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Santos LDS, Rehder MHHDS, Negrao MV, Goes-Santos BR, Toshi Dias E, Paixão CJ, Urias U, Giannetti NS, Hajjar LA, Filho RK, Negrão CE. Aerobic exercise training combined with local strength exercise restores muscle blood flow and maximal aerobic capacity in long-term Hodgkin lymphoma survivors. Am J Physiol Heart Circ Physiol 2024; 326:H1462-H1468. [PMID: 38639741 DOI: 10.1152/ajpheart.00132.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
It is unclear whether muscle blood flow (MBF) is altered in long-term Hodgkin lymphoma (HL) survivors. We tested the hypothesis that 1) MBF response during mental stress (MS) is impaired in long-term HL survivors and 2) aerobic exercise training combined with local strength exercise (ET) restores MBF responses during MS in these survivors. Eighteen 5-year HL survivors and 10 aged-paired healthy subjects (HC) were studied. Twenty HL survivors were randomly divided into two groups: exercise-trained (HLT, n = 10) and untrained (HLUT, n = 10). Maximal aerobic capacity was evaluated by a cardiopulmonary exercise test and forearm blood flow (FBF) by venous occlusion plethysmography. MS was elicited by Stroop color and word test. ET was conducted for 4 mo, 3/wk for 60 min each session. The aerobic exercise intensity corresponded to anaerobic threshold up to 10% below the respiratory compensation point. The strength exercises consisted of two to three sets of chest press, pulley and squat exercises, 12-15 repetitions each exercise at 30-50% of the maximal voluntary contraction. Baseline was similar in HL survivors and HC, except peak oxygen consumption (peak V̇o2, P = 0.013) and FBF (P = 0.006) that were lower in the HL survivors. FBF responses during MS were lower in HL survivors (P < 0.001). ET increased peak V̇o2 (11.59 ± 3.07%, P = 0.002) and FBF at rest (33.74 ± 5.13%, P < 0.001) and during MS (24 ± 5.31%, P = 0.001). Further analysis showed correlation between the changes in peak V̇o2 and the changes in FBF during MS (r = 0.711, P = 0.001). In conclusion, long-term HL survivors have impaired MBF responses during MS. ET restores MBF responses during MS.NEW & NOTEWORTHY Long-term Hodgkin lymphoma (HL) survivors have impaired muscle blood flow responses during mental stress and decreased maximal aerobic capacity. Supervised aerobic exercise training combined with local strength exercises restores muscle blood flow responses during mental stress and maximal aerobic capacity in these survivors. These findings provide evidence of safety and effectiveness of exercise training in HL survivors. Moreover, they highlight the importance of exercise training in the treatment of this set of patients.
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Affiliation(s)
- Luciana De Souza Santos
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marília Harumi Higuchi Dos Santos Rehder
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Vailati Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | | | | | - Camila Jordão Paixão
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ursula Urias
- Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, Brazil
| | - Natali Schiavo Giannetti
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ludhmila A Hajjar
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos E Negrão
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, Brazil
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Murphy AC, Koshy AN, Farouque O, Yeo B, Roccisano L, Octavia Y, Yudi MB. Cardiovascular Disease in Patients With Breast Cancer Treated in the Modern Era. Heart Lung Circ 2024; 33:648-656. [PMID: 37574416 DOI: 10.1016/j.hlc.2023.05.021] [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: 06/10/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 08/15/2023]
Abstract
AIMS With improving cancer survivorship, cardiovascular disease (CVD) has become a leading cause of death in breast cancer (BC) survivors. At present, there is no prospectively validated, contemporary risk assessment tool specific to this patient cohort. Accordingly, we sought to investigate long-term cardiovascular outcomes in early-stage BC patients utilising a well characterised database at a quaternary referral centre. With the assembly of this cohort, we have derived a BC cardiovascular risk index titled the 'CRIB (Cardiovascular Risk Index in Breast Cancer)' to estimate the risk of a major adverse cardiovascular event (MACE) in women undergoing treatment for BC. METHODS A retrospective cohort study was conducted examining all female patients aged ≥18 years of age who underwent treatment for early-stage BC at a cancer centre in Melbourne, Australia, between 2009 and 2019. The primary aim of this study was to assess causes and predictors of MACE. RESULTS A total of 1,173 women with early-stage BC were included. During a median follow-up of 4.4 (1.8-6.7) years, 80 (6.8%) women experienced a MACE. These women were more likely to be older, with a high burden of cardiovascular risk factors and were more likely to have a history of established coronary artery disease (CAD) (p≤0.001 for all). A CRIB ≥3 (2 points: renal impairment, 1 point: age ≥65 years, body mass index [BMI]>27, diabetes, hypertension, history of smoking) demonstrated moderate discrimination (c-statistic 0.75) with appropriate calibration. A CRIB ≥3, which represented 23.9% of our cohort, was associated with a high risk of MACE (odds ratio [OR] 17.85, 95% confidence interval [CI] 6.36-50.05; p<0.001). A total of 138 (11.8%) women died during the study period. Mortality was significantly higher in patients who experienced a MACE (HR 2.72, 95%CI 1.75-4.23; p<0.001). CONCLUSION Cardiovascular risk stratification at the time of BC diagnosis using the novel CRIB may help guide surveillance and the use of cardioprotective therapies as well as identify those who require long-term cardiac follow-up.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia; Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia.
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia
| | - Laura Roccisano
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Yanti Octavia
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
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Sverdlov AL, Koczwara B, Cehic DA, Clark RA, Hunt L, Nicholls SJ, Thomas L, Thornton-Benko E, Kritharides L. When Cancer and Cardiovascular Disease Intersect: The Challenge and the Opportunity of Cardio-Oncology. Heart Lung Circ 2024; 33:558-563. [PMID: 37321867 DOI: 10.1016/j.hlc.2023.04.301] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 06/17/2023]
Abstract
Cancer and cardiovascular disease (CVD) commonly coexist, with increasing evidence that long-term cancer survivors are more likely to die from CVD than the general population. Effective management of CVD and its risk factors requires identification of patients at increased risk who may benefit from early intervention and their appropriate monitoring across the disease trajectory. Improving outcomes requires new models of multidisciplinary cancer care supported by care pathways. Such pathways require a clear delineation of the roles and responsibilities of all team members and provision of appropriate enablers for their delivery. These include accessible point-of-care tools/risk calculators, patient resources, and the provision of tailored training opportunities for health care providers.
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Affiliation(s)
- Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Newcastle Centre of Excellence in Cardio-Oncology, Hunter Medical Research Institute, Hunter New England Local Health District, The University of Newcastle and Calvary Mater Newcastle, Newcastle, NSW, Australia.
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Daniel A Cehic
- Advara HeartCare, Adelaide, SA, Australia; School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network (SALHN), Adelaide, SA, Australia
| | - Lee Hunt
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia; South West Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Stephen J Nicholls
- Monash Heart, Monash Health, Melbourne, Vic, Australia; Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Liza Thomas
- Cancer Voices NSW, Sydney, NSW, Australia; South West Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Elysia Thornton-Benko
- Bondi Road Doctors, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, The Behavioural Sciences Unit, University of New South Wales, Sydney, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; ANZAC Medical Research Institute, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
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Wilcox NS, Amit U, Reibel JB, Berlin E, Howell K, Ky B. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol 2024:10.1038/s41569-024-01017-x. [PMID: 38600368 DOI: 10.1038/s41569-024-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.
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Affiliation(s)
- Nicholas S Wilcox
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Uri Amit
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob B Reibel
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kendyl Howell
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Miki T, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Yamashita M, Uchida S, Noda T, Ueno K, Hotta K, Maekawa E, Sasaki J, Yamaoka-Tojo M, Matsunaga A, Ako J. Cancer history and physical function in patients with cardiovascular disease. Heart Vessels 2024:10.1007/s00380-024-02379-5. [PMID: 38578318 DOI: 10.1007/s00380-024-02379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis.
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Affiliation(s)
- Takashi Miki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan.
