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Kim J, Hong YJ, Han K, Kim JY, Lee HJ, Hur J, Kim YJ, Choi BW. Chemotherapy-Related Cardiac Dysfunction: Quantitative Cardiac Magnetic Resonance Image Parameters and Their Prognostic Implications. Korean J Radiol 2023; 24:838-848. [PMID: 37634639 PMCID: PMC10462900 DOI: 10.3348/kjr.2023.0095] [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: 10/28/2022] [Revised: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). MATERIALS AND METHODS A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. RESULTS Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m² vs. 78.9 g/m²; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01-1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. CONCLUSION Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.
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Affiliation(s)
- Jinhee Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Gileva A, Trushina D, Yagolovich A, Gasparian M, Kurbanova L, Smirnov I, Burov S, Markvicheva E. Doxorubicin-Loaded Polyelectrolyte Multilayer Capsules Modified with Antitumor DR5-Specific TRAIL Variant for Targeted Drug Delivery to Tumor Cells. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:902. [PMID: 36903780 PMCID: PMC10005140 DOI: 10.3390/nano13050902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Recently, biodegradable polyelectrolyte multilayer capsules (PMC) have been proposed for anticancer drug delivery. In many cases, microencapsulation allows to concentrate the substance locally and prolong its flow to the cells. To reduce systemic toxicity when delivering highly toxic drugs, such as doxorubicin (DOX), the development of a combined delivery system is of paramount importance. Many efforts have been made to exploit the DR5-dependent apoptosis induction for cancer treatment. However, despite having a high antitumor efficacy of the targeted tumor-specific DR5-B ligand, a DR5-specific TRAIL variant, its fast elimination from a body limits its potential use in a clinic. A combination of an antitumor effect of the DR5-B protein with DOX loaded in the capsules could allow to design a novel targeted drug delivery system. The aim of the study was to fabricate PMC loaded with a subtoxic concentration of DOX and functionalized with the DR5-B ligand and to evaluate a combined antitumor effect of this targeted drug delivery system in vitro. In this study, the effects of PMC surface modification with the DR5-B ligand on cell uptake both in 2D (monolayer culture) and 3D (tumor spheroids) were studied by confocal microscopy, flow cytometry and fluorimetry. Cytotoxicity of the capsules was evaluated using an MTT test. The capsules loaded with DOX and modified with DR5-B demonstrated synergistically enhanced cytotoxicity in both in vitro models. Thus, the use of the DR5-B-modified capsules loaded with DOX at a subtoxic concentration could provide both targeted drug delivery and a synergistic antitumor effect.
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Affiliation(s)
- Anastasia Gileva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
| | - Daria Trushina
- Laboratory of Bioorganic Structures, Shubnikov Institute of Crystallography of Federal Scientific Research Centre “Crystallography and Photonics” of Russian Academy of Sciences, 119333 Moscow, Russia
| | - Anne Yagolovich
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
- Faculty of Biology, Lomonosov Moscow State University, 119192 Moscow, Russia
| | - Marine Gasparian
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
| | - Leyli Kurbanova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
| | - Ivan Smirnov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
| | - Sergey Burov
- Cytomed JSC, Orlovo-Denisovsky pr. 14, 197375 St. Petersburg, Russia
| | - Elena Markvicheva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry RAS, 117997 Moscow, Russia
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Wei X, Lin L, Zhang G, Zhou X. Cardiovascular Magnetic Resonance Imaging in the Early Detection of Cardiotoxicity Induced by Cancer Therapies. Diagnostics (Basel) 2022; 12:diagnostics12081846. [PMID: 36010197 PMCID: PMC9406931 DOI: 10.3390/diagnostics12081846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
The significant progress in cancer treatment, including chemotherapy, immunotherapy, radiotherapy, and combination therapies, has led to higher long-term survival rates in cancer patients, while the cardiotoxicity caused by cancer treatment has become increasingly prominent. Cardiovascular magnetic resonance (CMR) is a non-invasive comprehensive imaging modality that provides not only anatomical information, but also tissue characteristics and cardiometabolic and energetic assessment, leading to its increased use in the early identification of cardiotoxicity, and is of major importance in improving the survival rate of cancer patients. This review focused on CMR techniques, including myocardial strain analysis, T1 mapping, T2 mapping, and extracellular volume fraction (ECV) calculation in the detection of early myocardial injury induced by cancer therapies. We summarized the existing studies and ongoing clinical trials using CMR for the assessment of subclinical ventricular dysfunction and myocardial changes at the tissue level. The main focus was to explore the potential of clinical and preclinical CMR techniques for continuous non-invasive monitoring of myocardial toxicity associated with cancer therapy.
