumors, yet its use is limited owing to its cytotoxic effects, the therapeutic use of DOX has been limited. This work aimed to explore whether curcumin (CMN) can prevents DOX-induced cardiotoxicity in rats. Four groups of rats were created, with the first functioning as a control, while the second group received CMN. DOX alone was administered to the third group, whereas CMN and DOX were administered to the fourth group. Lipid peroxidation assessed as Malondialdehyde (MDA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), oxidative stress markers as catalase (CAT), superoxide dismutase (SOD), and inflammatory markers as tumor necrosis factor-alpha (TNF-α) in heart homogenates, each one was assessed. Heart specimens was investigated histologically and ultrastructurally. Increased, AST, and ALT serum levels, increased MDA levels, decreased SOD and CAT levels, and increased TNF-α concentrations in heart homogenates were all signs of DOX-induced myocardial injury. Histological and ultrastructural examinations revealed vacuoles and larger, swollen mitochondria in the cytoplasm. Furthermore, DOX caused significant changes in the myocardium, most notably nuclei disintegration, myofibrillar loss, and myocyte vacuolization. Using CMN with DOX reduced the harmful consequences of DOX on the myocardium by returning the increased AST and ALT levels to their original levels as compared to the control and reducing them. In cardiac tissue, CMN significantly increased the concentrations of SOD and CAT and significantly decreased the concentrations of MDA and TNF-α. Biochemical and histological studies have demonstrated that CMN has a heart-protective effect that might be related to its antioxidant and anti-inflammatory capabilities.
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Affiliation(s)
- Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Refaat A. Eid
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Attalla F. El-kott
- Department of Biology, College of Science, King Khalid University, Abha, 61421, Saudi Arabia
- Department of Zoology, College of Science, Damanhour University, Damanhour, 22511, Egypt
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdullah S. Shatoor
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohamed Samir Ahmed Zaki
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Department of Histology and Cell Biology, College of Medicine, Zagazig University, Zagazig, Egypt
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Hong YJ, Han K, Lee HJ, Hur J, Kim YJ, Kim MJ, Choi BW. Assessment of Feasibility and Interscan Variability of Short-time Cardiac MRI for Cardiotoxicity Evaluation in Breast Cancer. Radiol Cardiothorac Imaging 2024; 6:e220229. [PMID: 38329404 PMCID: PMC10912882 DOI: 10.1148/ryct.220229] [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: 10/12/2022] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024]
Abstract
Purpose To investigate the feasibility and interscan variability of short-time cardiac MRI protocol after chemotherapy in individuals with breast cancer. Materials and Methods A total of 13 healthy female controls (mean age, 52.4 years ± 13.2 [SD]) and 85 female participants with breast cancer (mean age, 51.8 years ± 9.9) undergoing chemotherapy prospectively underwent routine breast MRI and short-time cardiac MRI using a 3-T scanner with peripheral pulse gating in the prone position. Interscan, intercoil, and interobserver reproducibility and variability of native T1 and extracellular volume (ECV), as well as ventricular functional parameters, were measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), or coefficient of variation (CoV). Results Left ventricular functional parameters had excellent interscan reproducibility (ICC ≥ 0.80). Left ventricular ejection fraction showed low interscan variability in control and chemotherapy participants (SEM, 2.0 and 1.2; CoV, 3.1 and 1.9, respectively). Native T1 showed excellent interscan (ICC, 0.75) and intercoil (ICC, 0.81) reproducibility in the control group and good interscan reproducibility (ICC, 0.72 and 0.73, respectively) in the participants undergoing immediate and remote chemotherapy. Interscan reproducibility for ECV was excellent in the control group and in the remote chemotherapy group (ICC, 0.93 and 0.88, respectively) and fair in the immediate chemotherapy group (ICC, 0.52). In the regional analysis, interscan repeatability and variability of native T1 and ECV were superior in the anteroseptum or inferoseptum than in other segments in the immediate chemotherapy group. Native T1 and ECV had good to excellent interobserver agreement across all groups. Conclusion Short-time cardiac MRI showed excellent results for interscan, intercoil, and interobserver reproducibility and variability for ventricular functional or tissue characterization parameters, suggesting that this modality is feasible for routine surveillance of cardiotoxicity evaluation in individuals with breast cancer. Keywords: Cardiac MRI, Heart, Cardiomyopathy ClinicalTrials.gov registration no. NCT03301389 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yoo Jin Hong
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Kyunghwa Han
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Hye-Jeong Lee
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Jin Hur
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Young Jin Kim
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Min Jung Kim
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Byoung Wook Choi
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
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Čiburienė E, Aidietienė S, Ščerbickaitė G, Sadauskienė E, Sudavičienė D, Baltruškevičienė E, Brasiūnienė B, Drobnienė M, Čelutkienė J. Ivabradine for the Prevention of Anthracycline-Induced Cardiotoxicity in Female Patients with Primarily Breast Cancer: A Prospective, Randomized, Open-Label Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2140. [PMID: 38138243 PMCID: PMC10745010 DOI: 10.3390/medicina59122140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Cancer therapy containing anthracyclines is associated with cancer-treatment-related cardiac dysfunction and heart failure (HF). Conventional cardioprotective medications can be frequently complicated by their blood-pressure-lowering effect. Recently, elevated resting heart rate was shown to independently predict mortality in patients with cancer. As a heart rate-lowering drug without affecting blood pressure, ivabradine could present an alternative management of anthracyclines-induced cardiotoxicity. Materials and Methods: This study aimed to investigate the probable protective effects of ivabradine in cancer patients with elevated heart rate (>75 beats per minute) undergoing anthracycline chemotherapy. Patients referred by oncologists for baseline cardiovascular risk stratification before anthracycline chemotherapy who met the inclusion criteria and had no exclusion criteria were randomly assigned to one of two strategies: ivabradine 5 mg twice a day (intervention group) or controls. Electrocardiogram, transthoracic echocardiogram with global longitudinal strain (GLS), troponin I (Tn I), and N-terminal natriuretic pro-peptide (NT-proBNP) were performed at baseline, after two and four cycles of chemotherapy and at six months of follow-up. The primary endpoint was the prevention of a >15% reduction in GLS. Secondary endpoints were effects of ivabradine on Tn I, NT-proBNP, left ventricular (LV) systolic and diastolic dysfunction, right ventricle dysfunction, and myocardial work indices. Results: A total of 48 patients were enrolled in the study; 21 were randomly assigned to the ivabradine group and 27 to the control group. Reduced GLS was detected 2.9 times less often in patients receiving ivabradine than in the control group, but this change was non-significant (OR [95% CI] = 2.9 [0.544, 16.274], p = 0.208). The incidence of troponin I elevation was four times higher in the control group (OR [95% CI] = 4.0 [1.136, 14.085], p = 0.031). There was no significant change in NT-proBNP between groups, but the increase in NT-proBNP was almost 12% higher in the control group (OR [95% CI] = 1.117 [0.347, 3.594], p = 0.853). LV diastolic dysfunction was found 2.7 times more frequently in the controls (OR [95% CI] = 2.71 [0.49, 15.10], p = 0.254). Patients in the ivabradine group were less likely to be diagnosed with mild asymptomatic CTRCD during the study (p = 0.045). No differences in right ventricle function were noted. A significant difference was found between the groups in global constructive work and global work index at six months in favour of the ivabradine group (p = 0.014 and p = 0.025). Ivabradine had no adverse effects on intracardiac conduction, ventricular repolarization, or blood pressure. However, visual side effects (phosphenes) were reported in 14.3% of patients. Conclusions: Ivabradine is a safe, well-tolerated drug that has shown possible cardioprotective properties reducing the incidence of mild asymptomatic cancer-therapy-induced cardiac dysfunction, characterised by a new rise in troponin concentrations and diminished myocardial performance in anthracycline-treated women with breast cancer and increased heart rate. However, more extensive multicentre trials are needed to provide more robust evidence.
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Affiliation(s)
- Eglė Čiburienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
| | - Sigita Aidietienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
| | - Greta Ščerbickaitė
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
| | - Eglė Sadauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
| | - Diana Sudavičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
| | - Edita Baltruškevičienė
- Department of Medical Oncology, National Cancer Institute, 08406 Vilnius, Lithuania (M.D.)
| | - Birutė Brasiūnienė
- Department of Medical Oncology, National Cancer Institute, 08406 Vilnius, Lithuania (M.D.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Monika Drobnienė
- Department of Medical Oncology, National Cancer Institute, 08406 Vilnius, Lithuania (M.D.)
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Cardiology and Angiology, Vilnius University Hospital “Santaros Clinics”, 08661 Vilnius, Lithuania
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Azzam M, Wasef M, Khalaf H, Al-Habbaa A. 3D-based strain analysis and cardiotoxicity detection in cancer patients received chemotherapy. BMC Cancer 2023; 23:760. [PMID: 37587421 PMCID: PMC10428536 DOI: 10.1186/s12885-023-11261-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Chemotherapy-induced cardiotoxicity has become a prevalent complication. Regular monitoring of patients who received chemotherapy using 3D strain parameters may aid in early detection of myocardial damage and its prevention. The purpose of this study was to evaluate the effectiveness of three-dimensional speckle tracking imaging (3D-STI) in diagnosing and predicting the likelihood of cardiotoxicity. This was achieved by conducting a systematic review of original research articles. OBJECTIVES To evaluate the role of 3D speckle tracking echocardiography in early detection of cardiotoxicity. METHODS Relevant case control studies published prior to December 2022 were extracted to assess cardiotoxicity by 3D STE in patients after chemotherapy. RESULTS A total of 1991 chemotherapy treated patients and control patients were included in the present review via pooling 22 studies. CONCLUSIONS 3D speckle tracking echocardiography has the utility of non-invasive and objective evaluation of changes in left ventricular function in cancer patients undergoing chemotherapy. ROSPERO REGISTRATION NO Study ID, CRD42023383790 on PROSPERO: International prospective register of systematic reviews.