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Division of Research, ARCE Inc., Sagamihara, Kanagawa, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Huang Z, Li T, Zhang S, Jiang B, Li M, Cao B, Zhang H, Zhou Z, Huang Z, Wang X. Association between coronary artery disease and clinical outcome in cancer patients: A propensity score matching analysis. Heliyon 2024; 10:e28262. [PMID: 38560695 PMCID: PMC10979226 DOI: 10.1016/j.heliyon.2024.e28262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The aim of this study was to evaluate the prognostic value of coronary artery disease (CAD) detected by coronary computed tomography angiography (CTA) to predict the risk of all-cause mortality in cancer patients in a propensity score matching (PSM) analysis. Methods A total of 331 patients who previously had cancer and underwent coronary CTA from January 2015 to December 2019 were included. Multivariate Cox proportional hazards regression analysis and propensity-score matching analysis were performed. The primary endpoint was all-cause of mortality. Results In total, 125 with CAD and 206 with no CAD during a median follow-up of 3.3 years were included in this study. After PSM, age (HR, 1.040; 95%CI, 1.001-1.081; p = 0.014) and CAD (HR, 2.164; 95%CI, 1.057-4.430; p = 0.035) remained significant factors for all-cause mortality. Conclusion CAD evaluated by coronary CTA was found to be at higher risk for all-cause mortality in cancer patients. Due to the retrospective design and lack of information on some medical history and treatments, especially immune checkpoint inhibitors, a large-scale prospective study is needed to further determine the prognostic value of coronary CTA in cancer patients.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Tao Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Shan Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Bei Jiang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Mei Li
- Department of Community Health, Wuhan Hanyang Center For Disease Prevention and Control, Wuhan, 430050, China
| | - Beibei Cao
- Department of Community Health, Wuhan Hanyang Center For Disease Prevention and Control, Wuhan, 430050, China
| | - Hongfeng Zhang
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Zhiqiang Zhou
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zheng Huang
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
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Affiliation(s)
- Michelle N. Johnson
- Cardiology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Minga I, Okwuosa T, Akhter N, Gans C, Pauwaa S, Gomez-Valencia J, Ilias-Basha H, Pursnani A, Kalyan A, DeCara JM. Developing a Model for Cross-Institutional Educational Collaborations. JACC: CARDIOONCOLOGY 2023; 5:262-266. [PMID: 37144102 PMCID: PMC10152202 DOI: 10.1016/j.jaccao.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 03/09/2023]
Affiliation(s)
- Iva Minga
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Tochukwu Okwuosa
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
- Address for correspondence: Dr Tochi M. Okwuosa, Rush University Medical Center, 1717 West Congress Parkway, Kellogg Building, Suite 328, Chicago, Illinois 60612, USA.
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Christopher Gans
- Division of Cardiology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sunil Pauwaa
- Division of Cardiology, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Javier Gomez-Valencia
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Haseeb Ilias-Basha
- Division of Cardiology, Care Clinic Foundation Hospital, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Amit Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Aparna Kalyan
- Division of Medical Oncology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Jeanne M. DeCara
- Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
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Ng CT, Tan LL, Sohn IS, Gonzalez Bonilla H, Oka T, Yinchoncharoen T, Chang WT, Chong JH, Cruz Tan MK, Cruz RR, Astuti A, Agarwala V, Chien V, Youn JC, Tong J, Herrmann J. Advancing Cardio-Oncology in Asia. Korean Circ J 2023; 53:69-91. [PMID: 36792558 PMCID: PMC9932224 DOI: 10.4070/kcj.2022.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Cardio-oncology is an emerging multi-disciplinary field, which aims to reduce morbidity and mortality of cancer patients by preventing and managing cancer treatment-related cardiovascular toxicities. With the exponential growth in cancer and cardiovascular diseases in Asia, there is an emerging need for cardio-oncology awareness among physicians and country-specific cardio-oncology initiatives. In this state-of-the-art review, we sought to describe the burden of cancer and cardiovascular disease in Asia, a region with rich cultural and socio-economic diversity. From describing the uniqueness and challenges (such as socio-economic disparity, ethnical and racial diversity, and limited training opportunities) in establishing cardio-oncology in Asia, and outlining ways to overcome any barriers, this article aims to help advance the field of cardio-oncology in Asia.
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Affiliation(s)
- Choon Ta Ng
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | | | - Toru Oka
- Onco-Cardiology Unit, Department of Internal Medicine, Saitama Cancer Center, Saitama, Japan
| | | | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jun Hua Chong
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Rochelle Regina Cruz
- Department of Cardiology, Cardinal Santos Medical Center, Metro Manila, The Philippines
| | - Astri Astuti
- Department of Cardiology and Vascular Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Vivek Agarwala
- Department of Medical Oncology and Haemato-Oncology, Narayana Superspeciality Hospital and Cancer Institute, Howrah, India
| | - Van Chien
- Department of Cardiology, National Heart Institute, Hanoi, Vietnam
| | - Jong-Chan Youn
- Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jieli Tong
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
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Brown SA, Chung BY, Doshi K, Hamid A, Pederson E, Maddula R, Hanna A, Choudhuri I, Sparapani R, Bagheri Mohamadi Pour M, Zhang J, Kothari AN, Collier P, Caraballo P, Noseworthy P, Arruda-Olson A. Patient similarity and other artificial intelligence machine learning algorithms in clinical decision aid for shared decision-making in the Prevention of Cardiovascular Toxicity (PACT): a feasibility trial design. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:7. [PMID: 36691060 PMCID: PMC9869606 DOI: 10.1186/s40959-022-00151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/26/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The many improvements in cancer therapies have led to an increased number of survivors, which comes with a greater risk of consequent/subsequent cardiovascular disease. Identifying effective management strategies that can mitigate this risk of cardiovascular complications is vital. Therefore, developing computer-driven and personalized clinical decision aid interventions that can provide early detection of patients at risk, stratify that risk, and recommend specific cardio-oncology management guidelines and expert consensus recommendations is critically important. OBJECTIVES To assess the feasibility, acceptability, and utility of the use of an artificial intelligence (AI)-powered clinical decision aid tool in shared decision making between the cancer survivor patient and the cardiologist regarding prevention of cardiovascular disease. DESIGN This is a single-center, double-arm, open-label, randomized interventional feasibility study. Our cardio-oncology cohort of > 4000 individuals from our Clinical Research Data Warehouse will be queried to identify at least 200 adult cancer survivors who meet the eligibility criteria. Study participants will be randomized into either the Clinical Decision Aid Group (where patients will use the clinical decision aid in addition to current practice) or the Control Group (current practice). The primary endpoint of this study is to assess for each patient encounter whether cardiovascular medications and imaging pursued were consistent with current medical society recommendations. Additionally, the perceptions of using the clinical decision tool will be evaluated based on patient and physician feedback through surveys and focus groups. This trial will determine whether a clinical decision aid tool improves cancer survivors' medication use and imaging surveillance recommendations aligned with current medical guidelines. TRIAL REGISTRATION ClinicalTrials.Gov Identifier: NCT05377320.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Brian Y Chung
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Krishna Doshi
- Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | | | | | - Allen Hanna
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Rodney Sparapani
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Jun Zhang
- Department of Computer Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Anai N Kothari
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patrick Collier
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Yaseen IF, Farhan HA. Cardiovascular drug interventions in the cardio-oncology clinic by a cardiology pharmacist: ICOP-Pharm study. Front Cardiovasc Med 2022; 9:972455. [PMID: 36247485 PMCID: PMC9556995 DOI: 10.3389/fcvm.2022.972455] [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: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cardio-oncology is a rapidly growing field that requires a novel service design to deal with the increasing number of patients. It is reported that the volume of patients at the cardio-oncology clinic in the United Kingdom is 535 patients/5 years and in Canada is 779 patients/7 years. The pharmacist has a role in reducing the consultation time of physicians. Objective To identify the role of a qualified cardiology pharmacist at the cardio-oncology clinic using a new paradigm based on complementary interventions with the cardiologist for the management of patients with cancer and cardiovascular risk factors and/or cardiovascular diseases (CVRF/CVD). Methods A prospective observational study was conducted at the cardio-oncology clinic in the Medical City in Baghdad, Iraq between December 2020 and December 2021. Patients with CVRF/CVD were registered. The Iraqi Cardio-Oncology Program-Pharmacist (ICOP-Pharm) paradigm was designed to involve a qualified cardiology pharmacist for initial cardiovascular (CV) drug interventions. Results Among 333 patients who attended our clinic over the 1-year interval, 200 (60%) CVRF/CVD cases were enrolled in the study, and of them 79 (40%) patients had CV drug interventions. A total of 196 interventions were done, including 147 (75%) cases performed by the cardiology pharmacist, and 92 (63%) of the latter were CV drug initiations. Among the total CVRF/CVD treated initially by the cardiology pharmacist, hypertension 32 (26%) and cancer therapy-related cardiac dysfunction 29 (24%) were the main types. Conclusion The qualified cardiology pharmacist was responsible for three-quarters of the initial CV drug interventions at the cardio-oncology clinic in a complementary approach to the cardiologist. The role of the cardiology pharmacist in the ICOP-Pharm paradigm may be one of the reasons for the ability of the heart team to manage 3-fold of the patient volume when compared with those in the United Kingdom or Canada.