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Iskander J, Kelada P, Rashad L, Massoud D, Afdal P, Abdelmassih AF. Advanced Echocardiography Techniques: The Future Stethoscope of Systemic Diseases. Curr Probl Cardiol 2022; 47:100847. [PMID: 33992429 PMCID: PMC9046647 DOI: 10.1016/j.cpcardiol.2021.100847] [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: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease (CVD) has been showing patterns of extensive rise in prevalence in the contemporary era, affecting the quality of life of millions of people and leading the causes of death worldwide. It has been a provocative challenge for modern medicine to diagnose CVD in its crib, owing to its etiological factors being attributed to a large array of systemic diseases, as well as its non-binary hideous nature that gradually leads to functional disability. Novel echocardiography techniques have enabled the cardiac ultrasound to provide a comprehensive analysis of the heart in an objective, feasible, time- and cost-effective manner. Speckle tracking echocardiography, contrast echocardiography, and 3D echocardiography have shown the highest potential for widespread use. The uses of novel modalities have been elaborately demonstrated in this study as a proof of concept that echocardiography has a place in routine general practice with supportive evidence being as recent as its role in the concurrent COVID-19 pandemic. Despite such evidence, many uses remain off-label and unexploited in practice. Generalization of echocardiography at the point of care can become a much-needed turning point in the clinical approach to case management. To actualize such aspirations, we recommend further prospective and interventional studies to examine the effect of implementing advanced techniques at the point of care on the decision-making process and evaluate their effectiveness in prevention of cardiovascular morbidities and mortalities.
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Affiliation(s)
- John Iskander
- Faculty of Medicine, Cairo University, Cairo, Egypt,Corresponding author: John Iskander, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Kelada
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lara Rashad
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Massoud
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Afdal
- Residency program, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Antoine Fakhry Abdelmassih
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, Egypt,Consultant of Pediatric Cardiology, Children Cancer Hospital of Egypt (57357 Hospital), Cairo, Egypt
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The efficacy and safety of high-intensity interval training in chemotherapy-related cardiomyopathy: Report of two cases. Turk J Phys Med Rehabil 2022; 68:290-294. [PMID: 35989957 PMCID: PMC9366486 DOI: 10.5606/tftrd.2022.7375] [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: 09/08/2020] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
Abstract
Studies suggest that exercise regimens are beneficial across all phases of cancer treatment and rehabilitation. However, studies on the efficacy and safety of cardiac rehabilitation in patients with chemotherapy-related cardiomyopathy are lacking. Herein, we present two patients diagnosed with chemotherapy-related cardiomyopathy who participated in a cardiac rehabilitation program, including eight weeks of high-intensity interval training, and their exercise capacity was monitored. Both patients showed significant increases in peak oxygen consumption and 6-min walk distance. High-intensity interval training results in objective improvements in aerobic exercise capacity without serious cardiovascular complications in patients with chemotherapy-related cardiomyopathy.
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Akgoz H, Gurkan U. Subclinical myocardial dysfunction in patients with complete recovery from peripartum cardiomyopathy: a long-term clinical strain-echocardiographic study. Hypertens Pregnancy 2022; 41:89-96. [DOI: 10.1080/10641955.2022.2046049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Haldun Akgoz
- Cardiology Department, Acıbadem Kadıkoy Hospital, Istanbul, Turkey
| | - Ufuk Gurkan
- Cardiology Department, Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
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Cardiovascular toxicity of PI3Kα inhibitors. Clin Sci (Lond) 2021; 134:2595-2622. [PMID: 33063821 DOI: 10.1042/cs20200302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
The phosphoinositide 3-kinases (PI3Ks) are a family of intracellular lipid kinases that phosphorylate the 3'-hydroxyl group of inositol membrane lipids, resulting in the production of phosphatidylinositol 3,4,5-trisphosphate from phosphatidylinositol 4,5-bisphosphate. This results in downstream effects, including cell growth, proliferation, and migration. The heart expresses three PI3K class I enzyme isoforms (α, β, and γ), and these enzymes play a role in cardiac cellular survival, myocardial hypertrophy, myocardial contractility, excitation, and mechanotransduction. The PI3K pathway is associated with various disease processes but is particularly important to human cancers since many gain-of-function mutations in this pathway occur in various cancers. Despite the development, testing, and regulatory approval of PI3K inhibitors in recent years, there are still significant challenges when creating and utilizing these drugs, including concerns of adverse effects on the heart. There is a growing body of evidence from preclinical studies revealing that PI3Ks play a crucial cardioprotective role, and thus inhibition of this pathway could lead to cardiac dysfunction, electrical remodeling, vascular damage, and ultimately, cardiovascular disease. This review will focus on PI3Kα, including the mechanisms underlying the adverse cardiovascular effects resulting from PI3Kα inhibition and the potential clinical implications of treating patients with these drugs, such as increased arrhythmia burden, biventricular cardiac dysfunction, and impaired recovery from cardiotoxicity. Recommendations for future directions for preclinical and clinical work are made, highlighting the possible role of PI3Kα inhibition in the progression of cancer-related cachexia and female sex and pre-existing comorbidities as independent risk factors for cardiac abnormalities after cancer treatment.