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Affiliation(s)
- Muhammad Azzam
- Cardiology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Hani Khalaf
- Cardiology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Al-Habbaa
- Cardiology department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Alexandraki A, Papageorgiou E, Zacharia M, Keramida K, Papakonstantinou A, Cipolla CM, Tsekoura D, Naka K, Mazzocco K, Mauri D, Tsiknakis M, Manikis GC, Marias K, Marcou Y, Kakouri E, Konstantinou I, Daniel M, Galazi M, Kampouroglou E, Ribnikar D, Brown C, Karanasiou G, Antoniades A, Fotiadis D, Filippatos G, Constantinidou A. New Insights in the Era of Clinical Biomarkers as Potential Predictors of Systemic Therapy-Induced Cardiotoxicity in Women with Breast Cancer: A Systematic Review. Cancers (Basel) 2023; 15:3290. [PMID: 37444400 PMCID: PMC10340234 DOI: 10.3390/cancers15133290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiotoxicity induced by breast cancer therapies is a potentially serious complication associated with the use of various breast cancer therapies. Prediction and better management of cardiotoxicity in patients receiving chemotherapy is of critical importance. However, the management of cancer therapy-related cardiac dysfunction (CTRCD) lacks clinical evidence and is based on limited clinical studies. AIM To provide an overview of existing and potentially novel biomarkers that possess a promising predictive value for the early and late onset of CTRCD in the clinical setting. METHODS A systematic review of published studies searching for promising biomarkers for the prediction of CTRCD in patients with breast cancer was undertaken according to PRISMA guidelines. A search strategy was performed using PubMed, Google Scholar, and Scopus for the period 2013-2023. All subjects were >18 years old, diagnosed with breast cancer, and received breast cancer therapies. RESULTS The most promising biomarkers that can be used for the development of an alternative risk cardiac stratification plan for the prediction and/or early detection of CTRCD in patients with breast cancer were identified. CONCLUSIONS We highlighted the new insights associated with the use of currently available biomarkers as a standard of care for the management of CTRCD and identified potentially novel clinical biomarkers that could be further investigated as promising predictors of CTRCD.
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Affiliation(s)
- Alexia Alexandraki
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Elisavet Papageorgiou
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Marina Zacharia
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Kalliopi Keramida
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Cardiology Department, General Anti-Cancer Oncological Hospital, Agios Savvas, 11522 Athens, Greece
| | - Andri Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institute, 17176 Stockholm, Sweden;
- Department for Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Carlo M. Cipolla
- Cardioncology and Second Opinion Division, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Dorothea Tsekoura
- 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece; (D.T.); (E.K.)
| | - Katerina Naka
- 2nd Cardiology Department, University of Ioannina Medical School, 45110 Ioannina, Greece;
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20139 Milan, Italy;
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Davide Mauri
- Department of Medical Oncology, University of Ioannina, 45110 Ioannina, Greece;
| | - Manolis Tsiknakis
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece; (M.T.); (K.M.)
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Georgios C. Manikis
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Kostas Marias
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece; (M.T.); (K.M.)
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Yiola Marcou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Eleni Kakouri
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Ifigenia Konstantinou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Maria Daniel
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus;
| | - Myria Galazi
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Effrosyni Kampouroglou
- 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece; (D.T.); (E.K.)
| | - Domen Ribnikar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia;
| | - Cameron Brown
- Translational Medicine, Stremble Ventures Ltd., 59 Christaki Kranou, Limassol 4042, Cyprus;
| | - Georgia Karanasiou
- Biomedical Research Institute, Foundation for Research and Technology, Hellas, 45500 Ioannina, Greece;
| | - Athos Antoniades
- Research and Development, Stremble Ventures Ltd., 59 Christaki Kranou, Limassol 4042, Cyprus;
| | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Gerasimos Filippatos
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, National and Kapodistrian University of Athens Medical School, Athens University Hospital Attikon, 11527 Athens, Greece;
| | - Anastasia Constantinidou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
- School of Medicine, University of Cyprus, Panepistimiou 1, Aglantzia, Nicosia 2408, Cyprus
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Chen J, Cheng C, Fan L, Xu X, Chen J, Feng Y, Tang Y, Yang C. Assessment of left heart dysfunction to predict doxorubicin cardiotoxicity in children with lymphoma. Front Pediatr 2023; 11:1163664. [PMID: 37215605 PMCID: PMC10196234 DOI: 10.3389/fped.2023.1163664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives The objectives of this study were to assess the changes in the left myocardial function after chemotherapy for childhood lymphoma and observe the predictive or monitor value for cancer treatment-related cardiac dysfunction (CTRCD) by speckle-tracking echocardiography. Methods A total of 23 children with histopathological diagnoses of lymphoma were included, with age-matched normal controls. Comparative analysis of clinical serological tests and left heart strain parameters in children with lymphoma, including left ventricular global longitudinal strain (LVGLS); global myocardial work (GMW) indices, which include global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency; and the LS of subendocardial, middle, and subepicardial layer myocardium during left ventricular systole were measured: left atrial strain of reservoir phase (LASr), left atrial strain of conduit phase (LAScd), and left atrial strain of contraction phase (LASct). Results One-way ANOVA showed that GLS, GWI, GCW, LASr, and LAScd were closely associated with CTRCD and multivariate logistic regression analysis showed that GLS was the most sensitive predictor for detecting patients at lofty risk of anthracycline-related cardiotoxicity. Both before and after chemotherapy, GLS in the left ventricle showed a pattern of basal segment < middle segment < apical segment and subepicardial < middle < subendocardial layer (p < 0.05), and the degree of decrease also showed a regular pattern of epicardial layer < middle layer < subendocardial layer while the difference was not significant (p > 0.05). After chemotherapy, maximum flow rate in early mitral relaxation/left atrial systolic maximum flow rate (E/A) and left atrial volume index of each group were in the normal range, and the values of LASr, LAScd, and LASct slightly increased in the second cycle and decreased significantly in the fourth cycle after chemotherapy, reaching the lowest level; LASr and LAScd were positively correlated with GLS. Conclusion LVGLS is a more sensitive and earlier indicator to predict CTRCD compared with conventional echocardiography-related parameters and serological markers, and GLS of each myocardial layer showed a certain regularity. Left atrial strain can be used for early monitoring of cardiotoxicity in children with lymphoma after chemotherapy.
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Affiliation(s)
- Jiaqi Chen
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Chunyue Cheng
- Department of Ultrasound, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Fan
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xiaochuan Xu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jing Chen
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yang Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yi Tang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Chunjiang Yang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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7
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El-Sherbeny WS, Sabry NM, El-Saied SB, Elnagar B. Detection of right ventricular dysfunction by three - dimensional echocardiography and two - dimensional speckle tracking in breast cancer patients receiving anthracycline- based chemotherapy. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:20. [PMID: 37024988 PMCID: PMC10077607 DOI: 10.1186/s40959-023-00169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Despite the cardiotoxic effect of anthracycline on the left ventricle (LV) was totally identified. The assessment of the anthracycline effect on the right ventricle(RV) by conventional echocardiography was a challenge due to its complex geometry. We aimed to evaluate the impact of anthracycline on the RV volume and function using 3 dimensional -echocardiography (3DE) and 2 dimensional -speckle tracking echocardiography (2D-STE) in patients with breast cancer. METHODS This prospective study was conducted on 66 female patients with breast cancer receiving anthracycline chemotherapy, in addition to full echocardiography, 2D-STE and 3DE evaluation of RV function and volume were done at baseline, after 4th cycle of chemotherapy, six and nine months after the end of chemotherapy. RESULTS Cardiotoxicity from anthracycline occurred in 18 patients whose LV ejection fraction became significantly reduced after 9 months of therapy according to that, the patients were divided into the non-cardiotoxic group (n:48) and the cardiotoxic group (n:18). At cardiotoxic group, 3D RV end-systolic volume, and 3D RV end-diastolic volume increased significantly at 6 months and continued till 9 months after the therapy end compared to baseline values (42.50 ± 5.98 vs. 50.44 ± 7.01, p = 0.005) and (86.78 ± 9.16 vs. 95.78 ± 9.23, p = 0.021).LV global longitudinal strain (GLS) showed a significant reduction early after 6 months of therapy, 2D GLS and free wall longitudinal strain (FWLS) of RV were significantly decreased at 6 months and continued till 9 months after therapy (-22.54 ± 0.79 vs. -19.53 ± 1.32, p = 0.001) and (-24.67 ± 1.27vs. -22.22 ± 1.41, p = 0.001) respectively. The variation of RV FWLS was a predictor of cardiotoxicity, the relative drop of RV FWLS > 19.3% had 83% sensitivity and 71% specificity, (AUC = 0.82) to identify patients who developed cardiotoxicity. CONCLUSION 3DE is a promising modality in recognizing the early changes in RV volumes and minute alteration in RV function and 2D-STE is a reliable predictor of RV systolic dysfunction which identify the subclinical affliction.
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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
| | - Shaimaa B El-Saied
- Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Basma Elnagar
- Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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8
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Oikawa M, Ishida T, Takeishi Y. Cancer therapeutics-related cardiovascular dysfunction: Basic mechanisms and clinical manifestation. J Cardiol 2023; 81:253-259. [PMID: 35589463 DOI: 10.1016/j.jjcc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
Although recent advances in cancer treatment improve cancer prognosis, cancer therapeutics-related cardiovascular dysfunction (CTRCD) significantly contributes to the global burden of cardiovascular disease. CTRCD causes two crucial issues: first, premature treatment interruption or discontinuation of chemotherapy; second, the development of congestive heart failure during and after cancer treatment. Thus, early detection and prompt treatment of CTRCD may improve the prognosis in cancer patients. This review covers representative anticancer drugs, including anthracyclines, human epidermal growth factor 2 inhibitors, tyrosine kinase inhibitors, proteasome inhibitors, and immune checkpoint inhibitors. We focus on the molecular mechanisms of CTRCD and various approaches to diagnosis, prevention, monitoring, and treatment.
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Affiliation(s)
- Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima prefecture 960-1295, Japan.
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima prefecture 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1-Hikarigaoka, Fukushima, Fukushima prefecture 960-1295, Japan
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9
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Hegazy M, Ghaleb S, Das BB. Diagnosis and Management of Cancer Treatment-Related Cardiac Dysfunction and Heart Failure in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010149. [PMID: 36670699 PMCID: PMC9856743 DOI: 10.3390/children10010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
It is disheartening for parents to discover that their children have long-term cardiac dysfunction after being cured of life-threatening childhood cancers. As the number of childhood cancer survivors increases, early and late oncology-therapy-related cardiovascular complications continues to rise. It is essential to understand that cardiotoxicity in childhood cancer survivors is persistent and progressive. A child's cancer experience extends throughout his lifetime, and ongoing care for long-term survivors is recognized as an essential part of the cancer care continuum. Initially, there was a lack of recognition of late cardiotoxicities related to cancer therapy. About 38 years ago, in 1984, pioneers like Dr. Lipshultz and others published anecdotal case reports of late cardiotoxicities in children and adolescents exposed to chemotherapy, including some who ended up with heart transplantation. At that time, cardiac tests for cancer survivors were denied by insurance companies because they did not meet appropriate use criteria. Since then, cardio-oncology has been an emerging field of cardiology that focuses on the early detection of cancer therapy-related cardiac dysfunction occurring during and after oncological treatment. The passionate pursuit of many healthcare professionals to make life better for childhood cancer survivors led to more than 10,000 peer-reviewed publications in the last 40 years. We synthesized the existing evidence-based practice and described our experiences in this review to share our current method of surveillance and management of cardiac dysfunction related to cancer therapy. This review aims to discuss the pathological basis of cancer therapy-related cardiac dysfunction and heart failure, how to stratify patients prone to cardiotoxicity by identifying modifiable risk factors, early detection of cardiac dysfunction, and prevention and management of heart failure during and after cancer therapy in children. We emphasize serial longitudinal follow-ups of childhood cancer survivors and targeted intervention for high-risk patients. We describe our experience with the new paradigm of cardio-oncology care, and collaboration between cardiologist and oncologist is needed to maximize cancer survival while minimizing late cardiotoxicity.