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Affiliation(s)
- Israa Fadhil Yaseen
- Baghdad Heart Center, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
- *Correspondence: Israa Fadhil Yaseen,
| | - Hasan Ali Farhan
- Baghdad Heart Center, Medical City, Baghdad, Iraq
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq
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12
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Abstract
Cardiovascular disease is a leading cause of death in cancer survivors, after recurrence of the primary tumor or occurrence of a secondary malignancy. Consequently, the interdisciplinary field of cardio-oncology has grown rapidly in recent years to address the cardiovascular care needs of this unique population through clinical care and research initiatives. Here, the authors discuss the ideal infrastructure for training and career development in cardio-oncology translational and implementation science and emphasize the importance of the multidisciplinary cardiovascular team for both research and patient care. Cardio-oncology training opportunities in general cardiology, hematology/oncology, and specialized cardio-oncology clinical and research fellowships are also considered.
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13
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Ahmad J, Muthyala A, Kumar A, Dani SS, Ganatra S. Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement. Curr Cardiol Rep 2022; 24:1117-1127. [PMID: 35759170 PMCID: PMC9244335 DOI: 10.1007/s11886-022-01732-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review The purpose of this article is to provide a comprehensive review of available data on health disparities and the interconnected social determinants of health (SDOH) in cardio-oncology. We identify the gaps in the literature and suggest areas for future research. In addition, we propose strategies to address these disparities at various levels. Recent Findings There has been increasing recognition of health disparities and the role of SODH on an individual’s access to health care, quality of care, and outcomes of the illness. There is growing evidence of sex and race-based differences in cancer therapy-related cardiotoxicity. Recent studies have shown how access and quality of health care are affected by financial stability and rurality. Our recent study utilizing the social vulnerability index (SVI) and county-level patient data found graded increase in county-level cardio-oncology mortality with greater social vulnerability. The incremental impact of social vulnerability was higher for cardio-oncology mortality than for mortality related to either cancer or CVD alone. The mortality rates in these patients were higher in rural areas compared to urban areas regardless of social vulnerability. Additionally, for those within the counties within highest social vulnerability, Black individuals had significantly higher cardio-oncology mortality compared with White individuals. Summary Disparities in the cardio-oncology population are deep-rooted and widespread, leading to poor quality of life and increased mortality. It is crucial to integrate SDOH, not only in clinical care delivery but also in future research, and registry data to improve our understanding and the outcomes in our unique subset of cardio-oncology patients.
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Affiliation(s)
- Javaria Ahmad
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Sourbha S Dani
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
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14
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Yang EH, Ohman RE. Understanding the biological mechanisms of cancer treatment-induced cardiac toxicity. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 18:100177. [PMID: 38559415 PMCID: PMC10978326 DOI: 10.1016/j.ahjo.2022.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 04/04/2024]
Abstract
While many strides have been made in the multidisciplinary science of Cardio-Oncology, gaps in knowledge remain despite these advances to identify optimal strategies of detection and treatment of cancer treatment-associated cardiotoxicity. Many opportunities are available for advocates from all avenues of the field to transform cardio-oncology from a reactionary to a preventative science.
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Affiliation(s)
- Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Rachel E. Ohman
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, United States of America
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15
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Cuomo A, Mercurio V, Varricchi G, Galdiero MR, Rossi FW, Carannante A, Arpino G, Formisano L, Bianco R, Carlomagno C, De Angelis C, Giuliano M, Matano E, Picardi M, Salvatore D, De Vita F, Martinelli E, Della Corte CM, Morgillo F, Orditura M, Napolitano S, Troiani T, Tocchetti CG. Impact of a cardio-oncology unit on prevention of cardiovascular events in cancer patients. ESC Heart Fail 2022; 9:1666-1676. [PMID: 35362255 PMCID: PMC9065840 DOI: 10.1002/ehf2.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Aims As the world population grows older, the co‐existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio‐Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications. Methods and results We enrolled 231 consecutive patients referred to our Cardio‐Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month‐survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow‐up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04). Conclusions Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments.
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Affiliation(s)
- Alessandra Cuomo
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy
| | - Gilda Varricchi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Maria Rosaria Galdiero
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Francesca Wanda Rossi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Antonio Carannante
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Grazia Arpino
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luigi Formisano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Bianco
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carmine De Angelis
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Mario Giuliano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Ferdinando De Vita
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Erika Martinelli
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Floriana Morgillo
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Michele Orditura
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
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16
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Cardio-Oncology Care Delivered in the Non-academic Environment. Curr Treat Options Oncol 2022; 23:762-773. [DOI: 10.1007/s11864-022-00978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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17
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Osman M, Benjamin MM, Balla S, Kheiri B, Bianco C, Sengupta PP, Daggubati R, Malla M, Liu SV, Mamas M, Patel B. Index Admission and Thirty-Day Readmission Outcomes of Patients With Cancer Presenting With STEMI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 35:121-128. [PMID: 33888417 PMCID: PMC8521583 DOI: 10.1016/j.carrev.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND National-level data of cancer patients' readmissions after ST-segment elevation myocardial infarction (STEMI) are lacking. OBJECTIVES The primary aim of this study was to compare the rates and causes of 30-day readmissions in patients with and without cancer. METHODS Among patients admitted with STEMI in the United States National Readmission Database (NRD) from October 2015-December 2017, we identified patients with the diagnosis of active breast, colorectal, lung, or prostate cancer. The primary endpoint was the 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of patients with and without cancer. RESULTS A total of 385,522 patients were included in the analysis: 5956 with cancer and 379,566 without cancer. After propensity score matching, 23,880 patients were compared (Cancer = 5949, No Cancer = 17,931). Patients with cancer had higher 30-day readmission rates (19% vs. 14%, p < 0.01). The most common causes for readmission among patients with cancer were cardiac (31%), infectious (21%), oncologic (17%), respiratory (4%), stroke (4%), and renal (3%). During the first readmission, patients with cancer had higher adjusted rates of in-hospital mortality (15% vs. 7%; p < 0.01) and bleeding complications (31% vs. 21%; p < 0.01), compared to the non-cancer group. In addition, cancer (OR 1.5, 95% CI 1.2-1.6, p < 0.01) was an independent predictor for 30-day readmission. CONCLUSIONS About one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cardiac causes predominated the reason for 30-day readmissions in patients with cancer.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mina M. Benjamin
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Partho P. Sengupta
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Midhun Malla
- Division of Oncology, West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Stephen V. Liu
- Division of Oncology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom,Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA,Corresponding author at: WVU Heart & Vascular Institute, West Virginia University, One Medical Center Drive, Box 8003, Morgantown, WV 26506., USA.
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18
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Ohman RE, Yang EH, Abel ML. Inequity in Cardio-Oncology: Identifying Disparities in Cardiotoxicity and Links to Cardiac and Cancer Outcomes. J Am Heart Assoc 2021; 10:e023852. [PMID: 34913366 PMCID: PMC9075267 DOI: 10.1161/jaha.121.023852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Minority and underresourced communities experience disproportionately high rates of fatal cancer and cardiovascular disease. The intersection of these disparities within the multidisciplinary field of cardio‐oncology is in critical need of examination, given the risk of perpetuating health inequities in the growing vulnerable population of patients with cancer and cardiovascular disease. This review identifies 13 cohort studies and 2 meta‐analyses investigating disparate outcomes in treatment‐associated cardiotoxicity and situates these data within the context of oncologic disparities, preexisting cardiovascular disparities, and potential system‐level inequities. Black survivors of breast cancer have elevated risks of cardiotoxicity morbidity and mortality compared with White counterparts. Adolescent and young adult survivors of cancer with lower socioeconomic status experience worsened cardiovascular outcomes compared with those of higher socioeconomic status. Female patients treated with anthracyclines or radiation have higher risks of cardiotoxicity compared with male patients. Given the paucity of data, our understanding of these racial and ethnic, socioeconomic, and sex and gender disparities remains limited and large‐scale studies are needed for elucidation. Prioritizing this research while addressing clinical trial inclusion and access to specialist care is paramount to reducing health inequity.
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Affiliation(s)
- Rachel E Ohman
- Department of Medicine University of California Los Angeles Los Angeles CA
| | - Eric H Yang
- UCLA Cardio-Oncology Program Division of Cardiology Department of Medicine University of California at Los Angeles CA
| | - Melissa L Abel
- Center for Cancer Research National Cancer Institute Bethesda MD
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19
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Cehic DA, Sverdlov AL, Koczwara B, Emery J, Ngo DTM, Thornton-Benko E. The Importance of Primary Care in Cardio-Oncology. Curr Treat Options Oncol 2021; 22:107. [PMID: 34674055 DOI: 10.1007/s11864-021-00908-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT There is significant interplay between cancer and cardiovascular disease involving shared risk factors, cross disease communication where cardiovascular events can influence cancer recurrence, and mortality rates and cardiotoxicity from cancer treatments with resultant increased cardiovascular mortality and morbidity in cancer patients. This is a major cause of death in many long-term cancer survivors. As a result, cardio-oncology, which involves the prevention, early detection, and optimal treatment of cardiovascular disease in patients treated for cancer, is expanding globally. However, there is still limited awareness of its importance and limited application of the lessons already learnt. Primary care physicians, and their clinical teams, especially nursing colleagues, have a foundation role in the management of all patients, and this paper outlines areas where they can lead in the cardio-oncology management of cancer patients. Although there is currently a lack of an adequate clinical framework or shared care plan, primary care physicians have a role to play in the various phases of cancer treatment: pre-therapy, during therapy, and survivorship.
