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Kesting S, Giordano U, Weil J, McMahon CJ, Albert DC, Berger C, Budts W, Fritsch P, Hidvégi EV, Oberhoffer-Fritz R, Milano GM, Wacker-Gußmann A, Herceg-Čavrak V. Association of European Paediatric and Congenital Cardiology practical recommendations for surveillance and prevention of cardiac disease in childhood cancer survivors: the importance of physical activity and lifestyle changes From the Association of European Paediatric and Congenital Cardiology Working Group Sports Cardiology, Physical Activity and Prevention, Working Group Adult Congenital Heart Disease, Working Group Imaging and Working Group Heart Failure. Cardiol Young 2024; 34:250-261. [PMID: 38174736 DOI: 10.1017/s1047951123004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Childhood cancer survivors are at increased risk of developing cardiovascular diseases, presenting as the main causes of morbidity and mortality within this group. Besides the usual primary and secondary prevention in combination with screening during follow-up, the modifiable lifestyle factors of physical activity, nutrition, and body weight have not yet gained enough attention regarding potential cardiovascular risk reduction. OBJECTIVE These practical recommendations aim to provide summarised information and practical implications to paediatricians and health professionals treating childhood cancer survivors to reduce the risk of cardiovascular late effects. METHODS The content derives from either published guidelines or expert opinions from Association of European Paediatric and Congenital Cardiology working groups and is in accordance with current state-of-the-art. RESULTS All usual methods of prevention and screening regarding the risk, monitoring, and treatment of occurring cardiovascular diseases are summarised. Additionally, modifiable lifestyle factors are explained, and clear practical implications are named. CONCLUSION Modifiable lifestyle factors should definitely be considered as a cost-effective and complementary approach to already implemented follow-up care programs in cardio-oncology, which can be actively addressed by the survivors themselves. However, treating physicians are strongly encouraged to support survivors to develop and maintain a healthy lifestyle, including physical activity as one of the major influencing factors. This article summarises relevant background information and provides specific practical recommendations on how to advise survivors to increase their level of physical activity.
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Affiliation(s)
- Sabine Kesting
- Institute of Preventive Paediatrics, Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Kinderklinik München Schwabing, Department of Paediatrics and Children's Cancer Research Centre, Department Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ugo Giordano
- Pediatric Cardiac Surgery, Cardiology and Heart/Lung Transplantation Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Jochen Weil
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Dimpna C Albert
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Claire Berger
- Department of Paediatric Haematology and Oncology, University Jean Monnet, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Fritsch
- Private Practice, Institute for Pediatric Cardiology, Graz, Austria
| | | | - Renate Oberhoffer-Fritz
- Institute of Preventive Paediatrics, Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Giuseppe M Milano
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Annette Wacker-Gußmann
- Institute of Preventive Paediatrics, Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Vesna Herceg-Čavrak
- Faculty of Health Science, Libertas International University, Zagreb, Croatia
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Imbert L, Marie PY. Low-dose gated bloodpool SPECT: Is it time to make the shift? J Nucl Cardiol 2021; 28:951-954. [PMID: 31468378 DOI: 10.1007/s12350-019-01872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Laetitia Imbert
- Department of Nuclear Medicine and Nancyclotep Molecular Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
- Université de Lorraine, INSERM, UMR 1254, 54000, Nancy, France.