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Affiliation(s)
- Mohamed Hegazy
- University of Mississippi Medical Center Program, Jackson, MS 39216, USA
| | - Stephanie Ghaleb
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Bibhuti B Das
- Division of Pediatric Cardiology, Department of Pediatrics, McLane Children’s Baylor Scott and White Medical Center, Baylor College of Medicine-Temple, Temple, TX 76502, USA
- Correspondence: ; Tel.: +1-254-935-4980
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10
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Normative healthy reference values for global and segmental 3D principal and geometry dependent strain from cine cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:115-134. [PMID: 36598686 DOI: 10.1007/s10554-022-02693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 01/07/2023]
Abstract
3-Dimensional (3D) myocardial deformation analysis (3D-MDA) enables novel descriptions of geometry-independent principal strain (PS). Applied to routine 2D cine cardiovascular magnetic resonance (CMR), this provides unique measures of myocardial biomechanics for disease diagnosis and prognostication. However, healthy reference values remain undefined. This study describes age- and sex-stratified reference values from CMR-based 3D-MDA, including 3D PS. One hundred healthy volunteers were prospectively recruited following institutional ethics approval and underwent CMR imaging. 3D-MDA was performed using validated software. Age- and sex-stratified global and segmental strain measures were derived for conventional geometry-dependent [circumferential (CS), longitudinal (LS), and radial (RS)] and geometry-independent [minimum (minPS) and maximum principal (maxPS)] directions of deformation. Layer-specific contraction angle interactions were determined using local minPS vectors. The average age was 43 ± 15 years and 55% were women. Strain measures were higher in women versus men. 3D PS-based assessment of maximum tissue shortening (minPS) and maximum tissue thickening (maxPS) were greater than corresponding geometry-dependent markers of LS and RS, consistent with improved representation of local tissue deformations. Global maxPS amplitude best discriminated both age and sex. Segmental analyses showed greater strain amplitudes in apical segments. Transmural PS contraction angles were higher in females and showed a heterogeneous distribution across segments. In this study we provided age and sex-based reference values for 3D strain from CMR imaging, demonstrating improved capacity for 3D PS to document maximal local tissue deformations and to discriminate age and sex phenotypes. Novel markers of layer-specific strain angles from 3D PS were also described.
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11
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The Role of Multimodality Cardiac Imaging in Patients Undergoing Cancer Treatment. Curr Cardiol Rep 2023; 25:1-8. [PMID: 36527535 DOI: 10.1007/s11886-022-01825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Modern therapeutics have led to improved survival for many types of cancer but have also been associated with adverse effects including potentially life-threatening cardiotoxicities. We sought to review the uses of multimodality cardiac imaging for risk stratification, prevention, and identification of cardiotoxicities in patients undergoing cancer treatment. RECENT FINDINGS Advancements in both echocardiography and emerging modalities, like cardiac magnetic resonance imaging and cardiac computed tomography, continue to improve the pre- and during therapy cardiac evaluation of cancer patients. Echocardiography and cardiac magnetic resonance imaging, with the incorporation of global longitudinal strain, can identify overt and subclinical cancer therapy-related cardiac dysfunction and myocarditis, and stress echocardiography and cardiac computed tomography can noninvasively screen and monitor for coronary artery disease. Multimodality cardiac imaging is an evolving and critical tool for the pre-therapy screening and risk stratification, as well as during therapy surveillance of cancer treatment-related cardiotoxicity.
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12
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Ibrahim ESH, Sosa A, Brown SA, An D, Klawikowski S, Baker J, Bergom C. Myocardial Contractility Pattern Characterization in Radiation-Induced Cardiotoxicity Using Magnetic Resonance Imaging: A Pilot Study with ContractiX. Tomography 2022; 9:36-49. [PMID: 36648991 PMCID: PMC9844312 DOI: 10.3390/tomography9010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation therapy (RT) plays an integral role in treating thoracic cancers, despite the risk of radiation-induced cardiotoxicity. We hypothesize that our newly developed magnetic resonance imaging (MRI)-based contractility index (ContractiX) is a sensitive marker for early detection of RT-induced cardiotoxicity in a preclinical rat model of thoracic cancer RT. Adult salt-sensitive rats received image-guided heart RT and were imaged with MRI at 8 weeks and 10 weeks post-RT or sham. The MRI exam included cine and tagging sequences to measure left-ventricular ejection fraction (LVEF), mass, myocardial strain, and ContractiX. Furthermore, ventricular torsion, diastolic strain rate, and mechanical dyssynchrony were measured. Statistical analyses were performed between the sham, 8 weeks post-RT, and 10 weeks post-RT MRI parameters. The results showed that both LVEF and myocardial mass increased post-RT. Peak systolic strain and ContractiX significantly decreased post-RT, with a more relative reduction in ContractiX compared to strain. ContractiX showed an inverse nonlinear relationship with LVEF and continuously decreased with time post-RT. While early diastolic strain rate and mechanical dyssynchrony significantly changed post-RT, ventricular torsion changes were not significant post-RT. In conclusion, ContractiX measured via non-contrast MRI is a sensitive early marker for the detection of subclinical cardiac dysfunction post-RT, and it is superior to other MRI cardiac measures.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
- Correspondence:
| | - Antonio Sosa
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Sherry-Ann Brown
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Dayeong An
- Department of Biomedical Engineering, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA
| | - Slade Klawikowski
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - John Baker
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University, 1 Brookings Dr, St. Louis, MO 63130, USA
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 734] [Impact Index Per Article: 367.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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14
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Trifunović-Zamaklar D, Jovanović I, Vratonjić J, Petrović O, Paunović I, Tešić M, Boričić-Kostić M, Ivanović B. The basic heart anatomy and physiology from the cardiologist's perspective: Toward a better understanding of left ventricular mechanics, systolic, and diastolic function. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1026-1040. [PMID: 36218206 DOI: 10.1002/jcu.23316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/16/2023]
Abstract
A comprehensive understanding of the cardiac structure-function relationship is essential for proper clinical cardiac imaging. This review summarizes the basic heart anatomy and physiology from the perspective of a heart imager focused on myocardial mechanics. The main issues analyzed are the left ventricular (LV) architecture, the LV myocardial deformation through the cardiac cycle, the LV diastolic function basic parameters and the basic parameters of the LV deformation used in clinical practice for the LV function assessment.
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Affiliation(s)
- Danijela Trifunović-Zamaklar
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Jovanović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Vratonjić
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Petrović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Paunović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milorad Tešić
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Branislava Ivanović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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15
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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16
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Gálvez LC, Redondo EA, Lorenzo CC, Fernández TL. Advanced Echocardiographic Techniques in Cardio-Oncology: the Role for Early Detection of Cardiotoxicity. Curr Cardiol Rep 2022; 24:1109-1116. [PMID: 35881319 DOI: 10.1007/s11886-022-01728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Implementation of advanced echocardiographic techniques in cardio-oncology is a growing need as they are the cornerstone of early detection of cancer therapy-related cardiovascular toxicity (CTR-CVT). RECENT FINDINGS Three-dimensional echocardiography and myocardial deformation techniques have shown more accuracy and reproducibility than classic 2D measurements in detecting cardiovascular adverse effects in patients undergoing anticancer therapies. Application of advanced echo techniques to daily monitoring of patients with cancer helps to identify those at risk of developing CTR-CVT during and after cancer treatment. Furthermore, advanced echo parameters improve early initiation of cardioprotective treatments in order to minimize cardiovascular events and cancer treatment interruption.
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Affiliation(s)
- Lucía Cobarro Gálvez
- Cardiology Department, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Emilio Arbas Redondo
- Cardiology Department, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Teresa López Fernández
- Cardio-Oncology Unit, La Paz University Hospital, Paseo de La Castellana, Cardiology Department, 261, 28046, Madrid, Spain
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17
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Chaganti BT, Negishi K, Okajima K. Role of Myocardial Strain Imaging in Cancer Therapy-Related Cardiac Dysfunction. Curr Cardiol Rep 2022; 24:739-748. [PMID: 35522421 DOI: 10.1007/s11886-022-01692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This review aims to provide a contemporary perspective on the role of myocardial strain imaging in the management of patients on cardiotoxic therapy. RECENT FINDINGS Risk/benefit evaluation of cardiotoxic cancer treatment remains challenging, weighing life-saving cancer therapy with fatal cardiac dysfunction potentially caused by cancer therapy. The serial change in left ventricular ejection fraction (LVEF) was conventionally used for the detection of cancer therapy-related cardiac dysfunction (CTRCD). Peak systolic global longitudinal strain (GLS) by speckle-tracking echocardiography has turned into a vital pre- and post-chemotherapy assessment for the early detection of cardiotoxicity. Complexity in cardiotoxic therapy regimen, different definition of CTRCD by LVEF, variations in GLS values, timings, and variable cutoffs make it challenging to standardize the protocol for the detection of CTRCD. GLS > 15% relative reduction from baseline has been widely used. Evidence suggests that GLS could predict early subclinical LV dysfunction, and initiation of cardioprotective therapy led to less decline of LV function. Most of the studies used an echocardiographic endpoint, and the impact of GLS on the long-term clinical outcome is not established. GLS has emerged as a reliable measure to identify early subclinical LV dysfunction by detecting myocardial deformation in patients on cardiotoxic chemotherapy. To date, a significant decline in GLS suggests the initiation of cardioprotective therapy with close monitoring. Interruption of prognostically important cardiotoxic chemotherapies requires a multidisciplinary team approach guided mainly by LVEF and other clinical factors. Further randomized control trials with hard clinical endpoints and longer follow-ups may help to determine the role of GLS in CTRCD.
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Affiliation(s)
- Bhanu T Chaganti
- Department of Cardiovascular Medicine, Texas Tech University Health Science Center El Paso, 4800 Alberta Avenue, El Paso, TX, USA
| | - Kazuaki Negishi
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Nepean, NSW, Australia.,Department of Cardiology, Nepean Hospital, Sydney, NSW, Australia
| | - Kazue Okajima
- Department of Cardiovascular Medicine, Texas Tech University Health Science Center El Paso, 4800 Alberta Avenue, El Paso, TX, USA.