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Affiliation(s)
- Daniel A Cehic
- GenesisCare Cardiology, GenesisCare, Building 1 & 11, The Mill, 41-43 Bourke Road, Alexandria, Sydney, NSW, 2015, Australia. .,Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia.
| | - Aaron L Sverdlov
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter Cancer Research Alliance, Waratah, NSW, 2298, Australia.,Hunter New England Local Health District, Newcastle, NSW, 2305, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,Flinders Health and Medical Research Institute, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 10, Victorian Comprehensive Cancer Centre, 305 Grattan St, Victoria, 3000, Australia
| | - Doan T M Ngo
- Hunter Cancer Research Alliance, Waratah, NSW, 2298, Australia.,Hunter New England Local Health District, Newcastle, NSW, 2305, Australia.,School of Biomedical Science and Pharmacy, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Elysia Thornton-Benko
- Bondi Road Doctors, 27 Bondi Road, Bondi Junction, Sydney, NSW, 2022, Australia.,Faculty of Medicine, Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, University of NSW, Randwick, NSW, Australia
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20
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Cuomo A, Paudice F, D'Angelo G, Perrotta G, Carannante A, Attanasio U, Iengo M, Fiore F, Tocchetti CG, Mercurio V, Pirozzi F. New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management. Curr Heart Fail Rep 2021; 18:191-199. [PMID: 34181210 PMCID: PMC8342372 DOI: 10.1007/s11897-021-00517-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Oncological treatments are known to induce cardiac toxicity, but the impact of new-onset cancer in patients with pre-existing HF remains unknown. This review focuses on the epidemiology, pathophysiological mechanisms, and clinical implications of HF patients who develop malignancies. RECENT FINDINGS Novel findings suggest that HF and cancer, beside common risk factors, are deeply linked by shared pathophysiological mechanisms. In particular, HF itself may enhance carcinogenesis by producing pro-inflammatory cytokines, and it has been suggested that neurohormonal activation, commonly associated with the failing heart, might play a pivotal role in promoting neoplastic transformation. The risk of malignancies seems to be higher in HF patients compared to the general population, probably due to shared risk factors and common pathophysiological pathways. Additionally, management of these patients represents a challenge for clinicians, considering that the co-existence of these diseases significantly worsens patients' prognosis and negatively affects therapeutic options for both diseases.
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Affiliation(s)
- Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Francesca Paudice
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni D'Angelo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Perrotta
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Antonio Carannante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Martina Iengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Fiore
- Department of Translational Medical Sciences, Federico II University, Naples, 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
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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21
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Ortega Pérez R, Pardo Sanz A, García Gutiérrez V, Zamorano Gómez JL. Cardiovascular Oncology: The Need for a Multidisciplinary Approach. Semin Thromb Hemost 2021; 47:907-913. [PMID: 34154001 DOI: 10.1055/s-0041-1726297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Improved cancer survivorship has led to an increase in cardiovascular (CV) complications in the oncologic population, mainly associated with therapeutic regimens. Hence, cardio-oncology has grown toward unifying the cancer care process in which the best prevention, early detection, treatment, and CV surveillance are offered to patients. This multidisciplinary approach allows us to optimize and agree upon clinical decisions to enhance clinical outcomes. Atrial fibrillation is one of the hot topics in the field because it is still challenging in cancer patients. The optimal antithrombotic therapy remains unclear. Nevertheless, evidence supports that specific recommendations are needed due to a hemorrhagic/thrombotic disbalance present within this subgroup of patients and a low rate of anticoagulation treatments compared with the general population. Further, cardiotoxicity management is currently transforming. Increasingly, early detection of subclinical alterations is raising awareness. When medical therapy is initiated early, fewer patients progress to ventricular dysfunction and the rate of patients completing cancer therapy gradually increases. New approaches are demonstrating better outcomes and these strategies will expectedly be established in clinical practice. Cardio-oncology enables us to find the best balance between cancer treatment and CV health protection. Nowadays, more and more physicians are being instructed in this discipline, which gradually exhibits a greater presence in conferences and scientific journals. However, given the need for physicians thoroughly trained in cardio-oncology, this subspecialty must be promoted further.
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Affiliation(s)
| | - Ana Pardo Sanz
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
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22
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Canale ML, Turazza F, Lestuzzi C, Parrini I, Camerini A, Russo G, Colivicchi F, Gabrielli D, Gulizia MM, Oliva S, Tarantini L, Maurea N, Rigacci L, Petrolati S, Casolo G, Bisceglia I. Portrait of Italian Cardio-Oncology: Results of a Nationwide Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Survey. Front Cardiovasc Med 2021; 8:677544. [PMID: 34222373 PMCID: PMC8242580 DOI: 10.3389/fcvm.2021.677544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: Cardio-oncology has achieved a pivotal role in science, but real world data on its clinical impact are still limited. Methods: A questionnaire was sent out to all cardio-oncology services across Italy (n = 120). The questionnaire was made up of 28 questions divided into four blocks: (A) general information on hospitals and service, (B) the inner organization of cardio-oncology and its relationships with out-of-hospital cardiologists and general practitioners, (C) educational needs and referral guidelines, and (D) activities/specific workload. Results: Ninety-six out of 120 (80%) completed the questionnaire; 9.4% were cancer centers while 90.6% were general hospitals. A cardio-oncology team was present in 56% of the cancer centers and in 20% only of general hospitals, and a cardio-oncology pathway was active in 55% of cancer centers and in just 14% of the general hospitals. Relationships with out-of-hospital cardiologists and general practitioners were lacking. The guidelines of reference were ESC and ANMCO/AIOM. Patients receiving anthracycline chemotherapy underwent scheduled monitoring by means of echocardiography in 58% of cases. Routine use of cardiac damage biomarkers was overall low, ranging from 22 to 33% while the use of global longitudinal strain reached 44%. Conclusions: Italian cardio-oncology showed a growing influence on clinical practice but still has room for improvement. Cardio-oncology teams are still scarce, and the application of dedicated paths is poor. The need for specific training has been highlighted.
