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Nohria A, Ben Zadok OI. Pulse check: Exploring the potential of the shock index as a biomarker for cancer-therapy-related cardiotoxicity in breast cancer patients. J Nucl Cardiol 2024; 35:101861. [PMID: 38604494 DOI: 10.1016/j.nuclcard.2024.101861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Adult Survivorship Program, Dana Farber Cancer Institute, Boston, MA, USA.
| | - Osnat Itzhaki Ben Zadok
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Di Lisi D, Madaudo C, Faro DC, Rossetto L, Triolo OF, Losi V, Galassi AR, Monte IP, Novo G. The added value of the HFA/ICOS score in the prediction of chemotherapy-related cardiac dysfunction in breast cancer. J Cardiovasc Med (Hagerstown) 2024; 25:218-224. [PMID: 38305134 DOI: 10.2459/jcm.0000000000001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The 2022 ESC Guidelines on Cardio-Oncology recommend baseline cardiovascular risk stratification before starting anticancer drugs, using the new risk assessment tools proposed by the Heart Failure Association (HFA) and the International Cardio-Oncology Society (ICOS).Our study aimed to assess the clinical application of HFA/ICOS risk score in breast cancer patients undergoing chemotherapy and its usefulness in predicting the development of chemotherapy-related cardiac dysfunction (CTRCD). METHODS A prospective multicentric study enrolled 109 breast cancer patients treated with anthracyclines with or without trastuzumab. A cardiological evaluation, including ECG and echocardiogram at baseline (T0), 3 (T1), 6 (T2), and 12 months (T3) after starting treatment was performed. HFA/ICOS score was assessed in all patients. The population was divided into low, medium, high, and very-high risk.During follow-up, CTRCD and other cardiovascular events have been evaluated. RESULTS 61 patients were low risk, 37 medium, 9 high, 2 very-high risk criteria. We found a significantly higher incidence of overall cardiotoxicity (CTRCD and other cardiovascular events) in the very-high risk group (100%) compared with the medium (29%) and low risk groups (13%). CTRCD incidence was also significantly higher in the high risk group (55%). CTRCD resulted as being associated with baseline arterial hypertension and baseline HFA/ICOS risk score of high ( p = 0.006) or very-high ( p < 0.0001). CONCLUSION Our study confirms the HFA/ICOS score's ability to predict cardiovascular toxicity in breast cancer women and the need for close monitoring especially in high and very-high risk patients.
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Affiliation(s)
- Daniela Di Lisi
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
| | - Cristina Madaudo
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
| | - Denise Cristiana Faro
- Department of General Surgery and Medical-Surgery Specialities (CHIRMED), University of Catania
- Cardiology Unit, University Hospital G. Rodolico - San Marco, Catania, Italy
| | - Ludovico Rossetto
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
| | - Oreste Fabio Triolo
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
| | - Valentina Losi
- Department of General Surgery and Medical-Surgery Specialities (CHIRMED), University of Catania
- Cardiology Unit, University Hospital G. Rodolico - San Marco, Catania, Italy
| | - Alfredo Ruggero Galassi
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
| | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities (CHIRMED), University of Catania
- Cardiology Unit, University Hospital G. Rodolico - San Marco, Catania, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital Paolo Giaccone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) 'G. D'Alessandro', University of Palermo, Palermo
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Di Lisi D, Cadeddu Dessalvi C, Zito C, Madaudo C, Manganaro R, Mercurio V, Deidda M, Santoro C, Penna C, Monte IP, Spallarossa P, Tocchetti CG, Novo G. Management of cancer patients at high and very-high risk of cardiotoxicity: Main questions and answers. Curr Probl Cardiol 2024; 49:102229. [PMID: 38154703 DOI: 10.1016/j.cpcardiol.2023.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
In recent years, important advances have been made in the field of Cardio-Oncology. The 2022 ESC Guidelines on Cardio-Oncology proposed a baseline cardiovascular risk stratification for cancer patients and preventive strategies in patients at high and very-high risk of cardiotoxicity. Cardiovascular toxic effects of anti-cancer drugs are being extensively studied; surveillance programs have been proposed, based on the baseline cardiovascular risk. On the other hand, there is little data on Cardio-Oncological management of patients at high and very-high cardiovascular risk with previous cardiovascular diseases. For example, little is known about management of cancer patients with heart failure with reduced ejection fraction (HFrEF), patients with a recent myocardial infarction or other cardiovascular diseases; when to resume anti-cancer drugs after a cardiovascular toxic event. Collaboration between Cardiologists and Oncologists and multidisciplinary team evaluations are certainly essential to decide the best therapeutic strategy for cancer patients, to treat cancer while saving the heart. Therefore, in the present review, we attempt to provide a useful guide to clinicians in treating patients with high and very-high risk of cardiotoxicity by enucleating main questions and answering them based on the evidence available as well as expert opinion and our clinical experience.
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Affiliation(s)
- Daniela Di Lisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy..
| | | | - Concetta Zito
- Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Madaudo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Roberta Manganaro
- Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy; Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Martino Deidda
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16121 Genova, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Claudia Penna
- Department of Clinical and Biological Sciences of Turin University, Orbassano, Turin, I-10043, Italy
| | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities- Cardiology, University of Catania, Catania, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16121 Genova, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy; Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
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Rashed ER, Margulies KB. New Cardiotoxicity Risk Assessment Guidelines: Searching for Validation. JACC CardioOncol 2023; 5:638-640. [PMID: 37969648 PMCID: PMC10635886 DOI: 10.1016/j.jaccao.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- Eman R. Rashed
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth B. Margulies
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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