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18
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Jin C, Chai Y, Hu Z, Tian W, Ling W, Li J, Wu M. Higenamine Attenuates Doxorubicin-Induced Cardiac Remodeling and Myocyte Apoptosis by Suppressing AMPK Activation. Front Cell Dev Biol 2022; 10:809996. [PMID: 35602605 PMCID: PMC9117701 DOI: 10.3389/fcell.2022.809996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: As an effective antitumor drug, doxorubicin (DOX) is primarily used to treat solid tumors and hematologic malignancies. However, increasing evidence has emerged indicating its cardiotoxicity, and few solutions have been proposed to counter this side effect. Higenamine (HG) is a natural compound widely found in many Chinese herbs and also serves as a component in many healthcare products. Several studies have demonstrated its cardioprotective effect in different models, but little is known about the underlying influences of HG against myocardial damage from DOX-induced chronic cardiotoxicity. Methods and Results: C57BL/6 mice and neonatal rat ventricular cardiomyocytes (NRVMs) were used to evaluate the cardioprotective effect of HG against DOX-induced myocardial damage. In mice, DOX (intraperitoneally injected 5 mg/kg every 3 days for 4 weeks) significantly increased cardiomyocyte apoptosis, cardiac atrophy, and cardiac dysfunction, which were significantly attenuated by HG (intragastrically administered with 10 mg/kg every day for 4 weeks). In NRVMs, DOX (3 μM for 24 h) significantly increased cell apoptosis and the level of reactive oxygen species while reducing the level of superoxide dismutase and mitochondrial membrane potential. Remarkably, HG can reverse these pathological changes caused by DOX. Interestingly, the protective effect of HG on DOX-induced cardiotoxicity was independent of the activation of the beta-2 adrenergic receptor (β2-AR), known for mediating the effect of HG on antagonizing ischemia/reperfusion-induced cardiac apoptosis. Furthermore, HG attenuated the abnormal activation of phosphorylated adenosine-activated protein kinase (AMPK). Consistently, AMPK agonists (AICAR) can eliminate these pharmacological actions of HG. Conclusion: Collectively, our results suggested that HG alleviated DOX-induced chronic myocardial injury by suppressing AMPK activation and ROS production.
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Affiliation(s)
- Cuiliu Jin
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Chai
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhimin Hu
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wencong Tian
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China
| | - Wang Ling
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Li
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China
- *Correspondence: Jing Li, ; Meiping Wu,
| | - Meiping Wu
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jing Li, ; Meiping Wu,
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Esmaeilzadeh M, Urzua Fresno CM, Somerset E, Shalmon T, Amir E, Fan CPS, Brezden-Masley C, Thampinathan B, Thevakumaran Y, Yared K, Koch CA, Abdel-Qadir H, Woo A, Yip P, Marwick TH, Chan R, Wintersperger BJ, Thavendiranathan P. A Combined Echocardiography Approach for the Diagnosis of Cancer Therapy-Related Cardiac Dysfunction in Women With Early-Stage Breast Cancer. JAMA Cardiol 2022; 7:330-340. [PMID: 35138325 PMCID: PMC8829754 DOI: 10.1001/jamacardio.2021.5881] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/08/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Diagnosis of cancer therapy-related cardiac dysfunction (CTRCD) remains a challenge. Cardiovascular magnetic resonance (CMR) provides accurate measurement of left ventricular ejection fraction (LVEF), but access to repeated scans is limited. OBJECTIVE To develop a diagnostic model for CTRCD using echocardiographic LVEF and strain and biomarkers, with CMR as the reference standard. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, patients were recruited from University of Toronto-affiliated hospitals from November 2013 to January 2019 with all cardiac imaging performed at a single tertiary care center. Women with human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer were included. The main exclusion criterion was contraindication to CMR. A total of 160 patients were recruited, 136 of whom completed the study. EXPOSURES Sequential therapy with anthracyclines and trastuzumab. MAIN OUTCOMES AND MEASURES Patients underwent echocardiography, high-sensitivity troponin I (hsTnI), B-type natriuretic peptide (BNP), and CMR studies preanthracycline and postanthracycline every 3 months during and after trastuzumab therapy. Echocardiographic measures included 2-dimensional (2-D) LVEF, 3-D LVEF, peak systolic global longitudinal strain (GLS), and global circumferential strain (GCS). LVEF CTRCD was defined using the Cardiac Review and Evaluation Committee Criteria, GLS or GCS CTRCD as a greater than 15% relative change, and abnormal hsTnI and BNP as greater than 26 pg/mL and ≥ 35 pg/mL, respectively, at any follow-up point. Combinations of echocardiographic measures and biomarkers were examined to diagnose CMR CTRCD using conditional inference tree models. RESULTS Among 136 women (mean [SD] age, 51.1 [9.2] years), CMR-identified CTRCD occurred in 37 (27%), and among those with analyzable images, in 30 of 131 (23%) by 2-D LVEF, 27 of 124 (22%) by 3-D LVEF, 53 of 126 (42%) by GLS, 61 of 123 (50%) by GCS, 32 of 136 (24%) by BNP, and 14 of 136 (10%) by hsTnI. In isolation, 3-D LVEF had greater sensitivity and specificity than 2-D LVEF for CMR CTRCD while GLS had greater sensitivity than 2-D or 3-D LVEF. Regression tree analysis identified a sequential algorithm using 3-D LVEF, GLS, and GCS for the optimal diagnosis of CTRCD (area under the receiver operating characteristic curve, 89.3%). The probability of CTRCD when results for all 3 tests were negative was 1.0%. When 3-D LVEF was replaced by 2-D LVEF in the model, the algorithm still performed well; however, its primary value was to rule out CTRCD. Biomarkers did not improve the ability to diagnose CTRCD. CONCLUSIONS AND RELEVANCE Using CMR CTRCD as the reference standard, these data suggest that a sequential approach combining echocardiographic 3-D LVEF with 2-D GLS and 2-D GCS may provide a timely diagnosis of CTRCD during routine CTRCD surveillance with greater accuracy than using these measures individually. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02306538.
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Affiliation(s)
- Maryam Esmaeilzadeh
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Camila M. Urzua Fresno
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Emily Somerset
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tamar Shalmon
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eitan Amir
- Princess Margaret Cancer Center, Division of Medical Oncology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christine Brezden-Masley
- Division of Medical Oncology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Babitha Thampinathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yobiga Thevakumaran
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kibar Yared
- Division of Cardiology, Scarborough Health Network, Toronto, Ontario, Canada
| | - C. Anne Koch
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Anna Woo
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paul Yip
- Division of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Ontario, Canada
| | | | - Rosanna Chan
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bernd J. Wintersperger
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Vaz Ferreira V, Mano TB, Cardoso I, Coutinho Cruz M, Moura Branco L, Almeida-Morais L, Timóteo A, Galrinho A, Castelo A, Garcia Brás P, Simão D, Sardinha M, Gonçalves A, Cruz Ferreira R. Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052826. [PMID: 35270517 PMCID: PMC8910703 DOI: 10.3390/ijerph19052826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4–6 and 12–14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4–6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.
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Affiliation(s)
- Vera Vaz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
- Correspondence:
| | - Tania Branco Mano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Isabel Cardoso
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Madalena Coutinho Cruz
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Luísa Moura Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Luís Almeida-Morais
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Ana Timóteo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Alexandra Castelo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Pedro Garcia Brás
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Diana Simão
- Department of Oncology, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, 1169-050 Lisbon, Portugal; (D.S.); (M.S.)
| | - Mariana Sardinha
- Department of Oncology, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, 1169-050 Lisbon, Portugal; (D.S.); (M.S.)
| | - António Gonçalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal; (T.B.M.); (I.C.); (M.C.C.); (L.M.B.); (L.A.-M.); (A.T.); (A.G.); (A.C.); (P.G.B.); (A.G.); (R.C.F.)
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21
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Ibrahim Fouad G, Ahmed KA. Curcumin Ameliorates Doxorubicin-Induced Cardiotoxicity and Hepatotoxicity Via Suppressing Oxidative Stress and Modulating iNOS, NF-κB, and TNF-α in Rats. Cardiovasc Toxicol 2022; 22:152-166. [PMID: 34837640 DOI: 10.1007/s12012-021-09710-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/19/2021] [Indexed: 01/14/2023]
Abstract
Doxorubicin (DOX) is one of the widely used anti-tumor drugs. However, DOX-induced cardiotoxicity (DIC) and hepatotoxicity (DIH) are among the side effects that limited its therapeutic efficiency and clinical applicability. This study aimed to investigate the cardioprotective and hepatoprotective potentials of curcumin (CMN)-a bioactive polyphenolic compound-in alleviating DOX-induced cardiotoxicity (DIC) and hepatotoxicity (DIH) in male rats. A single intraperitoneal (i.p.) dose of DOX (20 mg/kg) was used to induce DIC and DIH. DOX-intoxicated rats were co-treated with CMN (100 mg/kg, oral) for 10 days before and 5 days after a single dose of DOX. We studied the anti-inflammatory and anti-oxidative activities of CMN on biochemical and immunohistochemical aspects. DOX disrupted cardiac and hepatic functions and stimulated oxidative stress and inflammation in both tissues that was confirmed biochemically and immunohistochemically. DOX enhanced inflammatory interferon-gamma (IFN-γ) and upregulated immunoexpression of nuclear factor-κB (NF-κB), inducible nitric oxide synthase (iNOS), and tumor necrosis factor-alpha (TNF-α). DOX induced structural alterations in both cardiac and hepatic tissues. CMN demonstrated cardioprotective potential through reducing cardiac troponin I (cTn1) and aspartate amino transaminase (AST). In addition, CMN significantly ameliorated liver function through decreasing alanine amino transaminase (ALT) and, gamma-glutamyl transferase (GGT), total cholesterol (TC), and triglycerides (TG). CMN demonstrated anti-inflammatory potential through decreasing IFN-γ levels and immunoexpression of iNOS, NF-κB, and TNF-α. Histopathologically, CMN restored DOX-associated cardiac and liver structural alterations. CMN showed anti-oxidative and anti-inflammatory potentials in both the cardiac and hepatic tissues. In addition, cTn1, IFN-γ, and AST could be used as blood-based biomarkers.
