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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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Heemelaar JC, Janson J, Braun J, Speetjens FM, van de Sande MAJ, Hugo JDV, Barge-Schaapveld DQCM, Beeres SLMA, Tops LF, Gelderblom H, Antoni ML. Case report: challenges in monitoring and treatment of anthracycline induced cardiotoxicity in young adults with osteosarcoma. CARDIO-ONCOLOGY 2022; 8:18. [PMCID: PMC9664690 DOI: 10.1186/s40959-022-00145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
Neo(adjuvant) systemic treatment regimens containing anthracyclines such as doxorubicin cause a significant risk of heart failure. These regimens are one of the corner stones of osteosarcoma treatment, and therefore several guidelines are in place to steer cardiotoxicity monitoring through baseline risk stratification and cardiac surveillance during and after completion of cancer therapy. Importantly, baseline risk stratification modules are dependent on age, prior cardiovascular disease and cardiovascular risk factors. Because the majority of osteosarcoma patients are below 30 years of age these criteria rarely apply and most patients are assigned to low or medium risk categories, whereas cardiovascular complications have profound impact on morbidity and mortality in this young population. Therefore, cardiac surveillance is very important in this group for timely detection of cardiotoxicity. Moreover, when severe cardiotoxicity that requires advanced heart failure treatment occurs, a cancer diagnosis has significant implications on treatment options, i.e. mechanical circulatory support and heart transplantation. These challenges are presented in this case of a patient without clinical risk factors admitted with cardiogenic shock requiring advanced heart failure treatment within 1 month after completion of doxorubicin containing chemotherapy for the treatment of high grade osteosarcoma.
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Affiliation(s)
- Julius C. Heemelaar
- grid.10419.3d0000000089452978Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Zuid-Holland the Netherlands
| | - Jeroen Janson
- grid.10419.3d0000000089452978Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Jerry Braun
- grid.10419.3d0000000089452978Department of Thoracic Surgery, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Frank M. Speetjens
- grid.10419.3d0000000089452978Department of Medical Oncology, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Michiel A. J. van de Sande
- grid.10419.3d0000000089452978Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Juan D. V. Hugo
- grid.10419.3d0000000089452978Department of Thoracic Surgery, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Daniela Q. C. M. Barge-Schaapveld
- grid.10419.3d0000000089452978Department of Clinical Genetics, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - Saskia L. M. A. Beeres
- grid.10419.3d0000000089452978Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Zuid-Holland the Netherlands
| | - Laurens F. Tops
- grid.10419.3d0000000089452978Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Zuid-Holland the Netherlands
| | - Hans Gelderblom
- grid.10419.3d0000000089452978Department of Medical Oncology, Leiden University Medical Center, Leiden, Zuid-Holland The Netherlands
| | - M. Louisa Antoni
- grid.10419.3d0000000089452978Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Zuid-Holland the Netherlands
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Carrasco R, Castillo RL, Gormaz JG, Carrillo M, Thavendiranathan P. Role of Oxidative Stress in the Mechanisms of Anthracycline-Induced Cardiotoxicity: Effects of Preventive Strategies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:8863789. [PMID: 33574985 PMCID: PMC7857913 DOI: 10.1155/2021/8863789] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/29/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022]
Abstract
Anthracycline-induced cardiotoxicity (AIC) persists as a significant cause of morbidity and mortality in cancer survivors. Although many protective strategies have been evaluated, cardiotoxicity remains an ongoing threat. The mechanisms of AIC remain unclear; however, several pathways have been proposed, suggesting a multifactorial origin. When the central role of topoisomerase 2β in the pathophysiology of AIC was described some years ago, the classical reactive oxygen species (ROS) hypothesis shifted to a secondary position. However, new insights have reemphasized the importance of the role of oxidative stress-mediated signaling as a common pathway and a critical modulator of the different mechanisms involved in AIC. A better understanding of the mechanisms of cardiotoxicity is crucial for the development of treatment strategies. It has been suggested that the available therapeutic interventions for AIC could act on the modulation of oxidative balance, leading to a reduction in oxidative stress injury. These indirect antioxidant effects make them an option for the primary prevention of AIC. In this review, our objective is to provide an update of the accumulated knowledge on the role of oxidative stress in AIC and the modulation of the redox balance by potential preventive strategies.
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Affiliation(s)
- Rodrigo Carrasco
- Division of Cardiology, Peter Munk Cardiac Centre and the Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Rodrigo L. Castillo
- Medicine Department, East Division, Faculty of Medicine, University of Chile. Santiago, Chile; Critical Care Patient Unit, Hospital Salvador, Santiago, Chile
| | - Juan G. Gormaz
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Montserrat Carrillo
- Division of Cardiology, Peter Munk Cardiac Centre and the Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Peter Munk Cardiac Centre and the Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
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Dwivedi G, Klein R, Bhat S, Dias PS, Dent S. Does Diastolic Dysfunction Precede Systolic Dysfunction Following Contemporary Breast Cancer Therapy? JACC Cardiovasc Imaging 2020; 13:1454-1455. [DOI: 10.1016/j.jcmg.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
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