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Doxorubicin-loaded biodegradable capsules: Temperature induced shrinking and study of cytotoxicity in vitro. J Mol Liq 2019. [DOI: 10.1016/j.molliq.2019.03.152] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kelly B, Carton E. Extended Indications for Extracorporeal Membrane Oxygenation in the Operating Room. J Intensive Care Med 2019; 35:24-33. [DOI: 10.1177/0885066619842537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:The use of extracorporeal life support (ECLS) for cardiorespiratory support is increasing. Traditional absolute contraindications are currently deemed relative contraindications. Extracorporeal life support is now considered for a wider cohort of patients on a case-by-case basis.Method:We performed a review of the literature and examined current Extracorporeal Life Support Organization guidelines that support the use of ECLS in the operating room, based on the underlying pathology and surgical procedure proposed. We discuss specific surgical populations and different modes of ECLS and cannulation strategies.Results:Based on the available literature, veno-venous extracorporeal membrane oxygenation (ECMO) can be used for the management of complex tracheobronchial and lung surgery, both in the elective and in the emergent setting. Elective veno-arterial (V-A) ECMO for cardiocirculatory support should be considered in high-risk patients undergoing ventricular tachycardia ablation. Extracorporeal life support should be considered as a potential life-saving intervention in almost all parturients with severe respiratory failure or refractory cardiogenic shock. V-A ECMO should be considered in unanticipated intraoperative cardiac arrest in patients without preexisting end-organ failure.Conclusion:As the number of indications for ECLS in the operating room is growing, anesthesiology and surgical staff should become familiar with the perioperative management of patients on ECLS.
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Affiliation(s)
- Barry Kelly
- Department of Critical Care Anesthesia and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Edmund Carton
- Mater Misericordiae University Hospital (MMUH), University College Dublin, Dublin, Ireland
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Snipelisky D, Park JY, Lerman A, Mulvagh S, Lin G, Pereira N, Rodriguez-Porcel M, Villarraga HR, Herrmann J. How to Develop a Cardio-Oncology Clinic. Heart Fail Clin 2017; 13:347-359. [PMID: 28279420 DOI: 10.1016/j.hfc.2016.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiovascular demands to the care of cancer patients are common and important given the implications for morbidity and mortality. As a consequence, interactions with cardiovascular disease specialists have intensified to the point of the development of a new discipline termed cardio-oncology. As an additional consequence, so-called cardio-oncology clinics have emerged, in most cases staffed by cardiologists with an interest in the field. This article addresses this gap and summarizes key points in the development of a cardio-oncology clinic.
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Affiliation(s)
- David Snipelisky
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jae Yoon Park
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Sharon Mulvagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Grace Lin
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Naveen Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Martin Rodriguez-Porcel
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Cardiomyopathic Toxicity From Chemotherapy: Is There an Opportunity for Preemptive Intervention? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:20. [PMID: 28299613 DOI: 10.1007/s11936-017-0517-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OPINION STATEMENT The fight against cancer has never appeared more optimistic with multiple ongoing advances in cancer therapeutics; however, the prevention of cardiotoxicity from these treatments, both old and new, is a major focus of recent research. We recommend conceptualizing the prevention of cardiotoxicity as binary whereby primary prevention involves a uniform application of preventative efforts to anyone receiving a potentially cardiotoxic drug and secondary prevention directed towards those with left ventricular dysfunction, whether symptomatic or not. Recent studies suggest that cardioprotective medications such as renin-angiotensin inhibitors and beta blockers, among others, may be beneficial in the primary prevention of cardiotoxicity. Importantly, the magnitude of this protective effect appears to be driven by baseline risk of cardiac disease. In terms of secondary prevention, we recommend that patients with symptomatic heart failure related to cancer treatment should be treated as aggressively as patients with heart failure from other causes, as indicated by the most recent guidelines. We identify a relative paucity of data to guide those with asymptomatic left ventricular dysfunction. We summarize the literature to date with an emphasis on recent investigation and outline the importance of a continued partnership between cardiologists, oncologists, and primary care providers.