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Affiliation(s)
- Ghadha Ibrahim Fouad
- Department of Therapeutic Chemistry, National Research Centre, 33 El-Bohouth St., Dokki, Cairo, 12622, Egypt.
| | - Kawkab A Ahmed
- Pathology Department, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
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22
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Guan J, Bao W, Xu Y, Yang W, Li M, Xu M, Zhang Y, Zhang M. Assessment of Myocardial Work in Cancer Therapy-Related Cardiac Dysfunction and Analysis of CTRCD Prediction by Echocardiography. Front Pharmacol 2021; 12:770580. [PMID: 34858189 PMCID: PMC8632001 DOI: 10.3389/fphar.2021.770580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
No study has examined myocardial work in subjects with cancer therapy-related cardiac dysfunction (CTRCD). Myocardial work, as a new ultrasonic indicator, reflects the metabolism and oxygen consumption of the left ventricle. The aim of this study was to test the relative value of new indices of myocardial work and global longitudinal strain (GLS) in detecting changes in myocardial function during the treatment of breast cancer by two-dimensional and three-dimensional echocardiography. We enrolled 79 breast cancer patients undergoing different tumor treatment regimens. Follow-up observation was conducted before and after chemotherapy. The effects of breast cancer chemotherapy and targeted therapy on the development of CTRCD [defined as an absolute reduction in left ventricular ejection fraction (LVEF) of >5% to <53%] were detected by two-dimensional and three-dimensional speckle tracking echocardiography. Our findings further indicate that LVEF, myocardial work index (GWI) and myocardial work efficiency (GWE) showed significant changes after the T6 cycle, and GLS showed significant changes after the T4 cycle (p < 0.05). The three-dimensional strain changes after T6 and T8 had no advantages compared with GLS. Body mass index (BMI), the GLS change rate after the second cycle of chemotherapy (G2v) and the 3D-GCS change rate after the second cycle of chemotherapy (C2v) were independent factors that could predict the occurrence of CTRCD during follow-up, among which BMI was the best predictor (area under the curve, 0.922). In conclusion, the current study determined that GLS was superior to GWI in predicting cardiac function in patients with tumors with little variation in blood pressure. BMI, G2v and C2v can be used to predict the occurrence of CTRCD.
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Affiliation(s)
- Jingyuan Guan
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Wuyun Bao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yao Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mingjun Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
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23
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Heck SL, Mecinaj A, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, Gravdehaug B, Røsjø H, Steine K, Geisler J, Gulati G, Omland T. Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Extended Follow-Up of a 2×2 Factorial, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Candesartan and Metoprolol. Circulation 2021; 143:2431-2440. [PMID: 33993702 PMCID: PMC8212877 DOI: 10.1161/circulationaha.121.054698] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adjuvant breast cancer therapy containing anthracyclines with or without anti-human epidermal growth factor receptor-2 antibodies and radiotherapy is associated with cancer treatment-related cardiac dysfunction. In the PRADA trial (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy), concomitant treatment with the angiotensin receptor blocker candesartan attenuated the reduction in left ventricular ejection fraction (LVEF) in women receiving treatment for breast cancer, whereas the β-blocker metoprolol attenuated the increase in cardiac troponins. This study aimed to assess the long-term effects of candesartan and metoprolol or their combination to prevent a reduction in cardiac function and myocardial injury. METHODS In this 2×2 factorial, randomized, placebo-controlled, double-blind, single-center trial, patients with early breast cancer were assigned to concomitant treatment with candesartan cilexetil, metoprolol succinate, or matching placebos. Target doses were 32 and 100 mg, respectively. Study drugs were discontinued after adjuvant therapy. All 120 validly randomized patients were included in the intention-to-treat analysis. The primary outcome measure was change in LVEF assessed by cardiovascular magnetic resonance imaging from baseline to extended follow-up. Secondary outcome measures included changes in left ventricular volumes, echocardiographic peak global longitudinal strain, and circulating cardiac troponin concentrations. RESULTS A small decline in LVEF but no significant between-group differences were observed from baseline to extended follow-up, at a median of 23 months (interquartile range, 21 to 28 months) after randomization (candesartan, 1.7% [95% CI, 0.5 to 2.8]; no candesartan, 1.8% [95% CI, 0.6 to 3.0]; metoprolol, 1.6% [95% CI, 0.4 to 2.7]; no metoprolol, 1.9% [95% CI, 0.7 to 3.0]). Candesartan treatment during adjuvant therapy was associated with a significant reduction in left ventricular end-diastolic volume compared with the noncandesartan group (P=0.021) and attenuated decline in global longitudinal strain (P=0.046) at 2 years. No between-group differences in change in cardiac troponin I and T concentrations were observed. CONCLUSIONS Anthracycline-containing adjuvant therapy for early breast cancer was associated with a decline in LVEF during extended follow-up. Candesartan during adjuvant therapy did not prevent reduction in LVEF at 2 years, but was associated with modest reduction in left ventricular end-diastolic volume and preserved global longitudinal strain. These results suggest that a broadly administered cardioprotective approach may not be required in most patients with early breast cancer without preexisting cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01434134.
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Affiliation(s)
- Siri Lagethon Heck
- Department of Diagnostic Imaging (S.L.H.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Albulena Mecinaj
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Anne Hansen Ree
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases (P.H.), Oslo University Hospital, Ullevål, Norway
| | - Jeanette Schulz-Menger
- Department of Cardiology, Charité Campus Buch, Universitätsmedizin Berlin, Germany (J.S.-M.)
- HELIOS Clinics, Berlin, Germany (J.S.-M.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway (M.W.F.)
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, (B.G.), Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Kjetil Steine
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Jürgen Geisler
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Geeta Gulati
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
- Department of Cardiology, Division of Medicine (G.G.), Oslo University Hospital, Ullevål, Norway
| | - Torbjørn Omland
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
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24
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López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, Cardinale D, Canales Albendea M, Feliu Batlle J, Rodríguez Rodríguez I, Rodríguez Fraga O, Albaladejo A, Mediavilla G, González-Juanatey JR, Martínez Monzonis A, Gómez Prieto P, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, López Fernández T. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J 2021; 41:1720-1729. [PMID: 32016393 DOI: 10.1093/eurheartj/ehaa006] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
AIM Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. METHODS AND RESULTS We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). CONCLUSIONS The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.
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Affiliation(s)
- José López-Sendón
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Carlos Álvarez-Ortega
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Pilar Zamora Auñon
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Antonio Buño Soto
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Alexander R Lyon
- Royal Brompton Hospital and Imperial College, Cardiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus.,Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S, Milan, Italy
| | - Miguel Canales Albendea
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Jaime Feliu Batlle
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Isabel Rodríguez Rodríguez
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Olaia Rodríguez Fraga
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Ainara Albaladejo
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Guiomar Mediavilla
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | | | - Amparo Martínez Monzonis
- University Hospital of Santiago de Compostela, Cardiology, CiberCV, Santiago De Compostela, Spain
| | - Pilar Gómez Prieto
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | | | | | | | - Teresa López Fernández
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
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25
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Cardiovascular Issues in Hematopoietic Stem Cell Transplantation (HSCT). Curr Treat Options Oncol 2021; 22:51. [PMID: 33939030 DOI: 10.1007/s11864-021-00850-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
OPINION STATEMENT Hematopoietic stem cell transplantation (HSCT) is considered, since 1957, a potentially curative therapeutic option for many hemopathies. Although it is an aggressive procedure, improvements in transplantation techniques and supportive strategies have markedly decreased treatment-related mortality, and the prevalence of HSCT survivors is expected to exceed half a million by 2030. At the same time, there is a growing awareness of the potentially negative effects of HSCT-related therapies on the cardiovascular (CV) system, and HSCT survivors constitute a population at high cardiovascular (CV) risk. Cardio-oncology has been proposed as a new approach to prevent cardiovascular toxicity during and after HSCT. The present article attempts to provide a multidisciplinary and practical approach to the prevention, monitoring, and management of the most common cardiovascular complications in patients undergoing hematopoietic stem cell transplantation.
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26
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab. Echo Res Pract 2021; 8:G1-G18. [PMID: 34106116 PMCID: PMC8052569 DOI: 10.1530/erp-21-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor (EGF) receptor (HER) 2-positive targeted treatment (e.g. trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Susannah Stanway
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Alexander R Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Daniel X Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - the British Society of Echocardiography (BSE) and the British Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- North West Anglia Foundation Trust, UK
- Liverpool John Moores University, Liverpool, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Belfast Health and Social Care Trust, Belfast, UK
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
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Xu H, Mao L, Liu H, Zhang Y, Yang J. Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy. Int J Gen Med 2021; 14:885-893. [PMID: 33758535 PMCID: PMC7981149 DOI: 10.2147/ijgm.s300257] [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: 01/03/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objective This study was aimed at assessing the longitudinal strain changes of RV function using three-dimensional speckle tracking echocardiography (3D STE) in breast cancer patients receiving anthracycline chemotherapy. Patients and Methods A total of 95 women with breast cancer receiving epirubicin (360 mg/m2) underwent 3D STE at baseline, the end of chemotherapy and 12 months after chemotherapy. 3D STE assessment included RV ejection fraction (EF), LV global longitudinal strain (GLS), RV GLS, and RV free wall longitudinal strain (RV FWLS). Meanwhile, serum hs‐cTnI and NT-proBNP were measured. Chemotherapy-related cardiac dysfunction (CTRCD) was defined as an absolute decrease in 3D LVEF > 10% to a value <50%, while a percent reduction of 3D LV GLS > 15% indicated subclinical CTRCD. Results Subclinical CTRCD occurred in 10 (10.5%) patients during follow-up. Compared to baseline, the 3D GLS of LV and GLS and FWLS of RV decreased significantly at 12months after chemotherapy (all p<0.01). Variations of 3D RV GLS and RV FWLS had a good discrimination for predicting subclinical CTRCD. The variation of 3D RV FWLS was the only independent predictor of subclinical CTRCD (OR, 1.37; 95% CI, 1.12–2.87; p = 0.028) in multivariate analysis. The cutoff value with −17.5% of 3D RV FWLS variation had a high predictive accuracy for subclinical CTRCD, with an AUC of 0.74, 80.5% sensitivity and 65.8% specificity. The association between 3D RV FWLS and the cumulative dose of anthracyclines was calculated by Spearman’s test (r = −0.71, p < 0.001). Conclusion Longitudinal strain analysis by 3D STE allows the identification of subclinical RV dysfunction when conventional indices of RV function are unaffected. 3D RV FWLS was superior to other parameters in early detection of the development of CTRCD in breast cancer patients receiving epirubicin therapy.
