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Gulati G, Broberg AM, Offersen BV. The Nordic Cardio-Oncology Society: mission and future goals. Eur Heart J 2024:ehae014. [PMID: 38607440 DOI: 10.1093/eurheartj/ehae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Affiliation(s)
- Geeta Gulati
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Postbox 4950 Nydalen, 0424 Oslo, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1000, 1478 Lørenskog, Norway
- Division of Research and Innovation, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Agneta Månsson Broberg
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Alpman MS, Jarting A, Magnusson K, Manouras A, Henter J, Broberg AM, Herold N. Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience. Cancer Rep (Hoboken) 2023; 6:e1852. [PMID: 37354068 PMCID: PMC10480418 DOI: 10.1002/cnr2.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/14/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The growing population of long-term childhood cancer survivors encounter a substantial burden of cardiovascular complications. The highest risk of cardiovascular complications is associated with exposure to anthracyclines and chest radiation. Longitudinal cardiovascular surveillance is recommended for childhood cancer patients; however, the optimal methods and timing are yet to be elucidated. AIMS We aimed to investigate the feasibility of different echocardiographic methods to evaluate left ventricular systolic function in retrospective datasets, including left ventricular ejection fraction (LVEF), fractional shortening (FS), global longitudinal strain (GLS) and longitudinal strain (LS) as well as the incidence and timing of subclinical left ventricular dysfunction detected by these methods. METHODS AND RESULTS A retrospective longitudinal study was performed with re-analysis of longitudinal echocardiographic data, acquired during treatment and early follow-up, including 41 pediatric sarcoma patients, aged 2.1-17.8 years at diagnosis, treated at Astrid Lindgren Children's Hospital, Stockholm, Sweden, during the period 2010-2021. All patients had received treatment according to protocols including high cumulative doxorubicin equivalent doses (≥250 mg/m2 ). In 68% of all 366 echocardiograms, LS analysis was feasible. Impaired LS values (<17%) was demonstrated in >40%, with concomitant impairment of either LVEF or FS in 20% and combined impairment of both LVEF and FS in <10%. Importantly, there were no cases of abnormal LVEF and FS without concomitant LS impairment. CONCLUSION Our findings demonstrate feasibility of LS in a majority of echocardiograms and a high incidence of impaired LS during anthracycline treatment for childhood sarcoma. We propose inclusion of LS in pediatric echocardiographic surveillance protocols.
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Affiliation(s)
- Maria Sjöborg Alpman
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Annica Jarting
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Kerstin Magnusson
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Aristomenis Manouras
- Department of CardiologyKarolinska University HospitalStockholmSweden
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Jan‐Inge Henter
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Pediatric Oncology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Agneta Månsson Broberg
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of CardiologyKarolinska University HospitalStockholmSweden
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Nikolas Herold
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Pediatric Oncology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
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Broberg AM, Tuohinen S, Skytta T, Geisler J, Hrafnkelsdóttir ÞJ, Smáradóttir A, Nielsen KM, Offersen BV, Jarfelt M, Gulati G. The Establishment of the Nordic Cardio-Oncology Society. JACC CardioOncol 2020; 2:333-335. [PMID: 34396242 PMCID: PMC8352298 DOI: 10.1016/j.jaccao.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Suvi Tuohinen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tanja Skytta
- Tampere University Hospital, Department of Oncology, Tampere, Finland
| | - Jürgen Geisler
- Department of Oncology, Akershus University Hospital, Lørenskog & Institute of Clinical Medicine, University of Oslo, Campus AHUS, Lørenskog, Norway
| | - þórdís Jóna Hrafnkelsdóttir
- Department of Cardiology, Landspitali University Hospital, Reykjavík, Iceland, and Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Agnes Smáradóttir
- Department of Medical Oncology, Landspitali University Hospital, Reykjavík, Iceland
| | | | - Birgitte V. Offersen
