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Martins Carvalho M, Alves Pinto R, Proença T, Costa I, Tavares N, Paiva M, Sousa C, Macedo F. Cardiovascular toxicity in breast cancer patients - contributors and role of cardioprotective drugs. Monaldi Arch Chest Dis 2023; 93. [PMID: 37009760 DOI: 10.4081/monaldi.2023.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Breast cancer (BC) patients treated with anthracyclines and/or anti-HER2-targeted therapies (AHT) are highly associated with cardiovascular toxicity (CVT). Our objective was to evaluate the risk of CVT secondary to cancer treatment and the role of cardioprotective-drugs (CPD) in BC patients. We collected a retrospective cohort of females with BC treated with chemotherapy and/or AHT from 2017 to 2019. CVT was defined as LVEF<50% or decline ≥10% during follow-up. As CPD, we considered renin-angiotensin-aldosterone-system inhibitors and beta-blockers. A subgroup analysis of the AHT patients was also performed. A total of 203 women were enrolled. The majority had high or very-high CVT risk score and normal cardiac function at presentation. As for CPD, 35.5% were medicated pre-chemotherapy. All patients were submitted to chemotherapy; AHT were applied to 41.7%. During a 16 months follow-up, 8.5% developed CVT. There was a significant decrease of GLS and LVEF at 12-months (decrease of 1.1% and 2.2%, p<0.001). AHT and combined therapy were significantly associated with CVT. In the AHT sub-group analysis (n=85), 15.7% developed CVT. Patients previously medicated with CPD had a significative lower incidence of CVT (2.9% vs 25.0%, p=0.006). Patients already on CPD presented a higher LVEF at 6-months follow-up (62.5% vs 59.2%, p=0.017). Patients submitted to AHT and anthracycline therapy had higher risk of developing CVT. In the AHT sub-group, pre-treatment with CPD was significantly associated with a lower prevalence of CVT. These results highlight the importance of cardio-oncology evaluation and strengthen the value of primary prevention.
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Affiliation(s)
- Miguel Martins Carvalho
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
| | | | - Tânia Proença
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto.
| | - Inês Costa
- Oncology Department, Centro Hospitalar Universitário de São João, Porto.
| | - Nuno Tavares
- Oncology Department, Centro Hospitalar Universitário de São João, Porto.
| | - Mariana Paiva
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto.
| | - Carla Sousa
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
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Tyebally S, Ghose A, Chen DH, Abiodun AT, Ghosh AK. Chest Pain in the Cancer Patient. Eur Cardiol 2022; 17:e15. [PMID: 35702571 PMCID: PMC9185574 DOI: 10.15420/ecr.2021.45] [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: 08/27/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Chest pain is one of the most common presenting symptoms in patients seeking care from a physician. Risk assessment tools and scores have facilitated prompt diagnosis and optimal management in these patients; however, it is unclear as to whether a standardised approach can adequately triage chest pain in cancer patients and survivors. This is of concern because cancer patients are often at an increased risk of cardiovascular mortality and morbidity given the shared risk factors between cancer and cardiovascular disease, compounded by the fact that certain anti-cancer therapies are associated with an increased risk of cardiovascular events that can persist for weeks and even years after treatment. This article describes the underlying mechanisms of the most common causes of chest pain in cancer patients with an emphasis on how their management may differ to that of non-cancer patients with chest pain. It will also highlight the role of the cardio-oncology team, who can aid in identifying cancer therapy-related cardiovascular side-effects and provide optimal multidisciplinary care for these patients.
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Affiliation(s)
- Sara Tyebally
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Aruni Ghose
- Oncology Department, St Bartholomew’s Hospital, London, UK
| | - Daniel H Chen
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
| | - Aderonke T Abiodun
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London, UK; Hatter Cardiovascular Institute, UCL Institute of Cardiovascular Science, University College London Hospital, London, UK
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Printezi MI, Yousif LIE, Kamphuis JAM, van Laake LW, Cramer MJ, Hobbelink MGG, Asselbergs FW, Teske AJ. LVEF by Multigated Acquisition Scan Compared to Other Imaging Modalities in Cardio-Oncology: a Systematic Review. Curr Heart Fail Rep 2022; 19:136-145. [PMID: 35355205 PMCID: PMC9177497 DOI: 10.1007/s11897-022-00544-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose of Review
The prevalence of cancer therapy-related cardiac dysfunction (CTRCD) is increasing due to improved cancer survival. Serial monitoring of cardiac function is essential to detect CTRCD, guiding timely intervention strategies. Multigated radionuclide angiography (MUGA) has been the main screening tool using left ventricular ejection fraction (LVEF) to monitor cardiac dysfunction. However, transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) may be more suitable for serial assessment. We aimed to assess the concordance between different non-radiating imaging modalities with MUGA to determine whether they can be used interchangeably.