| | - Pierre-Yves Marie
- Department of Nuclear Medicine and Nancyclotep Molecular Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
- Université de Lorraine, INSERM, UMR 1116, 54000, Nancy, France
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Toro C, Elliott DA, La Gerche A, Lange PW, Bsc FB, O'Sullivan M, Bhatia K, Conyers R. Optimal Detection of Cardiac Sequelae: The Need for Rigorous, Harmonized Magnetic Resonance Studies in Pediatric Survivors. JACC: CARDIOONCOLOGY 2021; 3:154-156. [PMID: 34396317 PMCID: PMC8352032 DOI: 10.1016/j.jaccao.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claudia Toro
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, Melbourne University, Carlton, Melbourne, Victoria, Australia
| | - David A Elliott
- Department of Paediatrics, Melbourne University, Carlton, Melbourne, Victoria, Australia.,Heart Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter W Lange
- Department of Paediatrics, Melbourne University, Carlton, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Melbourne, Hospital, Melbourne, Victoria, Australia
| | - Francesca Bolk Bsc
- Heart Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Department of Physiology, Melbourne University, Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, Melbourne University, Carlton, Melbourne, Victoria, Australia
| | - Kanika Bhatia
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Rachel Conyers
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.,Department of Paediatrics, Melbourne University, Carlton, Melbourne, Victoria, Australia.,Heart Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
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Benetou DR, Stergianos E, Geropeppa M, Ntinopoulou E, Tzanni M, Pourtsidis A, Petropoulos AC, Georgakis MK, Tousoulis D, Petridou ET. Late-onset cardiomyopathy among survivors of childhood lymphoma treated with anthracyclines: a systematic review. Hellenic J Cardiol 2018; 60:152-164. [PMID: 30273645 DOI: 10.1016/j.hjc.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 09/24/2018] [Indexed: 02/01/2023] Open
Abstract
Medical advances in pediatric oncology have led to increases in survival but the long-term adverse effects of treatment in childhood cancer survivors have not yet been examined in depth. In this systematic review, we aimed to study the prevalence and risk factors of late-onset cardiomyopathy (LOCM) among survivors of childhood lymphoma treated with anthracyclines. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines we searched Pubmed/Medline, abstracted data and rated studies on quality regarding late-onset (>1 year following treatment) cardiotoxicity of anthracyclines in survivors of childhood lymphoma. Across 22 identified studies, the prevalence of anthracycline-induced LOCM among survivors of childhood lymphoma ranges from 0 to 40%. Anthracycline dose, administration and dose of mediastinal radiation, patient's age and era of diagnosis and evaluation, follow-up duration as well as disease relapse have been reported as risk factors for LOCM, whereas administration of dexrazoxane seems to act protectively. There was significant between-study heterogeneity with regards to lymphoma subtypes, follow-up duration, definition of outcomes, and anthracycline-based treatment protocols. The rates of anthracycline-induced LOCM among survivors of childhood lymphoma are high and dependent on study design. Future studies should explore whether modifying risk factors and suggested supportive care could decrease its prevalence among childhood lymphoma survivors. Until then, lifelong follow-up of these patients aiming to determinate the earliest signs of cardiac dysfunction is the most important measure towards primordial prevention of LOCM.
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Affiliation(s)
- Despoina-Rafailia Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evangelos Stergianos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Geropeppa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Erato Ntinopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Tzanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. &Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Andreas C Petropoulos
- Department of Pediatric Cardiology, XMSK & Merkezi Hospital, National Medical University and the "Aziz Aliyev" National Postgraduate and CME Medical Training Center, Baku, Azerbaijan
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- 1(st) Department of Cardiology, Athens University Medical School, "Hippokration" Hospital, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Unit of Clinical Epidemiology, Medical School, Karolinska Institute, Stockholm, Sweden