- Department of Experimental Clinical Oncology & Department of Oncology, Aarhus University Hospital, Aarhus Denmark
| | - Marianne Jarfelt
- Department of Oncology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Geeta Gulati
- Oslo University Hospital, Ullevål, Department of Cardiology, Oslo, Norway
- Department of Research, Akershus University Hospital, Lørenskog, and the Institute of Clinical Medicine, University of Oslo, Campus AHUS, Lørenskog, Norway
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Najjar E, Hallberg Kristensen A, Thorvaldsen T, Hubbert L, Svenarud P, Dalén M, Månsson Broberg A, Lund LH. Controller and battery changes due to technical problems related to the HVAD® left ventricular assist device - a single center experience. J Cardiothorac Surg 2018; 13:74. [PMID: 29921307 PMCID: PMC6008928 DOI: 10.1186/s13019-018-0759-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background The use of left ventricular assist devices (LVADs) has increased in the last decade. Major complications have been well described, but there is no data on device alarms and actual or threatening malfunction which impair quality of life and may impair outcomes. This study describes the technical problems related to the use of the HVAD® left ventricular assist device in a single center. Methods We retrospectively reviewed device malfunctions and outcomes in 22 patients with HVAD® left ventricular assist device followed at Karolinska University Hospital between 2011 and 2016. Device malfunction was defined by INTERMACS as a failure of one or more of the components of the LVAD system. The primary outcome was defined as death or hospitalization or unplanned urgent clinic visit due to device alarm of unknown significance or actual or threatening malfunction. Separate secondary outcomes were malfunction resulting in controller exchange and malfunction resulting in battery change. Exploratory outcomes were death, transplantation, or explantation because of recovery. Results Median age was 59 years and 19% were women. Over a mean follow-up time of 1.7 years (37 patient-years), the primary outcome occurred 30 times (0.8 events per patient-year; 0 deaths, 2 hospitalizations and 28 un-planned clinic visits). Secondary outcomes were 41 device malfunctions for 14 patients requiring 45 controller exchanges in 12 patients (1.1 events per patient-year) and 128 battery changes in 12 patients (3.5 events per patient-year). Exploratory outcomes were 8 deaths (36.4%), 7 transplantations (31.8%) and 2 explants due to recovery (9.1%). Conclusion The use of HVAD® was associated with technical problems requiring frequent un-planned clinic visits and changes of controller and/or batteries. There were no deaths due to device malfunction. Further studies are warranted to evaluate the risk of device malfunction and associated reductions in quality of life and cost.
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Affiliation(s)
- Emil Najjar
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Karolinska University Hospital, S3:02, Stockholm, 17176, Sweden. .,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Tonje Thorvaldsen
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Karolinska University Hospital, S3:02, Stockholm, 17176, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Laila Hubbert
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Svenarud
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Dalén
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Månsson Broberg
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Karolinska University Hospital, S3:02, Stockholm, 17176, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H Lund
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Karolinska University Hospital, S3:02, Stockholm, 17176, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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Bühlmann Lerjen E, Hübbert L, Papakonstantinou A, Hedayati E, Linde C, Månsson Broberg A. [Cardiotoxicity relatively common in cancer treatment]. Lakartidningen 2016; 113:DYIE. [PMID: 27299327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Modern cancer therapy has noticeably improved the prognosis for various cancer diseases, but cardiovascular side effects are not uncommon, both in short and long term. The individual patient's cardiovascular risk profile affects the risk of developing side effects. Potential underestimation of this risk can lead to life-long severe cardiac disease for a patient that has been cured from cancer. Overestimation of the risk can lead to withdrawal of life-saving cancer treatment because of potentially reversible or mild cardiac side effects. A multidisciplinary approach will lead to better handling of cardio-oncologic patients.