Recent Findings
In order to identify relevant studies, a PubMed search was performed. We included cross-sectional studies comparing MUGA LVEF to that of 2D TTE, 3D TTE, and CMR. From 470 articles, 22 were selected, comprising 1017 patients in total. Among others, this included three 3D TTE, seven 2D harmonic TTE + contrast (2DHC), and seven CMR comparisons. The correlations and Bland-Altman limits of agreement varied for CMR but were stronger for 3D TTE and 2DHC.
Summary
Our findings suggest that MUGA and CMR should not be used interchangeably whereas 3D TTE and 2DHC are appropriate alternatives following an initial MUGA scan. We propose a multimodality diagnostic imaging strategy for LVEF monitoring in patients undergoing cancer treatment.
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Affiliation(s)
- Markella I Printezi
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Laura I E Yousif
- Graduate School of Life Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janine A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Linda W van Laake
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Room number F02.318, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Gal R, van Velzen SGM, Hooning MJ, Emaus MJ, van der Leij F, Gregorowitsch ML, Blezer ELA, Gernaat SAM, Lessmann N, Sattler MGA, Leiner T, de Jong PA, Teske AJ, Verloop J, Penninkhof JJ, Vaartjes I, Meijer H, van Tol-Geerdink JJ, Pignol JP, van den Bongard DHJG, Išgum I, Verkooijen HM. Identification of Risk of Cardiovascular Disease by Automatic Quantification of Coronary Artery Calcifications on Radiotherapy Planning CT Scans in Patients With Breast Cancer. JAMA Oncol 2021; 7:1024-1032. [PMID: 33956083 DOI: 10.1001/jamaoncol.2021.1144] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cardiovascular disease (CVD) is common in patients treated for breast cancer, especially in patients treated with systemic treatment and radiotherapy and in those with preexisting CVD risk factors. Coronary artery calcium (CAC), a strong independent CVD risk factor, can be automatically quantified on radiotherapy planning computed tomography (CT) scans and may help identify patients at increased CVD risk. Objective To evaluate the association of CAC with CVD and coronary artery disease (CAD) in patients with breast cancer. Design, Setting, and Participants In this multicenter cohort study of 15 915 patients with breast cancer receiving radiotherapy between 2005 and 2016 who were followed until December 31, 2018, age, calendar year, and treatment-adjusted Cox proportional hazard models were used to evaluate the association of CAC with CVD and CAD. Exposures Overall CAC scores were automatically extracted from planning CT scans using a deep learning algorithm. Patients were classified into Agatston risk categories (0, 1-10, 11-100, 101-399, >400 units). Main Outcomes and Measures Occurrence of fatal and nonfatal CVD and CAD were obtained from national registries. Results Of the 15 915 participants included in this study, the mean (SD) age at CT scan was 59.0 (11.2; range, 22-95) years, and 15 879 (99.8%) were women. Seventy percent (n = 11 179) had no CAC. Coronary artery calcium scores of 1 to 10, 11 to 100, 101 to 400, and greater than 400 were present in 10.0% (n = 1584), 11.5% (n = 1825), 5.2% (n = 830), and 3.1% (n = 497) respectively. After a median follow-up of 51.2 months, CVD risks increased from 5.2% in patients with no CAC to 28.2% in patients with CAC scores higher than 400. After adjustment, CVD risk increased with higher CAC score (hazard ratio [HR]CAC = 1-10 = 1.1; 95% CI, 0.9-1.4; HRCAC = 11-100 = 1.8; 95% CI, 1.5-2.1; HRCAC = 101-400 = 2.1; 95% CI, 1.7-2.6; and HRCAC>400 = 3.4; 95% CI, 2.8-4.2). Coronary artery calcium was particularly strongly associated with CAD (HRCAC>400 = 7.8; 95% CI, 5.5-11.2). The association between CAC and CVD was strongest in patients treated with anthracyclines (HRCAC>400 = 5.8; 95% CI, 3.0-11.4) and patients who received a radiation boost (HRCAC>400 = 6.1; 95% CI, 3.8-9.7). Conclusions and Relevance This cohort study found that coronary artery calcium on breast cancer radiotherapy planning CT scan results was associated with CVD, especially CAD. Automated CAC scoring on radiotherapy planning CT scans may be used as a fast and low-cost tool to identify patients with breast cancer at increased risk of CVD, allowing implementing CVD risk-mitigating strategies with the aim to reduce the risk of CVD burden after breast cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03206333.