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Affiliation(s)
- Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Fabio Turazza
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Lestuzzi
- Cardiology Unit, Oncology Department, CRO National Cancer Institute, Aviano, Italy
| | - Iris Parrini
- Divisione di Cardiologia, Ospedale Mauriziano, Turin, Italy
| | - Andrea Camerini
- Medical Oncology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Giulia Russo
- SC Centro Cardiovascolare Ospedale Maggiore, Trieste, Italy
| | - Furio Colivicchi
- Division of Cardiology, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Domenico Gabrielli
- Division of Cardiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | | | - Stefano Oliva
- Division of Cardiology, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Luigi Tarantini
- Divisione di Cardiologia, Arcispedale S. Maria Nuova, Reggio-Emilia, Italy
| | - Nicola Maurea
- S.C. Cardiologia, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Luigi Rigacci
- UOC Ematologia, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Sandro Petrolati
- Servizi Cardiologici Integrati, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giancarlo Casolo
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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23
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Baldassarre LA, Yang EH, Cheng RK, DeCara JM, Dent S, Liu JE, Rudski LG, Strom JB, Thavendiranathan P, Barac A, Zaha VG, Bucciarelli-Ducci C, Ellahham S, Deswal A, Lenneman C, Villarraga HR, Blaes AH, Ismail-Khan R, Ky B, Leja MJ, Scherrer-Crosbie M. Cardiovascular Care of the Oncology Patient During COVID-19: An Expert Consensus Document From the ACC Cardio-Oncology and Imaging Councils. J Natl Cancer Inst 2021; 113:513-522. [PMID: 33179744 PMCID: PMC7717327 DOI: 10.1093/jnci/djaa177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
In response to the coronavirus disease 2019 (COVID-19) pandemic, the Cardio-Oncology and Imaging Councils of the American College of Cardiology offers recommendations to clinicians regarding the cardiovascular care of cardio-oncology patients in this expert consensus statement. Cardio-oncology patients-individuals with an active or prior cancer history and with or at risk of cardiovascular disease-are a rapidly growing population who are at increased risk of infection, and experiencing severe and/or lethal complications by COVID-19. Recommendations for optimizing screening and monitoring visits to detect cardiac dysfunction are discussed. In addition, judicious use of multimodality imaging and biomarkers are proposed to identify myocardial, valvular, vascular, and pericardial involvement in cancer patients. The difficulties of diagnosing the etiology of cardiovascular complications in patients with cancer and COVID-19 are outlined, along with weighing the advantages against risks of exposure, with the modification of existing cardiovascular treatments and cardiotoxicity surveillance in patients with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Lauren A Baldassarre
- Affiliations of authors: Section of Cardiovascular Medicine, Department of Medicine, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Richard K Cheng
- Cardio-Oncology Program, Department of Medicine, Division of Cardiology and Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jeanne M DeCara
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC, USA
| | - Jennifer E Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lawrence G Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, Division of Cardiology, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, UK
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic-Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Anita Deswal
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carrie Lenneman
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Anne H Blaes
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, Division of Oncologic Sciences, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monika J Leja
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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24
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Whelton SP, Berning P, Blumenthal RS, Marshall CH, Martin SS, Mortensen MB, Blaha MJ, Dzaye O. Multidisciplinary prevention and management strategies for colorectal cancer and cardiovascular disease. Eur J Intern Med 2021; 87:3-12. [PMID: 33610416 DOI: 10.1016/j.ejim.2021.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/09/2021] [Accepted: 02/06/2021] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) and cardiovascular disease (CVD) are leading causes of morbidity and mortality worldwide. Their numerous shared and modifiable risk factors underscore the importance of effective prevention strategies for these largely preventable diseases. Conventionally regarded as separate disease entities, clear pathophysiological links and overlapping risk factors represent an opportunity for synergistic collaborative efforts of oncologists and cardiologists. In addition, current CRC treatment approaches can exert cardiotoxicity and thus increase CVD risk. Given the complex interplay of both diseases and increasing numbers of CRC survivors who are at increased risk for CVD, multidisciplinary cardio-oncological approaches are warranted for optimal patient care from primary prevention to acute disease treatment and long-term surveillance.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Catherine Handy Marshall
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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25
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Nishikawa T, Morishima T, Okawa S, Fujii Y, Otsuka T, Kudo T, Fujita T, Kamada R, Yasui T, Shioyama W, Oka T, Tabuchi T, Fujita M, Miyashiro I. Multicentre cohort study of the impact of percutaneous coronary intervention on patients with concurrent cancer and ischaemic heart disease. BMC Cardiovasc Disord 2021; 21:177. [PMID: 33849438 PMCID: PMC8045293 DOI: 10.1186/s12872-021-01968-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear. Methods Five-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention [PCI] or IHD diagnosis) were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n = 564, PCI + group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n = 3058, PCI-/IHD + group), and patients without IHD (n = 27,392, PCI-/IHD- group). Kaplan–Meier analysis was used for comparisons. Results After propensity score matching, the PCI + group had better prognosis (n = 489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51–0.81, P < 0.001) than the PCI-/IHD + group. PCI + patients (n = 282) had significantly higher mortality than those without IHD (n = 280 in each group, hazard ratio 2.88, 95% confidence interval 1.90–4.38, P < 0.001). Conclusions PCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD. Since the present study has some limitations, further research will be needed on this important topic in cardio-oncology. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01968-w.
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Affiliation(s)
- Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan.
| | | | - Sumiyo Okawa
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
| | - Yuki Fujii
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Tomoyuki Otsuka
- Department of Clinical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshihiro Kudo
- Department of Clinical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Risa Kamada
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Taku Yasui
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Wataru Shioyama
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Toru Oka
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Takahiro Tabuchi
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Fujita
- Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan.
| | - Isao Miyashiro
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
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26
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Khoury K, Lynce F, Barac A, Geng X, Dang C, Yu AF, Smith KL, Gallagher C, Pohlmann PR, Nunes R, Herbolsheimer P, Warren R, Srichai MB, Hofmeyer M, Asch F, Tan M, Isaacs C, Swain SM. Long-term follow-up assessment of cardiac safety in SAFE-HEaRt, a clinical trial evaluating the use of HER2-targeted therapies in patients with breast cancer and compromised heart function. Breast Cancer Res Treat 2021; 185:863-868. [PMID: 33400034 PMCID: PMC8207895 DOI: 10.1007/s10549-020-06053-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE HER2-targeted therapies are associated with cardiotoxicity which is usually asymptomatic and reversible. We report the updated cardiac safety assessment of patients with compromised heart function receiving HER2-targeted therapy for breast cancer, enrolled in the SAFE-HEaRt trial, at a median follow-up of 3.5 years. METHODS Thirty patients with stage I-IV HER2-positive breast cancer receiving trastuzumab with or without pertuzumab, or ado-trastuzumab emtansine (T-DM1), with asymptomatic LVEF (left ventricular ejection fraction) 40-49%, were started on cardioprotective medications, with the primary endpoint being completion of HER2-targeted therapy without cardiac events (CE) or protocol-defined asymptomatic worsening of LVEF. IRB-approved follow-up assessment included 23 patients. RESULTS Median follow-up as of June 2020 is 42 months. The study met its primary endpoint with 27 patients (90%) completing their HER2-targeted therapies without cardiac issues. Of the 23 evaluable patients at long-term f/u, 14 had early stage breast cancer, and 9 had metastatic disease, 8 of whom remained on HER2-targeted therapies. One patient developed symptomatic heart failure with no change in LVEF. There were no cardiac deaths. The mean LVEF improved to 52.1% from 44.9% at study baseline, including patients who remained on HER2-targeted therapy, and those who received prior anthracyclines. CONCLUSIONS Long-term follow-up of the SAFE-HEaRt study continues to provide safety data of HER2-targeted therapy use in patients with compromised heart function. The late development of cardiac dysfunction is uncommon and continued multi-disciplinary oncologic and cardiac care of patients is vital for improved patient outcomes.
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Affiliation(s)
- Katia Khoury
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
- O'Neal Comprehensive Cancer Center at UAB, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Filipa Lynce
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington DC, USA
| | - Xue Geng
- Georgetown University, Washington DC, USA
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony F Yu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen L Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
| | - Raquel Nunes
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Robert Warren
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
| | | | - Mark Hofmeyer
- MedStar Heart and Vascular Institute, Washington DC, USA
| | - Federico Asch
- MedStar Heart and Vascular Institute, Washington DC, USA
| | - Ming Tan
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA
- Georgetown University, Washington DC, USA
| | - Sandra M Swain
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington DC, USA.
- MedStar Health, Columbia, MD, USA.
- Georgetown University Medical Center, Building D Room 120, 4000 Reservoir Road NW, Washington DC, 20057, USA.