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Affiliation(s)
- Haiyan Xu
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Ling Mao
- Department of Thyroid and Breast Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and the Second People's Hospital of Huai'an, Huai'an, Jiangsu, People's Republic of China
| | - Hailang Liu
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Yuanyuan Zhang
- Department of Medical Laboratory, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
| | - Jing Yang
- Department of Cardiology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China
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28
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab. JACC CardioOncol 2021; 3:1-16. [PMID: 34396303 PMCID: PMC8352267 DOI: 10.1016/j.jaccao.2021.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- A2C, apical 2-chamber
- A3C, apical 3-chamber
- A4C, apical 4-chamber
- BSE, British Society of Echocardiography
- CMR, cardiac magnetic resonance
- CTRCD, cancer therapy–related cardiac dysfunction
- ECG, electrocardiogram
- GLS, global longitudinal strain
- HER2 therapy
- HER2, human epidermal growth factor receptor 2
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MV, mitral valve
- RH, right heart
- ROI, region of interest
- RV, right ventricular
- TDI, tissue Doppler imaging
- TRV, tricuspid regurgitant velocity
- anthracycline
- echocardiography
- guidelines
- imaging
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
| | - Arjun K. Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Susannah Stanway
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mark Harbinson
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander R. Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Daniel X. Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - British Society of Echocardiography (BSE) and theBritish Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- North West Anglia Foundation Trust, United Kingdom
- Liverpool John Moores University, Liverpool, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- Belfast Health and Social Care Trust, Belfast, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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29
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Yuan Y, Fan S, Shu L, Huang W, Xie L, Bi C, Yu H, Wang Y, Li Y. Exploration the Mechanism of Doxorubicin-Induced Heart Failure in Rats by Integration of Proteomics and Metabolomics Data. Front Pharmacol 2020; 11:600561. [PMID: 33362553 PMCID: PMC7758990 DOI: 10.3389/fphar.2020.600561] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Heart failure is a common systemic disease with high morbidity and mortality worldwide. Doxorubicin (DOX) is a commonly used anthracycline broad-spectrum antitumor antibiotic with strong antitumor effect and definite curative effect. However, cardiotoxicity is the adverse reaction of drug dose cumulative toxicity, but the mechanism is still unclear. In this study, proteomics and metabonomics techniques were used to analyze the tissue and plasma of DOX-induced heart failure (HF) in rats and to clarify the molecular mechanism of the harmful effects of DOX on cardiac metabolism and function in rats from a new point of view. The results showed that a total of 278 proteins with significant changes were identified by quantitative proteomic analysis, of which 118 proteins were significantly upregulated and 160 proteins were significantly downregulated in myocardial tissue. In the metabonomic analysis, 21 biomarkers such as L-octanoylcarnitine, alpha-ketoglutarate, glutamine, creatine, and sphingosine were detected. Correlation analysis showed that DOX-induced HF mainly affected phenylalanine, tyrosine, and tryptophan biosynthesis, D-glutamine and D-glutamate metabolism, phenylalanine metabolism, biosynthesis of unsaturated fatty acids, and other metabolic pathways, suggesting abnormal amino acid metabolism, fatty acid metabolism, and glycerol phospholipid metabolism. It is worth noting that we have found the key upstream target of DOX-induced HF, PTP1B, which inhibits the expression of HIF-1α by inhibiting the phosphorylation of IRS, leading to disorders of fatty acid metabolism and glycolysis, which together with the decrease of Nrf2, SOD, Cytc, and AK4 proteins lead to oxidative stress. Therefore, we think that PTP1B may play an important role in the development of heart failure induced by doxorubicin and can be used as a potential target for the treatment of heart failure.
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Affiliation(s)
| | | | | | | | | | | | | | - Yuming Wang
- Department of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yubo Li
- Department of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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30
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Liu JE, Barac A, Thavendiranathan P, Scherrer-Crosbie M. Strain Imaging in Cardio-Oncology. JACC CardioOncol 2020; 2:677-689. [PMID: 34396282 PMCID: PMC8352045 DOI: 10.1016/j.jaccao.2020.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- ACC, American College of Cardiology
- AL, amyloid light chains
- ASE, American Society of Echocardiography
- CMRI, cardiac magnetic resonance imaging
- CTRCD, cancer treatment–related cardiac dysfunction
- DICOM, Digital Imaging and Communications in Medicine
- EACVI, European Association of Cardiovascular Imaging
- GLS, global longitudinal strain
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- ROI, region of interest
- STE, speckle tracking echocardiography
- VEGF, vascular endothelium growth factor
- cancer
- cardiotoxicity
- echocardiography
- global longitudinal strain
- left ventricular function
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Affiliation(s)
- Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ana Barac
- Department of Cardiology, Medstar Washington Hospital Center, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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31
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Dong H, Yao L, Wang M, Wang M, Li X, Sun X, Yu X, Guo J, Li X, Xu Y. Can ACEI/ARB prevent the cardiotoxicity caused by chemotherapy in early-stage breast cancer?-a meta-analysis of randomized controlled trials. Transl Cancer Res 2020; 9:7034-7043. [PMID: 35117309 PMCID: PMC8799108 DOI: 10.21037/tcr-20-1869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Administration of anthracycline-based chemotherapy with or without trastuzumab is recognized as standard care for breast cancer, but it is associated with a decline in left ventricular ejection fraction (LVEF). Angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) might decrease this cardiac dysfunction caused by the anti-cancer therapy. We sought to evaluate the prophylactic effects of the cardioprotective agents ACEI/ARB for early-stage breast cancer. METHODS We systematically searched the electronic databases Cochrane, PubMed, and Embase for randomized controlled trials (RCTs) evaluating the effect of ACEI/ARB. This meta-analysis calculated weighted mean differences with 95% CI, for ejection fraction and pooled odds ratios (OR) with 95% CI, for cardiac events. Pooled analyses were used in a random-effect model. The primary endpoint was the change of LVEF in the ACEI/ARB group versus the control group from baseline through completion of the studies. RESULTS our meta-analysis includes 5 studies encompassing 702 early-stage breast cancer patients. There was statistically significant diversity in the magnitude of the change of mean LVEF in patients receiving ACEI/ARB compared with control groups, with a mean difference of 4.08% (95% CI: 0.8% to 7.35%, P=0.01). However, regarding patient outcomes, ACEI/ARB did not significantly reduce the risk of cardiac events (OR 0.91, 95% CI: 0.62 to 1.34, P=0.64) or increase the incidence of hypotension events as compared with controls (OR 2.72, 95% CI: 0.69 to 10.73, P=0.15). CONCLUSIONS Our study suggests that ACEI/ARB significantly attenuate the cardiac dysfunction caused by anthracycline-based chemotherapy and/or trastuzumab. Further studies are required to confirm the effectiveness of this cardioprotective agent.
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Affiliation(s)
- Haoran Dong
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Litong Yao
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Mozhi Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Mengshen Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xinyan Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiangyu Sun
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xueting Yu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingyi Guo
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiang Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yingying Xu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
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32
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Chung R, Tyebally S, Chen D, Kapil V, Walker JM, Addison D, Ismail-Khan R, Guha A, Ghosh AK. Hypertensive Cardiotoxicity in Cancer Treatment-Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies-Epidemiology, Incidence, and Pathophysiology. J Clin Med 2020; 9:jcm9103346. [PMID: 33081013 PMCID: PMC7603211 DOI: 10.3390/jcm9103346] [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] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiotoxicity is the umbrella term for cardiovascular side effects of cancer therapies. The most widely recognized phenotype is left ventricular dysfunction, but cardiotoxicity can manifest as arrhythmogenic, vascular, myocarditic and hypertensive toxicities. Hypertension has long been regarded as one of the most prevalent and modifiable cardiovascular risk factors in the general population, but its relevance during the cancer treatment journey may be underestimated. Hypertensive cardiotoxicity occurs de novo in a substantial proportion of treated cancer patients. The pathology is incompletely characterized—natriuresis and renin angiotensin system interactions play a role particularly in conventional treatments, but in novel therapies endothelial dysfunction and the interaction between the cancer and cardiac kinome are implicated. There exists a treatment paradox in that a significant hypertensive response not only mandates anti-hypertensive treatment, but in fact, in certain cancer treatment scenarios, hypertension is a predictor of cancer treatment efficacy and response. In this comprehensive review of over 80,000 patients, we explored the epidemiology, incidence, and mechanistic pathophysiology of hypertensive cardiotoxicity in adjunct, conventional chemotherapy, and novel cancer treatments. Conventional chemotherapy, adjunct treatments, and novel targeted therapies collectively caused new onset hypertension in 33–68% of treated patients. The incidence of hypertensive cardiotoxicity across twenty common novel therapies for any grade hypertension ranged from 4% (imatinib) to 68% (lenvatinib), and high grade 3 or 4 hypertension in <1% (imatinib) to 42% (lenvatinib). The weighted average effect was all-grade hypertension in 24% and grade 3 or 4 hypertension in 8%.
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Affiliation(s)
- Robin Chung
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
| | - Sara Tyebally
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
| | - Daniel Chen
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
| | - Vikas Kapil
- Barts Blood Pressure Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK;
- Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - J. Malcolm Walker
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (D.A.); (A.G.)
| | - Roohi Ismail-Khan
- Cardio-oncology Program, H. Lee Moffitt Cancer Center, Tampa, FL 33559, USA;
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (D.A.); (A.G.)
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
- Correspondence: ; Tel.: +44-20-7377-7000
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33
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Galderisi M, Santoro C, Bossone E, Mancusi C. Rationale and proposal for cardio-oncology services in Italy. J Cardiovasc Med (Hagerstown) 2020; 23:207-215. [PMID: 32858628 DOI: 10.2459/jcm.0000000000001087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: In the last 20 years, a substantial improvement in the efficacy of cancer treatment has induced a progressive increase in cancer survival, with an obvious parallel increase in morbidity and mortality related to the adverse effects of anticancer therapy, in particular, cardiovascular complications. In relation to the peculiar aspects related to cardiac and vascular toxicity, clinical management of patients should be ideally reserved for experts in the field of this novel medical discipline, which has been defined as cardio-oncology. The rationale for this choice corresponds to the aim of identifying patients more prone to developing cardiovascular damage, prevent overt cardiotoxicity and conduct active surveillance of treated patients for early identification of cardiac and vascular involvement during short- and long-term follow-up. Due to the burden of treated cancer patients, the development of dedicated cardio-oncology services has become one of the main goals of contemporary medicine, needed to accomplish the peculiar mission of guiding the patients through the narrow path of cancer survival without the expense of cardiovascular damage. The main purpose of cardio-oncology services is to provide dedicated cardiologic care to cancer patients affected by concomitant (subclinical or overt) cardiovascular diseases, either preexisting the cancer onset or acquired during and after the time course of anticancer therapy. In this article, we describe a possible spoke-hub model of cardio-oncology services, which could be appropriately applied in Italy. Rationale, organization, definition of referral criteria, strategies, interventional programs, long-term surveillance and home assistance of this model are described and discussed.