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Wang K, Eblan MJ, Deal AM, Lipner M, Zagar TM, Wang Y, Mavroidis P, Lee CB, Jensen BC, Rosenman JG, Socinski MA, Stinchcombe TE, Marks LB. Cardiac Toxicity After Radiotherapy for Stage III Non-Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy. J Clin Oncol 2017; 35:1387-1394. [PMID: 28113017 DOI: 10.1200/jco.2016.70.0229] [Citation(s) in RCA: 281] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The significance of radiotherapy (RT) -associated cardiac injury for stage III non-small-cell lung cancer (NSCLC) is unclear, but higher heart doses were associated with worse overall survival in the Radiation Therapy Oncology Group (RTOG) 0617 study. We assessed the impact of heart dose in patients treated at our institution on several prospective dose-escalation trials. Patients and Methods From 1996 to 2009, 127 patients with stage III NSCLC (Eastern Cooperative Oncology Group performance status, 0 to 1) received dose-escalated RT to 70 to 90 Gy (median, 74 Gy) in six trials. RT plans and cardiac doses were reviewed. Records were reviewed for the primary end point: symptomatic cardiac events (symptomatic pericardial effusion, acute coronary syndrome, pericarditis, significant arrhythmia, and heart failure). Cardiac risk was assessed by noting baseline coronary artery disease and calculating the WHO/International Society of Hypertension score. Competing risks analysis was used. Results In all, 112 patients were analyzed. Median follow-up for surviving patients was 8.8 years. Twenty-six patients (23%) had one or more events at a median of 26 months to first event (effusion [n = 7], myocardial infarction [n = 5], unstable angina [n = 3], pericarditis [n = 2], arrhythmia [n = 12], and heart failure [n = 1]). Heart doses (eg, heart mean dose; hazard ratio, 1.03/Gy; P = .002,), coronary artery disease ( P < .001), and WHO/International Society of Hypertension score ( P = .04) were associated with events on univariable analysis. Heart doses remained significant on multivariable analysis that accounted for baseline risk. Two-year competing risk-adjusted event rates for patients with heart mean dose < 10 Gy, 10 to 20 Gy, or ≥ 20 Gy were 4%, 7%, and 21%, respectively. Heart doses were not associated with overall survival. Conclusion Cardiac events were relatively common after high-dose thoracic RT and were independently associated with both heart dose and baseline cardiac risk. RT-associated cardiac toxicity after treatment of stage III NSCLC may occur earlier than historically understood, and heart doses should be minimized.