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Affiliation(s)
- Roxanne Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Sanne G M van Velzen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marleen J Emaus
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Madelijn L Gregorowitsch
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Erwin L A Blezer
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Sofie A M Gernaat
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Karolinska University, Stockholm, Sweden
| | - Nikolas Lessmann
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Margriet G A Sattler
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Centre, University of Utrecht, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, Utrecht University Medical Centre, University of Utrecht, Utrecht, the Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Janneke Verloop
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Joan J Penninkhof
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboudumc, Nijmegen, the Netherlands
| | | | - Jean-Philippe Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Hsu CD, Nichols HB, Lund JL. Polypharmacy and medication use by cancer history in a nationally representative group of adults in the USA, 2003-2014. J Cancer Surviv 2021; 16:659-666. [PMID: 34032998 DOI: 10.1007/s11764-021-01059-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study examines polypharmacy and prescription drug use patterns in cancer survivors, a growing population at risk for cancer sequelae and side effects from treatment, which can arise months or even years following diagnosis. Survivors may experience greater medication burden than the general population, increasing concerns for polypharmacy and subsequent risks of drug interactions and non-adherence. METHODS Using the National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2014, we examined the association between a cancer history and presence of polypharmacy (5+ medications). We estimated prevalence ratios and prevalence differences for polypharmacy comparing those with and without a cancer history using binomial regression models and propensity score (PS) weighting to account for baseline differences between groups. RESULTS We identified 32,238 adults aged 20 years or older; 1899 had cancer (excluding non-melanoma skin) at least 1 year before the survey. Overall, polypharmacy prevalence was 13% and 35% in those with and without a cancer history, respectively. After PS weighting, the polypharmacy prevalence was 1.26 times higher among those with versus without a cancer history (weighted prevalence ratio, 1.26; 95% CI, 1.18, 1.35). In sub-group analyses, the weighted prevalence ratio was largest for those 20-39 years old at survey (2.78; 95% CI, 1.71, 4.53), and the weighted prevalence difference was largest for those 40-64 years old at survey (9.35%; 95% CI, 5.70%, 13.01%). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors of all ages take more medications than those without cancer history and may benefit from discussions with providers about age-tailored medication use management.
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Affiliation(s)
- Christine D Hsu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kamphuis JAM, Linschoten M, Cramer MJ, Alsemgeest F, van Kessel DJW, Urgel K, Post MC, Manintveld OC, Hassing HC, Liesting C, Wardeh AJ, Olde Bijvank EGM, Schaap J, Stevense-den Boer AM, Doevendans PA, Asselbergs FW, Teske AJ. ONCOR: design of the Dutch cardio-oncology registry. Neth Heart J 2021; 29:288-294. [PMID: 33201485 PMCID: PMC8062648 DOI: 10.1007/s12471-020-01517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The relative new subspecialty 'cardio-oncology' was established to meet the growing demand for an interdisciplinary approach to the management of cancer therapy-related cardiovascular adverse events. In recent years, specialised cardio-oncology services have been implemented worldwide, which all strive to improve the cardiovascular health of cancer patients. However, limited data are currently available on the outcomes and experiences of these specialised services, and optimal strategies for cardio-oncological care have not been established. AIM The ONCOR registry has been created for prospective data collection and evaluation of cardio-oncological care in daily practice. METHODS Dutch hospitals using a standardised cardio-oncology care pathway are included in this national, multicentre, observational cohort study. All patients visiting these cardio-oncology services are eligible for study inclusion. Data collection at baseline consists of the (planned) cancer treatment and the cardiovascular risk profile, which are used to estimate the cardiotoxic risk. Information regarding invasive and noninvasive tests is collected during the time patients receive cardio-oncological care. Outcome data consist of the incidence of cardiovascular complications and major adverse cardiac events, and the impact of these events on the oncological treatment. DISCUSSION Outcomes of the ONCOR registry may aid in gaining more insight into the incidence of cancer therapy-related cardiovascular complications. The registry facilitates research on mechanisms of cardiovascular complications and on diagnostic, prognostic and therapeutic strategies. In addition, it provides a platform for future (interventional) studies. Centres with cardio-oncology services that are interested in contributing to the ONCOR registry are hereby invited to participate.