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Rodríguez-Veiga R, Igual B, Montesinos P, Tormo M, Sayas MJ, Linares M, Fernández JM, Salvador A, Maceira-González A, Estornell J, Calabuig M, Pedreño M, Roig M, Sanz J, Sanz G, Carretero C, Boluda B, Martínez-Cuadrón D, Sanz MÁ. Assessment of late cardiomyopathy by magnetic resonance imaging in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and idarubicin. Ann Hematol 2017; 96:1077-1084. [PMID: 28451804 DOI: 10.1007/s00277-017-3004-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/05/2017] [Indexed: 01/07/2023]
Abstract
Late cardiomyopathy CMP is regarded as a potential severe long-term complication after anthracycline-based regimens for acute promyelocitic leukaemia (APL). We assess by MRI the incidence and severity of clinical and subclinical long-term CMP in a cohort of adult APL patients in first complete remission with PETHEMA trials. Adult patients diagnosed with APL in first complete remission lasting ≥2 years underwent anamnesis and physical examination and were asked to perform a cardiac MRI. Clinical CMP was defined as radiographic and physical signs of heart failure accompanied by symptoms or by left ventricle ejection fraction (LVEF) <45% by MRI with or without symptoms. Subclinical CMP was defined as the following MRI abnormalities: LVEF 45-50% or late gadolinium enhancement or two or more of LVEF ≤55%, left ventricle end-diastolic volume index ≥98 ml/m2, left ventricle end-systolic volume index ≥38 ml/m2, right ventricle end-diastolic volume index ≥106 ml/m2 and regional wall motion abnormalities. Of the 82 patients enrolled in the study, median cumulative dose of anthracyclines (doxorubicin equivalence) was 650 mg/m2, and median time from APL diagnosis to the study was 87 months (range, 24-195). Seven out of 57 patients with available MRI (12%) had subclinical CMP (all of them showed late gadolinium enhancement in MRI), and none had clinical CMP. Among the 25 patients without MRI, none had CMP by chest X-ray and physical assessment. In summary, we found 12% of subclinical and no clinical late CMP assessed by MRI in APL patients treated with PETHEMA protocols. Due to the low number of patients, we must interpret our results cautiously.
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Affiliation(s)
- Rebeca Rodríguez-Veiga
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Begoña Igual
- Radiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain.
| | - Mar Tormo
- Hematology Department of the Hospital Clínico Universitario, Valencia, Spain
| | - Mª José Sayas
- Hematology Department of the Hospital Dr. Peset, Valencia, Spain
| | - Mariano Linares
- Hematology Department of the Hospital General, Valencia, Spain
| | | | - Antonio Salvador
- Cardiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Jordi Estornell
- Radiology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Marisa Calabuig
- Hematology Department of the Hospital Clínico Universitario, Valencia, Spain
| | - María Pedreño
- Hematology Department of the Hospital Dr. Peset, Valencia, Spain
| | - Mónica Roig
- Hematology Department of the Hospital General, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Carlos Carretero
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Avda. Fernando Abril Martorell 106, CP, 46026, Valencia, Spain
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Shahzad MA, Ishtiaq R, Zahid U, Anwer F. Successful recovery and allogeneic stem cell transplant following chemotherapy-induced severe cardiomyopathy: literature review of management and prognostic factors. BMJ Case Rep 2016; 2016:bcr-2016-217210. [PMID: 27852680 DOI: 10.1136/bcr-2016-217210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chemotherapy-induced cardiomyopathy is one of the major possible hazards that can result from potential cardiotoxic agents while treating cancer. Prognostic risk factors include the rate of drug administration, history of hypertension, female gender, extremes of age, previous history of mediastinal irradiation, cumulative dose and pre-existing heart disease. Close monitoring of the patients, timely diagnosis, use of well-known biomarkers including cardiac troponins, NT-ProBNP and imaging studies like 2D Echo or cardiac MRI are essential. Emerging biomarkers include carbonyl reductases (CBR1 and CBR3), aldo-keto reductases (AKR, type 1A1, 1C3, 7A2) and topoisomerase2β (Top2β). β blockers and ACE inhibitors have not only been shown to slow down the progression of cardiac dysfunction but also produce symptomatic improvement. Our case report describes a patient with acute myeloblastic leukaemia who developed severe cardiomyopathy acutely after starting the anthracycline-based regimen. Nevertheless, with timely intervention her symptoms improved and subsequently she successfully received allogeneic stem cell transplantation.