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Affiliation(s)
- Kyle Wang
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Michael J Eblan
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Allison M Deal
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Matthew Lipner
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Timothy M Zagar
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Yue Wang
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Panayiotis Mavroidis
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Carrie B Lee
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Brian C Jensen
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Julian G Rosenman
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Mark A Socinski
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Thomas E Stinchcombe
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
| | - Lawrence B Marks
- Kyle Wang, Michael J. Eblan, Matthew Lipner, Timothy M. Zagar, Panayiotis Mavroidis, Carrie B. Lee, Brian C. Jensen, Julian G. Rosenman, and Lawrence B. Marks, University of North Carolina Hospitals; Allison M. Deal and Yue Wang, Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill; Thomas E. Stinchcombe, Duke University Hospitals, Durham, NC; and Mark A. Socinski, Florida Hospital Cancer Institute, Orlando, FL
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Nair N, Gongora E. Heart failure in chemotherapy-related cardiomyopathy: Can exercise make a difference? BBA CLINICAL 2016; 6:69-75. [PMID: 27413695 PMCID: PMC4925806 DOI: 10.1016/j.bbacli.2016.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 12/20/2022]
Abstract
Medical therapies in oncology have resulted in better survival resulting in a large population who are at risk of early and late cardiac complications of chemotherapy. Cardiotoxicity related to chemotherapy can manifest decades after treatment with a threefold higher mortality rate as compared to idiopathic dilated cardiomyopathy. The leading cause of death in cancer survivors seems to be cardiac. Early detection and intervention could prevent progression of heart failure to end stage disease requiring advanced therapies such as implantation of ventricular assist devices or cardiac transplantation. This review focuses on the role of exercise in cardioprotection in this population. The current practice of depending on ejection fraction for diagnosis of heart failure is suboptimal to detect subclinical disease. It is also important to diagnose and treat early diastolic dysfunction as this tends to lead to heart failure with preserved ejection fraction. Hence we suggest an algorithm here that is based on using strain rate and tissue Doppler imaging modalities to detect subclinical systolic and diastolic dysfunction. Further research is warranted in terms of defining exercise prescriptions in this population. Human studies with multicenter participation in randomized controlled trials should be done to elucidate the intricacies of aerobic exercise intervention in cardiotoxicity dependent heart failure. It is also necessary to assess the utility of exercise interventions in the different chemotherapeutic regimens as they impact the outcomes. The need for exercise prescription to prevent cardiotoxicity in chemotherapy patients The molecular basis of exercise as an intervention Summary of existing evidence Need for further studies on the role of exercise in different chemotherapeutic regimens
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Affiliation(s)
- Nandini Nair
- Division of Cardiology, Texas Tech Health Sciences Center, Lubbock, TX 79382, United States
| | - Enrique Gongora
- Memorial Cardiac and Vascular Institute, Hollywood, FL 33021, United States
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Fei HW, Ali MT, Tan TC, Cheng KH, Salama L, Hua L, Zeng X, Halpern EF, Taghian A, MacDonald SM, Scherrer-Crosbie M. Left Ventricular Global Longitudinal Strain in HER-2 + Breast Cancer Patients Treated with Anthracyclines and Trastuzumab Who Develop Cardiotoxicity Is Associated with Subsequent Recovery of Left Ventricular Ejection Fraction. Echocardiography 2016; 33:519-26. [DOI: 10.1111/echo.13168] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Hong-wen Fei
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
- Division of Adult Echocardiography; Guangdong Provincial Cardiovascular Institute; Guangdong General Hospital and Guangdong Academy of Medical Sciences; Guangzhou China
| | - Mohammed T. Ali
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Timothy C. Tan
- Blacktown Clinical School; Department of Cardiology; Faculty of Medicine; University of Western Sydney; Sydney NSW Australia
- School of Medical Sciences; Faculty of Medicine; University of New South Wales; Sydney NSW Australia
| | - Kai-Hung Cheng
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Laura Salama
- Department of Radiation Oncology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Lanqi Hua
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Xin Zeng
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Elkan F. Halpern
- Institute for Technology Assessment; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Alphonse Taghian
- Department of Radiation Oncology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Shannon M. MacDonald
- Department of Radiation Oncology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Marielle Scherrer-Crosbie
- Cardiac Ultrasound Laboratory; Division of Cardiology; Department of Medicine; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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Morbidelli L, Donnini S, Ziche M. Targeting endothelial cell metabolism for cardio-protection from the toxicity of antitumor agents. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2016; 2:3. [PMID: 33530139 PMCID: PMC7837145 DOI: 10.1186/s40959-016-0010-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/16/2016] [Indexed: 12/17/2022]
Abstract
The vascular endothelium plays a fundamental role in the maintenance of tissue homeostasis, regulating local blood flow and other physiological processes. Chemotherapeutic drugs and target therapies, including antiangiogenic drugs targeting vascular endothelial growth factor (VEGF) or its receptors, not only efficiently act against tumor growth, but may also induce endothelial dysfunction and cardiovascular toxicity. Continued research efforts aim to better understand, prevent and mitigate these chemotherapy associated cardiovascular diseases. Conventional chemotherapeutic agents, such as anthracyclines, platinum compounds, and taxanes, and newer targeted agents, such as bevacizumab, trastuzumab, and tyrosine kinase inhibitors, have known risk of cardiovascular toxicity, which can limit their effectiveness by promoting increased morbidity and/or mortality. This review describes a) the activity of anticancer agents in inducing endothelial dysfunction, b) the metabolic pathways and signalling cascades which may be targeted by protective agents able to maintain or restore endothelial cell function, such as endothelial nitric oxide synthase/fibroblast growth factor-2 (eNOS-FGF-2) pathway, and c) the drugs/strategies reported to improve endothelial function and to reduce the risks of cardiovascular diseases such as angiotensin converting enzyme inhibitors (ACEi) and beta blockers, that are fundamental therapies in chronic heart failure (HF), as well as non-standard HF treatments such ad nitric oxide donors and antioxidant strategies. There is increasing interest in whether ACEi, beta-blockers, and/or statins might prevent and/or therapeutically control cardiotoxic effects in cancer patients. Maintaining endothelial function during or following treatments with chemotherapeutic agents, without affecting anti-tumor drug-effectiveness, is essential for preserving or recovering cardiovascular homeostasis. In this respect, the early detection and immediate therapy of cardiovascular toxicity appear crucial for substantial recovery of cardiac function in cancer patients.