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Affiliation(s)
- J A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F Alsemgeest
- Department of Cardiology, St Jansdal Hospital, Harderwijk, The Netherlands
| | - D J W van Kessel
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - K Urgel
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M C Post
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - O C Manintveld
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H C Hassing
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C Liesting
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A J Wardeh
- Department of Cardiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - E G M Olde Bijvank
- Department of Cardiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - J Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | | | - P A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Health Data Research UK, Institute of Health Informatics and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - A J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Faramand Z, Li H, Al-Rifai N, Frisch SO, Abu-Jaradeh O, Mahmoud A, Al-Zaiti S. Association between history of cancer and major adverse cardiovascular events in patients with chest pain presenting to the emergency department: a secondary analysis of a prospective cohort study. Eur J Emerg Med 2021; 28:64-69. [PMID: 32947416 PMCID: PMC7770076 DOI: 10.1097/mej.0000000000000753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cancer survivorship status among patients evaluated for chest pain at the emergency department (ED) warrants high degree of suspicion. However, it remains unclear whether cancer survivorship is associated with different risk of major adverse cardiac events (MACE) compared to those with no history of cancer. Furthermore, while HEART score is widely used in ED evaluation, it is unclear whether it can adequately triage chest pain events in cancer survivors. We sought to compare the rate of MACE in patients with a recent history of cancer in remission evaluated for acute chest pain at the ED to those with no history of cancer, and compare the performance of a common chest pain risk stratification score (HEART) between the two groups. METHODS We performed a secondary analysis of a prospective observational cohort study of chest pain patients presenting to the EDs of three tertiary care hospitals in the USA. Cancer survivorship status, HEART scores, and the presence of MACE within 30 days of admission were retrospectively adjudicated from the charts. We defined patients with recent history of cancer in remission as those with a past history of cancer of less than 10 years, and currently cured or in remission. RESULTS The sample included 750 patients (age: 59 ± 17; 42% females, 40% Black), while 69 patients (9.1%) had recent history of cancer in remission. A cancer in remission status was associated with a higher comorbidity burden, older age, and female sex. There was no difference in risk of MACE between those with a cancer in remission and their counterparts in both univariate [17.4 vs. 19.5%, odds ratio (OR) = 0.87 (95% confidence interval (CI), 0.45-1.66], P = 0.67] and multivariable analysis adjusting for demographics and comorbidities [OR = 0.62 (95% CI, 0.31-1.25), P = 0.18]. Patients with cancer in remission had higher HEART score (4.6 ± 1.8 vs. 3.9 ± 2.0, P = 0.006), and a higher proportion triaged as intermediate risk [68 vs. 56%, OR = 1.67 (95% CI, 1.00-2.84), P = 0.05]; however, no difference in the performance of HEART score existed between the groups (area under the curve = 0.86 vs. 0.84, P = 0.76). CONCLUSIONS There was no difference in rate of MACE between those with recent history of cancer in remission compared to their counterparts. A higher proportion of patients with cancer in remission was triaged as intermediate risk by the HEART score, but we found no difference in the performance of the HEART score between the groups.
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Affiliation(s)
- Ziad Faramand
- Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hongjin Li
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, Illinois
| | - Nada Al-Rifai
- Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Stephanie O Frisch
- Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Omar Abu-Jaradeh
- Department of Medicine, Kent Hospital, Warwick, Rhode Island, USA
| | - Ahmad Mahmoud
- Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Salah Al-Zaiti
- Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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8
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Patient-reported health problems and healthcare use after treatment for early-stage breast cancer. Breast 2019; 46:4-11. [DOI: 10.1016/j.breast.2019.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
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9
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Teske AJ, Linschoten M, Kamphuis JAM, Naaktgeboren WR, Leiner T, van der Wall E, Kuball J, van Rhenen A, Doevendans PA, Cramer MJ, Asselbergs FW. Cardio-oncology: an overview on outpatient management and future developments. Neth Heart J 2018; 26:521-532. [PMID: 30141030 PMCID: PMC6220023 DOI: 10.1007/s12471-018-1148-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent advances in the early detection and treatment of cancer have led to increasing numbers of cancer survivors worldwide. Nonetheless, despite major improvements in the outcome of these patients, long-term side effects of radio- and chemotherapy affect both patient survival and quality of life, independent of the oncological prognosis. Chemotherapy-related cardiac dysfunction is one of the most notorious short-term side effects of anticancer treatment, occurring in ~10% of patients. Progression to overt heart failure carries a strikingly poor prognosis with a 2-year mortality rate of 60%. Early detection of left ventricular damage by periodic monitoring and prompt initiation of heart failure treatment is key in improving cardiovascular prognosis. To meet the growing demand for a specialised interdisciplinary approach for the prevention and management of cardiovascular complications induced by cancer treatment, a new discipline termed cardio-oncology has evolved. However, an uniform, multidisciplinary approach is currently lacking in the Netherlands. This overview provides an introduction and comprehensive summary of this emerging discipline and offers a practical strategy for the outpatient management of this specific patient population.