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27
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Murphy AC, Koshy AN, Cameron W, Horrigan M, Kearney L, Yeo B, Farouque O, Yudi MB. Transcatheter aortic valve replacement in patients with a history of cancer: Periprocedural and long-term outcomes. Catheter Cardiovasc Interv 2021; 97:157-164. [PMID: 32497385 DOI: 10.1002/ccd.28969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND A history of cancer is incorporated into the surgical risk assessment of patients undergoing surgical aortic valve replacement through the Society for Thoracic Surgeons score. However, the prognostic significance of cancer in patients treated with transcatheter aortic valve replacement (TAVR) is unclear. As the cancer survivorship population increases, it is imperative to establish the efficacy and safety of TAVR in patients with severe symptomatic aortic stenosis (AS) and a history of malignancy. OBJECTIVES The primary goal of this study was to assess the periprocedural outcomes and long-term mortality in patients with a history of cancer undergoing TAVR. METHODS A systematic review of PubMed, MEDLINE, and EMBASE was conducted to identify studies reporting outcomes in patients with a history of malignancy undergoing TAVR. A meta-analysis was performed using a random-effects model with a primary outcome of all-cause mortality and cardiac mortality at the longest follow-up. On secondary analyses, procedural safety was assessed. RESULTS A total of 13 observational studies with 10,916 patients were identified in the systematic review. Seven studies including 6,323 patients were included in the quantitative analysis. Short-term mortality (relative risk [RR] 0.61, 95%CI 0.36-1.01; p = .06) and long-term all-cause mortality (RR 1.24, 95%CI 0.95-1.63; p = .11) were not significantly different when comparing patients with and without a history of cancer. No significant difference in the rate of periprocedural complications including stroke, bleeding, acute kidney injury, and pacemaker implantation was noted. CONCLUSION In patients with severe AS undergoing TAVR, a history of cancer was not associated with adverse short or long-term survival. Based on these findings, TAVR should be considered in all patients with severe symptomatic AS, irrespective of their history of malignancy.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Cameron
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Leighton Kearney
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton-John Cancer and Wellness Centre, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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28
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Tuzovic M, Brown SA, Yang EH, West BH, Bassi NS, Park S, Guha A, Ghosh AK, Ganatra S, Hayek SS, Moslehi J, Jahangir E. Implementation of Cardio-Oncology Training for Cardiology Fellows. JACC: CARDIOONCOLOGY 2020; 2:795-799. [PMID: 34396296 PMCID: PMC8352041 DOI: 10.1016/j.jaccao.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mirela Tuzovic
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Medical Center, Stanford, California, USA
| | - Sherry-Ann Brown
- Cardio-oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric H Yang
- University of California Los Angeles Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Brian H West
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Nikhil S Bassi
- University of California Los Angeles Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sandy Park
- University of California Los Angeles Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Avirup Guha
- Cardio-oncology Program, Division of Cardiology, Department of Medicine, The Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Arjun K Ghosh
- Cardio-oncology Services, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,University College London Hospital, London, United Kingdom.,Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Sarju Ganatra
- Cardio-Oncology Program, Landsman Heart and Vascular Center, Division of Cardiology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Javid Moslehi
- Cardio-oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eiman Jahangir
- Cardio-oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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29
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Cuomo A, Pirozzi F, Attanasio U, Franco R, Elia F, De Rosa E, Russo M, Ghigo A, Ameri P, Tocchetti CG, Mercurio V. Cancer Risk in the Heart Failure Population: Epidemiology, Mechanisms, and Clinical Implications. Curr Oncol Rep 2020; 23:7. [PMID: 33263821 PMCID: PMC7716920 DOI: 10.1007/s11912-020-00990-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Along with population aging, the incidence of both heart failure (HF) and cancer is increasing. However, little is known about new-onset cancer in HF patients. This review aims at showing recent discoveries concerning this subset of patients. RECENT FINDINGS Not only cancer and HF share similar risk factors but also HF itself can stimulate cancer development. Some cytokines produced by the failing heart induce mild inflammation promoting carcinogenesis, as it has been recently suggested by an experimental model of HF in mice. The incidence of new-onset cancer is higher in HF patients compared to the general population, and it significantly worsens their prognosis. Moreover, the management of HF patients developing new-onset cancer is challenging, especially due to the limited therapeutic options for patients affected by both cancer and HF and the higher risk of cardiotoxicity from anticancer drugs.
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Affiliation(s)
- Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Riccardo Franco
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Elia
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Eliana De Rosa
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michele Russo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Italian Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
- Interdepartmental Center of Clinical and Translational Research, Federico II University, Naples, Italy.
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Liu JE, Barac A, Thavendiranathan P, Scherrer-Crosbie M. Strain Imaging in Cardio-Oncology. JACC CardioOncol 2020; 2:677-689. [PMID: 34396282 PMCID: PMC8352045 DOI: 10.1016/j.jaccao.2020.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- ACC, American College of Cardiology
- AL, amyloid light chains
- ASE, American Society of Echocardiography
- CMRI, cardiac magnetic resonance imaging
- CTRCD, cancer treatment–related cardiac dysfunction
- DICOM, Digital Imaging and Communications in Medicine
- EACVI, European Association of Cardiovascular Imaging
- GLS, global longitudinal strain
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- ROI, region of interest
- STE, speckle tracking echocardiography
- VEGF, vascular endothelium growth factor
- cancer
- cardiotoxicity
- echocardiography
- global longitudinal strain
- left ventricular function
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Affiliation(s)
- Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ana Barac
- Department of Cardiology, Medstar Washington Hospital Center, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Alvarez-Cardona JA, Ray J, Carver J, Zaha V, Cheng R, Yang E, Mitchell JD, Stockerl-Goldstein K, Kondapalli L, Dent S, Arnold A, Brown SA, Leja M, Barac A, Lenihan DJ, Herrmann J. Cardio-Oncology Education and Training: JACC Council Perspectives. J Am Coll Cardiol 2020; 76:2267-2281. [PMID: 33153587 PMCID: PMC8174559 DOI: 10.1016/j.jacc.2020.08.079] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022]
Abstract
The innovative development of cancer therapies has led to an unprecedented improvement in survival outcomes and a wide array of treatment-related toxicities, including those that are cardiovascular in nature. Aging of the population further adds to the number of patients being treated for cancer, especially those with comorbidities. Such pre-existing and developing cardiovascular diseases pose some of the greatest risks of morbidity and mortality in patients with cancer. Addressing the complex cardiovascular needs of these patients has become increasingly important, resulting in an imperative for an intersecting discipline: cardio-oncology. Over the past decade, there has been a remarkable rise of cardio-oncology clinics and service lines. This development, however, has occurred in a vacuum of standard practice and training guidelines, although these are being actively pursued. In this council perspective document, the authors delineate the scope of practice in cardio-oncology and the proposed training requirements, as well as the necessary core competencies. This document also serves as a roadmap toward confirming cardio-oncology as a subspecialty in medicine.
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Affiliation(s)
- Jose A Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Jordan Ray
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Joseph Carver
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vlad Zaha
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Eric Yang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | | | - Lavanya Kondapalli
- Division of Cardiology University of Colorado School of Medicine, Aurora, Colorado
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina
| | - Anita Arnold
- Lee Physician Group Cardiology, Fort Myers, Texas
| | - Sherry Ann Brown
- Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin
| | - Monica Leja
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Joerg Herrmann
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
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32
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Ryan TD, Hayek SS. New perspectives in cardio-oncology. J Thromb Thrombolysis 2020; 51:835-836. [PMID: 32880797 DOI: 10.1007/s11239-020-02267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas D Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine; Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, University of Michigan Frankel Cardiovascular Center, University of Michigan, 1500 E Medical Center Dr, CVC #2709, Ann Arbor, MI, 48109, USA.
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Sadler D, Chaulagain C, Alvarado B, Cubeddu R, Stone E, Samuel T, Bastos B, Grossman D, Fu CL, Alley E, Nagarajan A, Nguyen T, Ahmed W, Elson L, Nahleh Z. Practical and cost-effective model to build and sustain a cardio-oncology program. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2020; 6:9. [PMID: 32690995 PMCID: PMC7363993 DOI: 10.1186/s40959-020-00063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardio-Oncology (CO) is a new subspecialty that thrives mostly in large academic quaternary centers. This study describes how to establish a successful cardio-oncology program, with limited resources, in order to effectively manage the unique care required by this patient population. METHODS Clinical data was collected from 25 consecutive months. There were four foundational elements to establish a CO program: 1. Clinical program: integrating staff and resources from the Heart and Vascular, and Cancer Centers; 2. Education Program: establishing a platform to educate/advocate with respect to CO; 3. Engagement with professional societies: active engagement allowed for the successful establishment of the proposed CO program; and 4. Research program: establishing data collection modalities/cooperation with other institutions. RESULTS 474 consecutive patients were treated by our CO program during the first 25 months of operation. Clinical data, information about cancer treatment, cardiovascular co morbidities, cardiac testing and impact of CO management are reported. CONCLUSIONS A successful CO program can be established utilizing existing resources without the need for significant additional assets. Integration with professional societies, advocacy, education and research, provide a platform for learning and growth. This model improves access to care and can be reproduced in a variety of settings.
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Affiliation(s)
- Diego Sadler
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Chakra Chaulagain
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Beatrice Alvarado
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Robert Cubeddu
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Elizabeth Stone
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Thomas Samuel
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Bruno Bastos
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - David Grossman
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Chieh-Lin Fu
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Evan Alley
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Arun Nagarajan
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Timmy Nguyen
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Wesam Ahmed
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Leah Elson
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Zeina Nahleh
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
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López-Fernández T. Cardiac Imaging in Oncology Patients in Europe: a Model for Advancement of CV Safety and Development of Comprehensive CV Care. J Cardiovasc Transl Res 2020; 13:490-494. [PMID: 32583314 PMCID: PMC7314619 DOI: 10.1007/s12265-020-10028-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Cancer therapy-related cardiovascular events are widely recognized as a global problem, and cardio-oncology has been proposed as a new approach to coordinate preventive strategies in oncologic patients. Cardiac imaging plays a critical role in this process. This article summarizes current practices and future needs in cardiac imaging to improve the cardiovascular surveillance of cancer patients.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, Cardiac Imaging and Cardio-Oncology Unit, IdiPAZ, CIBER CV, La Paz University Hospital, Madrid, Spain.