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Affiliation(s)
- Lucia Morbidelli
- Department of Life Sciences, University of Siena, Via A. Moro 2, 53100 Siena, Italy
| | - Sandra Donnini
- Department of Life Sciences, University of Siena, Via A. Moro 2, 53100 Siena, Italy
| | - Marina Ziche
- Department of Life Sciences, University of Siena, Via A. Moro 2, 53100 Siena, Italy
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17
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Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy. Case Rep Cardiol 2015; 2015:625451. [PMID: 26448882 PMCID: PMC4581496 DOI: 10.1155/2015/625451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/27/2015] [Indexed: 12/27/2022] Open
Abstract
Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is
a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later.
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Capocaccia R, Gatta G, Dal Maso L. Life expectancy of colon, breast, and testicular cancer patients: an analysis of US-SEER population-based data. Ann Oncol 2015; 26:1263-1268. [PMID: 25735314 DOI: 10.1093/annonc/mdv131] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer survivorship is an increasingly important issue in cancer control. Life expectancy of patients diagnosed with breast, colon, and testicular cancers, stratified by age at diagnosis and time since diagnosis, is provided as an indicator to evaluate future mortality risks and health care needs of cancer survivors. PATIENTS AND METHODS The standard period life table methodology was applied to estimate excess mortality risk for cancer patients diagnosed in 1985-2011 from SEER registries and mortality data of the general US population. The sensitivity of life expectancy estimates on different assumptions was evaluated. RESULTS Younger patients with colon cancer showed wider differences in life expectancy compared with that of the general population (11.2 years in women and 10.7 in men at age 45-49 years) than older patients (6.3 and 5.8 at age 60-64 years, respectively). Life expectancy progressively increases in patients surviving the first years, up to 4 years from diagnosis, and then starts to decrease again, approaching that of the general population. For breast cancer, the initial drop in life expectancy is less marked, and again with wider differences in younger patients, varying from 8.7 at age 40-44 years to 2.4 at ages 70-74 years. After diagnosis, life expectancy still decreases with time, but less than that in the general population, slowly approaching that of cancer-free women. Life expectancy of men diagnosed with testicular cancer at age 30 years is estimated as 45.2 years, 2 years less than cancer-free men of the same age. The difference becomes 1.3 years for patients surviving the first year, and then slowly approaches zero with increasing survival time. CONCLUSIONS Life expectancy provides meaningful information on cancer patients, and can help in assessing when a cancer survivor can be considered as cured.
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Affiliation(s)
- R Capocaccia
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Foundation National Cancer Institute, Milan; National Center of Epidemiology, Cancer Epidemiology Unit, National Institute of Health, Rome.
| | - G Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Foundation National Cancer Institute, Milan
| | - L Dal Maso
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
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Shim WJ. Role of echocardiography in the management of cardiac disease in women. J Cardiovasc Ultrasound 2014; 22:173-9. [PMID: 25580190 PMCID: PMC4286637 DOI: 10.4250/jcu.2014.22.4.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 12/14/2022] Open
Abstract
The widespread use of echocardiography has contributed to the early recognition of several distinct cardiac diseases in women. During pregnancy, safe monitoring of the disease process, as well as a better understanding of hemodynamics, is possible. During the use of potentially cardiotoxic drugs for breast cancer chemotherapy, echocardiographic patient monitoring is vital. Compared to men, the addition of an imaging modality to routine electrocardiogram monitoring during stress testing is more informative for diagnosing coronary disease in women. This review briefly discusses the role of echocardiography in the management of several women-specific cardiac diseases where echocardiography plays a pivotal role in disease management.
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Affiliation(s)
- Wan Joo Shim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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