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Affiliation(s)
- Maurizio Galderisi
- Interdepartmental Program of Cardiovascular Emergencies and Onco-Hematologic Complications, Department of advanced Biomedical Sciences, Federico II University Hospital
| | - Ciro Santoro
- Interdepartmental Program of Cardiovascular Emergencies and Onco-Hematologic Complications, Department of advanced Biomedical Sciences, Federico II University Hospital
| | - Eduardo Bossone
- Unit of Cardiac Rehabilitation, Antonio Cardarelli Hospital, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II, University Hospital
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Čelutkienė J, Pudil R, López‐Fernández T, Grapsa J, Nihoyannopoulos P, Bergler‐Klein J, Cohen‐Solal A, Farmakis D, Tocchetti CG, Haehling S, Barberis V, Flachskampf FA, Čeponienė I, Haegler‐Laube E, Suter T, Lapinskas T, Prasad S, Boer RA, Wechalekar K, Anker MS, Iakobishvili Z, Bucciarelli‐Ducci C, Schulz‐Menger J, Cosyns B, Gaemperli O, Belenkov Y, Hulot J, Galderisi M, Lancellotti P, Bax J, Marwick TH, Chioncel O, Jaarsma T, Mullens W, Piepoli M, Thum T, Heymans S, Mueller C, Moura B, Ruschitzka F, Zamorano JL, Rosano G, Coats AJ, Asteggiano R, Seferovic P, Edvardsen T, Lyon AR. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the
H
eart
F
ailure
A
ssociation (
HFA
), the
E
uropean
A
ssociation of
C
ardiovascular
I
maging (
EACVI
) and the
Cardio‐Oncology C
ouncil of the
E
uropean
S
ociety of
C
ardiology (
ESC
). Eur J Heart Fail 2020; 22:1504-1524. [DOI: 10.1002/ejhf.1957] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Vilnius Lithuania
- State Research Institute Centre For Innovative Medicine Vilnius Lithuania
| | - Radek Pudil
- First Department of Medicine ‐ Cardioangiology Charles University Prague, Medical Faculty and University Hospital Hradec Králové Hradec Kralove Czech Republic
| | | | - Julia Grapsa
- Department of Cardiology St Bartholomew Hospital, Barts Health Trust London UK
| | - Petros Nihoyannopoulos
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology Hippokrateion General Hospital, National and Kapodistrian University of Athens Athens Greece
- National Heart and Lung Institute Imperial College London, Hammersmith Hospital London UK
| | | | - Alain Cohen‐Solal
- UMR‐S 942, Cardiology Department Hôpital Lariboisière, AP‐HP, Université de Paris Paris France
| | - Dimitrios Farmakis
- University of Cyprus Medical School Nicosia Cyprus
- Cardio‐Oncology Clinic, Heart Failure Unit, Department of Cardiology Athens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, and Interdepartmental Center for Clinical and Translational Research (CIRCET) Federico II University Naples Italy
| | - Stephan Haehling
- Department of Cardiology and Pneumology University of Göttingen Medical Centre Göttingen Germany
| | | | - Frank A. Flachskampf
- Department of Medical Sciences Uppsala University, Clinical Physiology and Cardiology, Akademiska Hospital Uppsala Sweden
| | - Indrė Čeponienė
- Department of Cardiology, Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Eva Haegler‐Laube
- Department of Cardiology, Inselspital University of Bern Bern Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital University of Bern Bern Switzerland
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Sanjay Prasad
- Department of Cardiac Magnetic Resonance Royal Brompton Hospital London UK
- National Heart and Lung Institute, Imperial College London UK
| | - Rudolf A. Boer
- Department of Cardiology University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | | | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité; and Berlin Institute of Health Center for Regenerative Therapies (BCRT); and DZHK (German Centre for Cardiovascular Research), partner site Berlin; and Department of Cardiology, Charité Campus Benjamin Franklin Berlin Germany
| | - Zaza Iakobishvili
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Tel Aviv‐Jaffa District, Clalit Health Services Tel Aviv Israel
| | - Chiara Bucciarelli‐Ducci
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre and Clinical Research and Imaging Centre (CRIC) Bristol University Hospitals Bristol NHS Trust and University of Bristol Bristol UK
| | - Jeanette Schulz‐Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité ‐ Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max‐Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology Berlin Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - Bernard Cosyns
- Department of Cardiology CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel Brussels Belgium
| | | | - Yury Belenkov
- I.M. Sechenov's First Moscow State Medical University of Ministry of Health (Sechenov University) Moscow Russia
| | - Jean‐Sébastien Hulot
- Université de Paris, CIC1418, Paris Cardiovascular Research Center, INSERM Paris France
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences Federico II University Hospital Naples Italy
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman Liège Belgium
| | - Jeroen Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | | | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases C.C. Iliescu Bucuresti Romania
- University of Medicine Carol Davila Bucuresti Romania
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht and Utrecht University Utrecht The Netherlands
| | | | - Massimo Piepoli
- Heart Failure Unit, Cardiology Guglielmo da Saliceto Hospital Piacenza Italy
- University of Parma Parma Italy
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies (IMTTS) Hannover Germany
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
- William Harvey Research Institute, Barts Heart Centre, Queen Mary University of London, Charterhouse Square London UK
- Department of Cardiovascular Sciences Centre for Molecular and Vascular Biology, KU Leuven Leuven Belgium
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology Department, Military Hospital, and CINTESIS, CardioCare, Faculty of Medicine Porto University Porto Portugal
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jose Luis Zamorano
- Cardiology Department University Hospital Ramón y Cajal Madrid Spain
- University Alcala Madrid Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences IRCCS San Raffaele Pisana Rome Italy
| | | | | | - Petar Seferovic
- University of Belgrade Faculty of Medicine and Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Thor Edvardsen
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London UK
- Cardio‐Oncology Service, Royal Brompton Hospital London UK
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35
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Cardiac Monitoring for Thoracic Radiation Therapy: Survey of Practice Patterns in the United States. Am J Clin Oncol 2020; 43:249-256. [PMID: 31972567 DOI: 10.1097/coc.0000000000000666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The American Society of Clinical Oncology (ASCO) 2017 guidelines on cardiac monitoring during cancer treatments identified patients receiving thoracic radiation (TRT) ≥30 Gy (heart in field) at increased risk for developing radiation-induced heart disease (RIHD). ASCO encouraged clinicians to actively screen and monitor for baseline modifiable cardiac risk factors and therapy-induced cardiotoxicity in this high-risk population. Coronary artery calcium (CAC) is an independent risk factor for adverse cardiac events that can be mitigated with preventative medical therapy. It is unclear whether radiation oncologists (ROs) are aware of ASCO guidelines or the implications of CAC observed on computed tomographic scans. We report on practice patterns, perceptions, and experiences of cardiac monitoring for patients receiving definitive TRT, excluding breast patients. MATERIALS AND METHODS A 28-question survey was emailed to United States ROs 3 times from September 2018 to January 2019. RESULTS There were 162 respondents from 42 states, 51% in academic practice. Most ROs (81%) were not aware of the ASCO guidelines. Only 24% agreed with the guidelines, only 27% believed symptomatic RIHD could manifest within 2 years of TRT, and 69% thought there was a lack of strong evidence for type and timing of cardiac monitoring tests. If CAC was evident on computed tomographic scans, 40% took no further action to inform the patient or referring doctor. CONCLUSIONS This survey highlights a critical gap in knowledge about cardiac monitoring and potentially life-saving opportunities for preventive cardiac medical management. Future studies focusing on timing and detection of RIHD may elucidate the utility of cardiac monitoring for TRT patients.
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36
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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37
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Cadeddu Dessalvi C, Deidda M, Giorgi M, Colonna P. Vascular Damage - Coronary Artery Disease. J Cardiovasc Echogr 2020; 30:S11-S16. [PMID: 32566461 PMCID: PMC7293870 DOI: 10.4103/jcecho.jcecho_3_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/23/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular complications during chemotherapy and radiotherapy are becoming an increasing problem because many patients with cancer are treated with agents that exert significant vascular toxicity. Coronary heart disease in patients with cancer presents particular challenges, which directly impact the management of both the coronary disease and malignancy. Several chemotherapeutic agents have been shown to trigger ischemic heart disease, and as it has happened for myocardial cardiotoxicity, more attention should be dedicated to improving early recognition and prevention of cardiac vascular toxicity. Cardiac imaging could facilitate early detection of vascular toxicity, but a thorough risk stratification should always be performed to identify patients at higher risk of vascular impairment.
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Affiliation(s)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giorgi
- Department of Cardiology, University Hospital Città della Scienza e Salute, Molinette Hospital, Turin, Italy
| | - Paolo Colonna
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
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38
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Novo G, Nugara C, Fava A, Mantero A, Citro R. Early Detection of Myocardial Damage: A Multimodality Approach. J Cardiovasc Echogr 2020; 30:S4-S10. [PMID: 32566460 PMCID: PMC7293866 DOI: 10.4103/jcecho.jcecho_2_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/17/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases are possible complications of antineoplastic treatment and may lead to premature morbidity and mortality among cancer survivors. A symptom-based follow-up is ineffective, and there are growing evidences that early detection of myocardial damage in patients treated with antineoplastic drugs is the key point to prevent the occurrence of damage and improve the prognosis of these patients. Different techniques have been proposed to monitor cardiac function in oncologic patients such as cardiac imaging (echocardiography, nuclear imaging, and cardiac magnetic resonance) and biomarkers (troponin and natriuretic peptides). The European Association of Cardiovascular Imaging/American Society of Echocardiography consensus document encourages an integrated approach to early detect cardiotoxicity.
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Affiliation(s)
- Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Division of Cardiology University Hospital P. Giaccone, Palermo, Italy
| | - Cinzia Nugara
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Division of Cardiology University Hospital P. Giaccone, Palermo, Italy.,Neurolesi Center IRCCS "Bonino Pulejo", Messina, Italy
| | - Antonella Fava
- Department of Cardiology, University Hospital "Città della Salute e Della Scienza", Molinette Hospital, Turin, Italy
| | | | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, Salerno, Italy
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39
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Berliner D, Beutel G, Bauersachs J. Echocardiography and biomarkers for the diagnosis of cardiotoxicity. Herz 2020; 45:637-644. [DOI: 10.1007/s00059-020-04957-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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40
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Voigt JU, Cvijic M. 2- and 3-Dimensional Myocardial Strain in Cardiac Health and Disease. JACC Cardiovasc Imaging 2020; 12:1849-1863. [PMID: 31488253 DOI: 10.1016/j.jcmg.2019.01.044] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/08/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
Advances in speckle-tracking echocardiography allowed the rise of deformation imaging as a feasible, robust, and valuable tool for clinical routine. The global or segmental measurement of strain can objectively quantify myocardial deformation and can characterize myocardial function in a novel way. However, the proper interpretation of deformation measurements requires understanding of cardiac mechanics and the influence of loading conditions, ventricular geometry, conduction delays, and myocardial tissue characteristics on the measured values. The purpose of this manuscript is to review the basic concepts of deformation imaging, briefly describe imaging modalities for strain assessment, and discuss in depth the underlying physical and pathophysiological mechanisms which lead to the respective findings in a specific disease.