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35
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Mayer EL. Partnering Teams to Optimize the Care of Patients With HER2-Positive Breast Cancer. JACC CardioOncol 2020; 2:190-192. [PMID: 34396228 PMCID: PMC8352194 DOI: 10.1016/j.jaccao.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Murphy AC, Koshy AN, Yudi MB. Ischaemic heart disease and Cancer: competing malignant conditions. BMC Cardiovasc Disord 2020; 20:254. [PMID: 32460710 PMCID: PMC7254683 DOI: 10.1186/s12872-020-01539-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growing population of cancer survivors and their high frequency of cardiovascular disease have resulted in a dramatic increase in cancer patients requiring cardiovascular intervention. However, there is a lack of evidence to guide optimal management in this complex population who have historically been excluded from cardiovascular trials. DISCUSSION We review the recently published meta-analysis by Roule et al. The findings of this analysis demonstrate that patients with cancer presenting with acute coronary syndrome (ACS) have increased rates of in-hospital cardiovascular mortality, bleeding and one-year cardiovascular mortality. All-cause mortality measured in-hospital and at one-year were also significantly greater in cancer patients as was all-cause mortality in cancer patients that undergo percutaneous coronary intervention (PCI). In contrast to the short-term outcomes, rates of long-term cardiovascular mortality did not differ significantly between groups. Patient-specific assessment of risk, accounting for disease characteristics and treatment, and close communication with oncology providers is vital in defining optimal treatment strategies in this population.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia. .,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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37
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Clinical Practice and Research in Cardio-Oncology: Finding the "Rosetta Stone" for Establishing Program Excellence in Cardio-oncology. J Cardiovasc Transl Res 2020; 13:495-505. [PMID: 32444945 DOI: 10.1007/s12265-020-10010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
The burgeoning field of cardio-oncology (C-O) is now necessary for the delivery of excellent care for patients with cancer. Many factors have contributed to this increasing population of cancer survivors or those being treated with novel and targeted cancer therapies. There is a tremendous need to provide outstanding cardiovascular (CV) care for these patients; however, current medical literature actually provides a paucity of guidance. C-O therefore provides a novel opportunity for clinical, translational, and basic research to advance patient care. This review aims to be a primer for cardio-oncologists on how to develop a vibrant and comprehensive C-O program, use practical tools to assist in the construction of C-O services, and to proactively incorporate translational and clinical research into the training of future leaders as well as enhance clinical care.
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38
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Waddell KJ, Shah PD, Adusumalli S, Patel MS. Using Behavioral Economics and Technology to Improve Outcomes in Cardio-Oncology. JACC CardioOncol 2020; 2:84-96. [PMID: 34396212 PMCID: PMC8352113 DOI: 10.1016/j.jaccao.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer are often at elevated risk for cardiovascular disease due to overlapping risk factors and cardiotoxic anticancer treatments. Their cancer diagnoses may be the predominant focus of clinical care, with less of an emphasis on concurrent cardiovascular risk management. Widely adopted technology platforms, including electronic health records and mobile devices, can be leveraged to improve the cardiovascular outcomes of these patients. These technologies alone may be insufficient to change behavior and may have greater impact if combined with behavior change strategies. Behavioral economics is a scientific field that uses insights from economics and psychology to help explain why individuals are often predictably irrational. Combining insights from behavioral economics with these scalable technology platforms can positively impact medical decision-making and sustained healthy behaviors. This review focuses on the principles of behavioral economics and how "nudges" and scalable technology can be used to positively impact clinician and patient behaviors.
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Affiliation(s)
- Kimberly J. Waddell
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Payal D. Shah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Srinath Adusumalli
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mitesh S. Patel
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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39
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Hausenloy DJ, Ng CT, Chong JH. Repeated Remote Ischemic Conditioning Protects Against Doxorubicin Cardiotoxicity: Never Too Much of a Good Thing. JACC CardioOncol 2020; 2:53-55. [PMID: 34396209 PMCID: PMC8352202 DOI: 10.1016/j.jaccao.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Derek J. Hausenloy
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Choon Ta Ng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jun Hua Chong
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore
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40
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López‐Fernández T, López‐Sendón JL. Heart failure after treatment for breast cancer: old cancer therapies, new clinical data. What do we need to complete the puzzle? Eur J Heart Fail 2020; 22:375-377. [DOI: 10.1002/ejhf.1662] [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: 12/24/2022] Open
Affiliation(s)
| | - José L. López‐Sendón
- Servicio de CardiologíaHospital Universitario La Paz, IdiPAz, CIBERCV Madrid Spain
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41
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Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, Herrmann J, Porter C, Lyon AR, Lancellotti P, Patel A, DeCara J, Mitchell J, Harrison E, Moslehi J, Witteles R, Calabro MG, Orecchia R, de Azambuja E, Zamorano JL, Krone R, Iakobishvili Z, Carver J, Armenian S, Ky B, Cardinale D, Cipolla CM, Dent S, Jordan K. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 2020; 31:171-190. [PMID: 31959335 PMCID: PMC8019325 DOI: 10.1016/j.annonc.2019.10.023] [Citation(s) in RCA: 488] [Impact Index Per Article: 122.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.
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Affiliation(s)
- G. Curigliano
- European Institute of Oncology IRCCS, Milan
- Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy
| | - D. Lenihan
- Cardiovascular Division, Cardio-Oncology Center of Excellence, Washington University Medical Center, St. Louis
| | - M. Fradley
- Cardio-oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa
| | - S. Ganatra
- Cardio-Oncology Program, Lahey Medical Center, Burlington
| | - A. Barac
- Cardio-Oncology Program, Medstar Heart and Vascular Institute and MedStar Georgetown Cancer Institute, Georgetown University Hospital, Washington DC
| | - A. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis
| | | | - C. Porter
- University of Kansas Medical Center, Lawrence, USA
| | - A. R. Lyon
- Royal Brompton Hospital and Imperial College, London, UK
| | - P. Lancellotti
- GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, University Hospital of Liège, Liège, Belgium
| | - A. Patel
- Morsani College of Medicine, University of South Florida, Tampa
| | - J. DeCara
- Medicine Section of Cardiology, University of Chicago, Chicago
| | - J. Mitchell
- Washington University Medical Center, St. Louis
| | - E. Harrison
- HCA Memorial Hospital and University of South Florida, Tampa
| | - J. Moslehi
- Vanderbilt University School of Medicine, Nashville
| | - R. Witteles
- Division of Cardiovascular Medicine, Falk CVRC, Stanford University School of Medicine, Stanford, USA
| | - M. G. Calabro
- Department of Anesthesia and Intensive Care, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | | | - E. de Azambuja
- Institut Jules Bordet and L’Université Libre de Bruxelles, Brussels, Belgium
| | | | - R. Krone
- Division of Cardiology, Washington University, St. Louis, USA
| | - Z. Iakobishvili
- Clalit Health Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J. Carver
- Division of Cardiology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia
| | - S. Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte
| | - B. Ky
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - D. Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan
| | - C. M. Cipolla
- Cardiology Department, European Institute of Oncology, IRCCS, Milan, Italy
| | - S. Dent
- Duke Cancer Institute, Duke University, Durham, USA
| | - K. Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - ESMO Guidelines Committee
- Correspondence to: ESMO Guidelines Committee, ESMO Head Office, Via Ginevra 4, CH-6900 Lugano, Switzerland, (ESMO Guidelines Committee)
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42
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Mitroi C, Martín-García A, Mazón Ramos P, Virizuela Echaburu JA, Arenas-Prat M, García-Sanz R, Arrarte Esteban V, García-Pinilla JM, Cosín-Sales J, López-Fernández T. Current functioning of cardio-oncology units in Spain. Clin Transl Oncol 2019; 22:1418-1422. [PMID: 31863353 DOI: 10.1007/s12094-019-02250-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/24/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.