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Affiliation(s)
- A J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - M Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - W R Naaktgeboren
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Kuball
- Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A van Rhenen
- Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
- Durrer Centre for Cardiovascular Research, Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
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de Roos A. Onco-Cardiology: Value of Cardiac Imaging by Using CT and MRI after Radiation Therapy. Radiology 2018; 289:355-356. [DOI: 10.1148/radiol.2018181039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Albert de Roos
- From the Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
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Manolis AA, Manolis TA, Mikhailidis DP, Manolis AS. Cardiovascular safety of oncologic agents: A double-edged sword even in the era of targeted therapies - part 1. Expert Opin Drug Saf 2018; 17:875-892. [PMID: 30126304 DOI: 10.1080/14740338.2018.1513488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with cancer are subject to the cardiotoxic effects of cancer therapy and as more patients survive cancer due to improved treatment they are exposed to various forms of cardiovascular (CV) disease as they age, and vice-versa. Such an interplay of age with both malignancy and CV disease may contribute to increased morbidity and mortality. AREAS COVERED This two-part review considers the effects of cancer drug treatment on the CV system. In Part I, the various types of CV and cardiometabolic toxicity of anti-cancer drugs and the possible mechanisms involved are discussed. Also, among the specific oncologic agents, the CV effects of the classical agents and of the large molecule immunological agents (monoclonal antibodies, including immune checkpoint inhibitors) are detailed. EXPERT OPINION Oncologic agents produce a variety of CV adverse effects, including cardiomyopathy and heart failure, peri-myocarditis, coronary artery disease, peripheral vascular disease, hypertension (HTN), cardiac arrhythmias, valvular heart disease, and pulmonary HTN. Both the oncologist and the cardiologist need to be aware of such adverse effects and of the specific agents that produce them. They need to join forces to prevent, anticipate, recognize, and manage such complications.
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Affiliation(s)
| | | | - Dimitri P Mikhailidis
- c Department of Clinical Biochemistry , University College London Medical School , London , UK
| | - Antonis S Manolis
- d Third Department of Cardiology , Athens University School of Medicine , Athens , Greece
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Increased Plasma Nitrite and von Willebrand Factor Indicates Early Diagnosis of Vascular Diseases in Chemotherapy Treated Cancer Patients. Cardiovasc Toxicol 2018; 19:36-47. [DOI: 10.1007/s12012-018-9471-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bollini S, Silini AR, Banerjee A, Wolbank S, Balbi C, Parolini O. Cardiac Restoration Stemming From the Placenta Tree: Insights From Fetal and Perinatal Cell Biology. Front Physiol 2018; 9:385. [PMID: 29695981 PMCID: PMC5904405 DOI: 10.3389/fphys.2018.00385] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022] Open
Abstract
Efficient cardiac repair and ultimate regeneration still represents one of the main challenges of modern medicine. Indeed, cardiovascular disease can derive from independent conditions upsetting heart structure and performance: myocardial ischemia and infarction (MI), pharmacological cardiotoxicity, and congenital heart defects, just to name a few. All these disorders have profound consequences on cardiac tissue, inducing the onset of heart failure over time. Since the cure is currently represented by heart transplantation, which is extremely difficult due to the shortage of donors, much effort is being dedicated to developing innovative therapeutic strategies based on stem cell exploitation. Among the broad scenario of stem/progenitor cell subpopulations, fetal and perinatal sources, namely amniotic fluid and term placenta, have gained interest due to their peculiar regenerative capacity, high self-renewal capability, and ease of collection from clinical waste material. In this review, we will provide the state-of-the-art on fetal perinatal stem cells for cardiac repair and regeneration. We will discuss different pathological conditions and the main therapeutic strategies proposed, including cell transplantation, putative paracrine therapy, reprogramming, and tissue engineering approaches.
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Affiliation(s)
- Sveva Bollini
- Regenerative Medicine Laboratory, Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Antonietta R Silini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - Asmita Banerjee
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Susanne Wolbank
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Carolina Balbi
- Regenerative Medicine Laboratory, Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Ornella Parolini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy.,Institute of Human Anatomy and Cell Biology, "A. Gemelli" Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
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