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Affiliation(s)
- Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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41
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Affiliation(s)
- Jennifer E. Liu
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, New York, USA
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42
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Lee MS, Liu DW, Hung SK, Yu CC, Chi CL, Chiou WY, Chen LC, Lin RI, Huang LW, Chew CH, Hsu FC, Chan MWY, Lin HY. Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care. Front Cardiovasc Med 2020; 7:16. [PMID: 32154267 PMCID: PMC7047711 DOI: 10.3389/fcvm.2020.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/31/2020] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.
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Affiliation(s)
- Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Dai-Wei Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Chih-Chia Yu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Chen-Lin Chi
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anatomic Pathology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Ru-Inn Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Li-Wen Huang
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Chia-Hui Chew
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Feng-Chun Hsu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Michael W Y Chan
- Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
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43
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The Current and Future Role of Echocardiography for the Detection of Cardiotoxicity Related to Cancer Therapy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-019-9523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Anker MS, Hadzibegovic S, Lena A, Belenkov Y, Bergler‐Klein J, de Boer RA, Farmakis D, von Haehling S, Iakobishvili Z, Maack C, Pudil R, Skouri H, Cohen‐Solal A, Tocchetti CG, Coats AJ, Seferović PM, Lyon AR. Recent advances in cardio-oncology: a report from the 'Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019'. ESC Heart Fail 2019; 6:1140-1148. [PMID: 31884717 PMCID: PMC6989292 DOI: 10.1002/ehf2.12551] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
While anti-cancer therapies, including chemotherapy, immunotherapy, radiotherapy, and targeted therapy, are constantly advancing, cardiovascular toxicity has become a major challenge for cardiologists and oncologists. This has led to an increasing demand of cardio-oncology units in Europe and a growing interest of clinicians and researchers. The Heart Failure 2019 meeting of the Heart Failure Association of the European Society of Cardiology in Athens has therefore created a scientific programme that included four dedicated sessions on the topic along with several additional lectures. The major points that were discussed at the congress included the implementation and delivery of a cardio-oncology service, the collaboration among cardio-oncology experts, and the risk stratification, prevention, and early recognition of cardiotoxicity. Furthermore, sessions addressed the numerous different anti-cancer therapies associated with cardiotoxic effects and provided guidance on how to treat cancer patients who develop cardiovascular disease before, during, and after treatment.
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Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | - Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of CardiologyCharité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research)partner site Berlin and Department of Cardiology, Charité Campus Benjamin FranklinBerlinGermany
| | | | | | - Rudolf A. de Boer
- Department of CardiologyUniversity of GroningenUniversity Medical Center Groningen, GroningenThe Netherlands
| | - Dimitrios Farmakis
- University of Cyprus Medical SchoolNicosiaCyprus
- Department of Cardiology, Cardio‐Oncology Clinic, Heart Failure UnitAthens University Hospital ‘Attikon’, National and Kapodistrian University of AthensAthensGreece
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, German Center for Cardiovascular Medicine (DZHK)University of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Fund, and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC)University Clinic WürzburgWürzburgGermany
| | - Radek Pudil
- 1st Department of Medicine–Cardioangiology, Faculty of MedicineUniversity HospitalHradec KrálovéCzech Republic
| | - Hadi Skouri
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Alain Cohen‐Solal
- Department of Cardiology, Lariboisière Hospital and U942 INSERM, BIOCANVAS (Biomarqueurs Cardiovasculaires)Paris UniversityParisFrance
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Sciences (CIRCET)Federico II UniversityNaplesItaly
| | | | - Petar M. Seferović
- Faculty of Medicine and Heart Failure CenterBelgrade University Medical Center, University of BelgradeBelgradeSerbia
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Truong VT, Phan HT, Pham KN, Duong HN, Ngo TN, Palmer C, Nguyen TT, Truong BH, Vo MA, Tretter JT, Nagueh SF, Chung ES, Mazur W. Normal Ranges of Left Ventricular Strain by Three-Dimensional Speckle-Tracking Echocardiography in Adults: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2019; 32:1586-1597.e5. [DOI: 10.1016/j.echo.2019.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/16/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022]
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Abstract
Heart disease is the most important cause of non-cancer death for patients with cancer. Addressing the cardiotoxic effects of anticancer therapies to prevent increased cardiovascular risk in this population is crucial. Echocardiography plays a big role in monitoring cardiotoxicity induced by cancer treatment. Many emerging modalities, including tissue Doppler imaging measures, speckle tracking imaging, and three-dimensional echocardiography, may provide improved sensitivity and specificity to detect cancer treatment-induced cardiotoxicity. Additional research is critical to define the value of both conventional and novel indices in guiding the clinical management of cancer treatment-induced cardiotoxicity.
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Affiliation(s)
- Yu Kang
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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48
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Long TM, Lee F, Lam K, Wallman KE, Walwyn TS, Choong CS, Naylor LH. Cardiovascular Testing Detects Underlying Dysfunction in Childhood Leukemia Survivors. Med Sci Sports Exerc 2019; 52:525-534. [PMID: 31652239 DOI: 10.1249/mss.0000000000002168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Childhood leukemia survivors commonly develop late-onset cardiovascular disease after treatment with anthracyclines. Resting echocardiogram is the standard procedure for monitoring cardiac health but this method may not be sensitive enough to detect subclinical injury. Exercise echocardiography may provide a viable alternative. METHODS Nineteen (9 males; age, 19 ± 3 yr) anthracycline-treated survivors of childhood leukemia and 17 (8 males) healthy individuals of similar age (22 ± 2 yr) were recruited. All survivors had normal resting echocardiography upon recruitment. Exercise echocardiography was performed using contemporary imaging techniques. Flow-mediated dilation (FMD), body composition, and cardiorespiratory fitness (V˙O2peak) were assessed to determine predisposition to additional disease. RESULTS Mitral valve peak flow velocity in late diastole (interaction, P = 0.007) increased from rest in survivors (P = 0.023) and controls (P = 0.020) immediately postexercise but did not recover again in the survivors (exercise-recovery, P = 0.784) after recuperation. Consequently, E/A ratio (interaction, P < 0.001) was lower in the survivors at recovery (P < 0.001). Survivors had reduced FMD (7.88 ± 1.70 vs 9.65 ± 2.83; P = 0.030), maximal and recovery HR (P = 0.001; P < 0.001), minute ventilation (P < 0.001), and V˙O2peak (absolute, 2.64 ± 0.62 vs 3.14 ± 0.74 L·min, P = 0.034; relative, 36.78 ± 11.49 vs 45.14 ± 6.80 mL·kg·min; P = 0.013) compared with controls. They also had higher total body fat (percentage, P = 0.034; mass, P = 0.024) and fat mass in the central (P = 0.050), peripheral (P = 0.039) and visceral (P < 0.001) regions. Survivors matched controls with regard to height (173.0 ± 7.8 cm vs 173.8 ± 9.1 cm; P = 0.796), body mass (76.16 ± 19.05 kg vs 70.07 ± 13.96 kg; P = 0.287) and body mass index (25.2 ± 5.1 vs 22.9 ± 2.7; P = 0.109). CONCLUSIONS Exercise echocardiography unmasked subclinical diastolic dysfunction that may indicate late anthracycline toxicity in apparently healthy survivors of childhood leukemia. Presence of secondary risk factors indicates increased predisposition to comorbidities and highlights the importance of assessing cardiovascular health during follow-up.
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Affiliation(s)
- Treya M Long
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
| | - Felicity Lee
- Advanced Heart Failure Unit and Cardiac Transplant Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, AUSTRALIA
| | - Kaitlyn Lam
- Advanced Heart Failure Unit and Cardiac Transplant Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, AUSTRALIA
| | - Karen E Wallman
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
| | | | | | - Louise H Naylor
- School of Human Sciences: Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, AUSTRALIA
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49
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Coutinho Cruz M, Moura Branco L, Portugal G, Galrinho A, Timóteo AT, Rio P, Ilhão Moreira R, Mendonça T, Leal A, Gameiro F, Duarte Oliveira S, Luz R, Cruz Ferreira R. Three-dimensional speckle-tracking echocardiography for the global and regional assessments of left ventricle myocardial deformation in breast cancer patients treated with anthracyclines. Clin Res Cardiol 2019; 109:673-684. [DOI: 10.1007/s00392-019-01556-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022]
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50
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Seraphim A, Westwood M, Bhuva AN, Crake T, Moon JC, Menezes LJ, Lloyd G, Ghosh AK, Slater S, Oakervee H, Manisty CH. Advanced Imaging Modalities to Monitor for Cardiotoxicity. Curr Treat Options Oncol 2019; 20:73. [PMID: 31396720 PMCID: PMC6687672 DOI: 10.1007/s11864-019-0672-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ejection fraction, based on historical local expertise and resources. Recently, however, there has been growing recognition that simple measurement of left ventricular ejection fraction using 2D echocardiography may not be optimal for screening: diagnostic accuracy, reproducibility and feasibility are limited. Modern cancer therapies affect many myocardial pathways: inflammatory, fibrotic, metabolic, vascular and myocyte function, meaning that multiple biomarkers may be needed to track myocardial cardiotoxicity. Advanced imaging modalities including cardiovascular magnetic resonance (CMR), computed tomography (CT) and positron emission tomography (PET) add improved sensitivity and insights into the underlying pathophysiology, as well as the ability to screen for other cardiotoxicities including coronary artery, valve and pericardial diseases resulting from cancer treatment. Delivering screening for cardiotoxicity using advanced imaging modalities will however require a significant change in current clinical pathways, with incorporation of machine learning algorithms into imaging analysis fundamental to improving efficiency and precision. In the future, we should aspire to personalized rather than generic screening, based on a patient’s individual risk factors and the pathophysiological mechanisms of the cancer treatment they are receiving. We should aspire that progress in cardiooncology is able to track progress in oncology, and to ensure that the current ‘one size fits all’ approach to screening be obsolete in the very near future.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Mark Westwood
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Tom Crake
- Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - James C Moon
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Leon J Menezes
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Guy Lloyd
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Arjun K Ghosh
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Sarah Slater
- Department of Haematology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Heather Oakervee
- Department of Oncology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Charlotte H Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK. .,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.
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