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Affiliation(s)
- Eva Bühlmann Lerjen
- Triemli Hospital - Cardiology Department Zürich, Switzerland - Stockholm, Sweden
| | - Laila Hübbert
- University Hospital Linköping - Cardiology Department Linköping, Sweden University Hospital Linköping - Cardiology Department Linköping, Sweden
| | - Antroula Papakonstantinou
- Karolinska Universitetssjukhuset - Onkologiska kliniken Stockholm, Sweden Karolinska University Hospital - Oncology Department Stockholm, Sweden
| | - Elham Hedayati
- Karolinska Universitetssjukhuset - Onkologiska kliniken Stockholm, Sweden Karolinska Insitute - Department of Oncology-Pathology Stockholm, Sweden
| | - Cecilia Linde
- Karolinska Universitets Sjukhuset - Hjärtkliniken Stockholm, Sweden Karolinska University Hospital - Cardiology Stockholm, Sweden
| | - Agneta Månsson Broberg
- Karolinska Institutet - Department of Molecular Medicine and Surgery Stockholm, Sweden Karolinska Institutet - Department of Medicine Stockholm, Sweden
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Broberg AM, Siddiqui AJ, Fischer H, Grinnemo KH, Wardell E, Andersson AB, Inzunza J, Sylvén C, Gustafsson JÅ. Estrogen receptors do not influence angiogenesis after myocardial infarction. SCAND CARDIOVASC J 2011; 45:215-22. [PMID: 21486101 DOI: 10.3109/14017431.2011.569941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is controversy on whether estrogen receptors are present and functioning in the myocardium. Aims. To explore if after myocardial infarction (MI) estrogen receptors α (ERα) and β (ERβ) are upregulated in myocardial tissue and to explore if the presence/ absence of ERα or ERβ influences angiogenesis after MI. METHODS MI was induced by ligation of the left anterior descending artery in knockout (KO) mice, ERαKO and ERβKO, respectively, and non-KO littermate-controls, C57Bl/6 mice. The hearts were harvested after 12 days. A part of the periinfarct tissue was collected for ERα and ERβ mRNA expression determination by real-time polymerase chain reaction. Using immunohistochemistry, ERα and ERβ protein expression and capillary and arteriolar densities were blindly determined in the periinfarct area. RESULTS In myocardium disrupted mRNA was upregulated in both ERαKO and ERβKO, (p < 0.005) and did not change after MI. There was no change in mRNA expression of ERα or ERβ in wild type mice after MI. Expression of ERβ in ERαKO and of ERα in ERβKO did not change. Following MI ERα or ERβ could not be demonstrated by immunohistochemistry in either wild type or ERαKO or ERβKO. The capillary and arteriolar densities after MI did not differ between the groups in the periinfarct area. CONCLUSIONS Although disrupted ER mRNA is upregulated in myocardium of ER knockout mice, no change in these or native receptors occurs following MI. At least in this model ER therefore seems not to have a role in myocardial arteriogenesis and angiogenesis after MI.
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Affiliation(s)
- Agneta Månsson Broberg
- Department of Cardiology, Karolinska Institute, Clinical Research Center, Stockholm, Sweden
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Broberg AM, Grinnemo KH, Genead R, Danielsson C, Andersson AB, Wärdell E, Sylvén C. Erythropoietin has an antiapoptotic effect after myocardial infarction and stimulates in vitro aortic ring sprouting. Biochem Biophys Res Commun 2008; 371:75-8. [PMID: 18417077 DOI: 10.1016/j.bbrc.2008.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 04/01/2008] [Indexed: 11/18/2022]
Abstract
Aims were to explore if darbepoietin-alpha in mouse can induce angiogenesis and if moderate doses after myocardial infarction stimulates periinfarct capillary and arteriolar densities, cell proliferation, and apoptosis. Myocardial infarction was induced by ligation of LAD. Mouse aortic rings (0.8mm) were cultured in matrigel and the angiogenic sprouting was studied after addition of darbepoietin-alpha with and without VEGF-165. After 12 days the hemoglobin concentration was 25% higher in the darbepoietin-alpha treated mice than in the control group. No difference in capillary densities in the periinfarct or noninfarcted areas was seen with darbepoietin-alpha. Cell proliferation was about 10 times higher in the periinfarct area than in the noninfarcted wall. Darbepoietin-alpha treatment led to a decrease of cell proliferation (BrdU, (p<0.02)) and apoptosis (TUNEL, p<0.005) with about 30% in the periinfarct area. Darbepoietin-alpha and VEGF-165 both independently induced sprouting from aortic rings. The results suggest that darbepoietin-alpha can induce angiogenesis but that moderate doses after myocardial infarction are not angiogenic but antiapoptotic.
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