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Affiliation(s)
- Muhammad Asim Shahzad
- Department of General Internal Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Rizwan Ishtiaq
- Department of General Internal Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Umar Zahid
- Department of General Internal Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Faiz Anwer
- Department of Hematology Oncology, University of Arizona Medical Center, Tucson, Arizona, USA
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Valcovici M, Andrica F, Serban C, Dragan S. Cardiotoxicity of anthracycline therapy: current perspectives. Arch Med Sci 2016; 12:428-35. [PMID: 27186191 PMCID: PMC4848373 DOI: 10.5114/aoms.2016.59270] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/07/2014] [Indexed: 12/31/2022] Open
Abstract
Anthracyclines, especially doxorubicin and daunorubicin, are the drugs of first choice in the treatment of patients with hematologic malignancies, soft-tissue sarcomas, and solid tumors. Unfortunately, the use of anthracyclines is limited by their dose-dependent and cumulative cardiotoxicity. The molecular mechanism responsible for anthracycline-induced cardiotoxicity remains poorly understood, although experimental and clinical studies have shown that oxidative stress plays the main role. Hence, antioxidant agents, especially dexrazoxane, and also other drug classes (statins, β-blockers) proved to have a beneficial effect in protecting against anthracycline-induced cardiotoxicity. According to previous clinical trials, the major high-risk factors for anthracycline-induced cardiotoxicity are age, body weight, female gender, radiotherapy, and other diseases such as Down syndrome, familial dilated cardiomyopathy, diabetes and hypertension. Consequently, further studies are needed to elucidate the molecular pathogenesis of anthracycline-induced cardiotoxicity and also to discover new cardioprotective agents against anthracycline-induced cardiotoxicity.
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Affiliation(s)
- Mihaela Valcovici
- Cardiology Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Florina Andrica
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania; Center for Interdisciplinary Research, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Corina Serban
- Center for Interdisciplinary Research, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania; Department of Functional Sciences, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Simona Dragan
- Cardiology Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania; Center for Interdisciplinary Research, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
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8
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Ibraheem A, Stankowski-Drengler TJ, Gbolahan OB, Engel JM, Onitilo AA. Chemotherapy-induced cardiotoxicity in breast cancer patients. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy-induced cardiotoxicity (CIC) is a well-documented side effect of breast cancer treatment. Nearly all chemotherapeutic agents can cause CIC with the highest occurrence found in anthracycline and trastuzumab use. Treatment- and patient-related risk factors contribute to the development of CIC making risk modification an important consideration during breast cancer treatment. Prevention and early detection of cardiotoxicity are key to minimizing permanent and devastating cardiac damage; therefore, early involvement of a cardiologist including periodic cardiac monitoring during and after chemotherapy exposure is recommended.
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Affiliation(s)
| | | | | | - Jessica M Engel
- Marshfield Clinic Cancer Care at St Michaels, Stevens Point, WI 54481, USA
| | - Adedayo A Onitilo
- Marshfield Clinic Weston Center, Oncology/Hematology Department, Weston, WI 54481, USA
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Cardiac assessment of early breast cancer patients 18years after treatment with cyclophosphamide-, methotrexate-, fluorouracil- or epirubicin-based chemotherapy. Eur J Cancer 2015; 51:2517-24. [DOI: 10.1016/j.ejca.2015.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 11/15/2022]
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Abstract
The identification of patients at risk of cardiac toxicity (cardiotoxicity) from cancer therapy is challenging. There is an increasing focus on early detection of cardiotoxicity such that interventions can be instituted to prevent advanced heart failure. Clinical risk prediction tools are limited and clinical symptoms are not specific. Direct assessment of myocardial function before and during cancer treatment using cardiac imaging appears to be an objective method to identify patients at risk. Although, multiple imaging modalities and measures of cardiac function are available, the best modality or the optimal measure of function is unknown. Measurement of left ventricular ejection fraction is most commonly used; however, growing literature suggests that it is inadequate for the detection of early cardiac injury. Other measures include left ventricular diastolic function, myocardial deformation, and myocardial tissue characterization. This review will provide an overview of the clinically available measures for the assessment of cardiotoxicity.
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