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Affiliation(s)
- C Mitroi
- Cardiology Department, University Hospital Puerta de Hierro, Majadahonda, Manuel de Falla 1, 28222, Madrid, Spain.
| | - A Martín-García
- Cardiology Department, Institute for Biomedical Research of Salamanca (IBSAL), CIBER-CV, University Hospital of Salamanca (CAUSA), Salamanca, Spain
| | - P Mazón Ramos
- Cardiology Department, University Clinical Hospital Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - M Arenas-Prat
- Radiation Oncology Department, University Hospital Sant Joan de Reus, Rovira i Virgili University, Reus, Tarragona, Spain
| | - R García-Sanz
- Hematology Department, Institute for Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca (CAUSA), Salamanca, Spain
| | - V Arrarte Esteban
- Cardiology Department, University General Hospital Alicante, Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - J M García-Pinilla
- Cardiology Department, IBIMA, CIBER-CV, University Hospital Virgen de la Victoria, Málaga, Spain
| | - J Cosín-Sales
- Cardiology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | - T López-Fernández
- Cardiology Department, Institute for Health Research La Paz, CIBER-CV, University Hospital La Paz, Madrid, Spain
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Sundlöf DW, Patel BD, Schadler KC, Biggs RG, Silverstein Fadlon CA, Corotto PS, Tolay S, Nadeem AJ, Gupta R, Ahmad NV. Development of a Cardio-Oncology Program in a Community Hospital. JACC: CARDIOONCOLOGY 2019; 1:310-313. [PMID: 34396198 PMCID: PMC8352231 DOI: 10.1016/j.jaccao.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Deborah W Sundlöf
- Lehigh Valley Health Network, Heart Institute, Bethlehem, Pennsylvania, USA
| | - Brijesh D Patel
- Lehigh Valley Health Network, Heart Institute, Bethlehem, Pennsylvania, USA
| | - Kelly C Schadler
- Lehigh Valley Health Network, Heart Institute, Bethlehem, Pennsylvania, USA
| | - Ross G Biggs
- Lehigh Valley Health Network, Heart Institute, Bethlehem, Pennsylvania, USA
| | | | - Paul S Corotto
- Lehigh Valley Health Network, Heart Institute, Allentown, Pennsylvania, USA
| | - Sameer Tolay
- Lehigh Valley Health Network, Cancer Institute, Bethlehem, Pennsylvania, USA
| | - Ahmed J Nadeem
- Lehigh Valley Health Network, Cancer Institute, Bethlehem, Pennsylvania, USA
| | - Ranju Gupta
- Lehigh Valley Health Network, Cancer Institute, Bethlehem, Pennsylvania, USA
| | - Nadeem V Ahmad
- Lehigh Valley Health Network, Heart Institute, Bethlehem, Pennsylvania, USA
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Gertz ZM, Cain C, Kraskauskas D, Devarakonda T, Mauro AG, Thompson J, Samidurai A, Chen Q, Gordon SW, Lesnefsky EJ, Das A, Salloum FN. Remote Ischemic Pre-Conditioning Attenuates Adverse Cardiac Remodeling and Mortality Following Doxorubicin Administration in Mice. JACC: CARDIOONCOLOGY 2019; 1:221-234. [PMID: 32699841 PMCID: PMC7375406 DOI: 10.1016/j.jaccao.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives Because of its multifaceted cardioprotective effects, remote ischemic pre-conditioning (RIPC) was examined as a strategy to attenuate doxorubicin (DOX) cardiotoxicity. Background The use of DOX is limited by dose-dependent cardiotoxicity and heart failure. Oxidative stress, mitochondrial dysfunction, inflammation, and autophagy modulation have been proposed as mediators of DOX cardiotoxicity. Methods After baseline echocardiography, adult male CD1 mice were randomized to either sham or RIPC protocol (3 cycles of 5 min femoral artery occlusion followed by 5 min reperfusion) 1 h before receiving DOX (20 mg/kg, intraperitoneal). The mice were observed primarily for survival over 85 days (86 mice). An additional cohort of 50 mice was randomized to either sham or RIPC 1 h before DOX treatment and was followed for 25 days, at which time cardiac fibrosis, apoptosis, and mitochondrial oxidative phosphorylation were assessed, as well as the expression profiles of apoptosis and autophagy markers. Results Survival was significantly improved in the RIPC cohort compared with the sham cohort (p = 0.007). DOX-induced cardiac fibrosis and apoptosis were significantly attenuated with RIPC compared with sham (p < 0.05 and p < 0.001, respectively). Although no mitochondrial dysfunction was detected at 25 days, there was a significant increase in autophagy markers with DOX that was attenuated with RIPC. Moreover, DOX caused a 49% decline in cardiac BCL2/BAX expression, which was restored with RIPC (p < 0.05 vs. DOX). DOX also resulted in a 17% reduction in left ventricular mass at 25 days, which was prevented with RIPC (p < 0.01), despite the lack of significant changes in left ventricular ejection fraction. Conclusions Our preclinical results suggested that RIPC before DOX administration might be a promising approach for attenuating DOX cardiotoxicity.
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Affiliation(s)
- Zachary M Gertz
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Chad Cain
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Donatas Kraskauskas
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Teja Devarakonda
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Adolfo G Mauro
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeremy Thompson
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Arun Samidurai
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Qun Chen
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Sarah W Gordon
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Edward J Lesnefsky
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.,Medical Service, McGuire VA Medical Center, Richmond, Virginia
| | - Anindita Das
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Fadi N Salloum
- Pauley Heart Center, Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
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Meijers WC, Moslehi JJ. Need for Multidisciplinary Research and Data-Driven Guidelines for the Cardiovascular Care of Patients With Cancer. JAMA 2019; 322:1775-1776. [PMID: 31714975 PMCID: PMC7228138 DOI: 10.1001/jama.2019.17415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wouter C Meijers
- Cardio-oncology Program, Divisions of Cardiovascular Medicine and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Javid J Moslehi
- Cardio-oncology Program, Divisions of Cardiovascular Medicine and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Ryan TD, Border WL, Baker-Smith C, Barac A, Bock MJ, Canobbio MM, Choueiter NF, Chowdhury D, Gambetta KE, Glickstein JS, Kondapalli L, Mital S, Peiris V, Schiff RJ, Spicer RL, Towbin JA, Chen MH. The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group. CARDIO-ONCOLOGY 2019; 5:16. [PMID: 32154022 PMCID: PMC7048086 DOI: 10.1186/s40959-019-0051-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Objective To enhance the understanding of cardiovascular care delivery in childhood cancer patients and survivors. Study design A 20-question survey was created by the Pediatric Cardio-oncology Work Group of the American College of Cardiology (ACC) Cardio-oncology Section to assess the care, management, and surveillance tools utilized to manage pediatric/young adult cardio-oncology patients. The survey distribution was a collaborative effort between Cardio-oncology Section and membership of the Adult Congenital and Pediatric Cardiology Section (ACPC) of the ACC. Results Sixty-five individuals, all self-identified as physicians, responded to the survey. Most respondents (n = 58,89%) indicated childhood cancer patients are regularly screened prior to and during cancer therapy at their centers, predominantly by electrocardiogram (75%), standard echocardiogram (58%) and advanced echocardiogram (50%) (i.e. strain, stress echo). Evaluation by a cardiologist prior to/during therapy was reported by only 8(12%) respondents, as compared to post-therapy which was reported by 28 (43%, p < 0.01). The most common indications for referral to cardiology at pediatric centers were abnormal test results (n = 31,48%) and history of chemotherapy exposure (n = 27,42%). Of note, during post-treatment counseling, common cardiovascular risk-factors like blood pressure (31,48%), lipid control (22,34%), obesity & smoking (30,46%) and diet/exercise/weight loss (30,46%) were addressed by fewer respondents than was LV function (72%). Conclusions The survey data demonstrates that pediatric cancer patients are being screened by EKG and/or imaging prior to/during therapy at most centers. Our data, however, highlight the potential for greater involvement of a cardiovascular specialist for pre-treatment evaluation process, and for more systematic cardiac risk factor counseling in posttreatment cancer survivors.
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Affiliation(s)
- Thomas D Ryan
- Heart Institute, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229 USA
| | - William L Border
- 2Children's Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Carissa Baker-Smith
- 3Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Ana Barac
- 4MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Matthew J Bock
- 5Loma Linda University Children's Hospital, Loma Linda, CA USA
| | - Mary M Canobbio
- 6Ahmanson/UCLA ACHD Center, UCLA Health, Los Angeles, CA USA
| | - Nadine F Choueiter
- 7The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | | | | | - Julie S Glickstein
- 10Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Lavanya Kondapalli
- 11UC Health Heart & Vascular Center - Anschutz, University of Colorado School of Medicine, Aurora, CO USA
| | - Seema Mital
- 12The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Vasum Peiris
- Department of Health and Human Services, Food and Drug Administration Center for Devices and Radiological Health, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Russell J Schiff
- Cohen Children's Medical Center of New York - Northwell Health, New Hyde Park and Huntington, NY USA
| | - Robert L Spicer
- 15Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE USA
| | - Jeffrey A Towbin
- Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, St. Jude Children's Research Hospital, Memphis, TN USA
| | - Ming Hui Chen
- Departments of Cardiology and Pediatrics, Boston Children's Hospital, Dana-Farber Cancer Institute/Harvard Cancer Center, and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 USA
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The advent of immunotherapy, particularly immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, has ushered in a promising new era of treatment of patients with a variety of malignancies who historically had a poor prognosis. However, these therapies are associated with potentially life-threatening cardiovascular adverse effects. As immunotherapy evolves to include a wider variety of malignancies, risk stratification, prompt recognition, and treatment of cardiotoxicity will become increasingly important and hence cardiologists will need to play a fundamental role in the comprehensive care of these patients. This article reviews cardiotoxicity associated with contemporary immunotherapy and discusses potential management strategies.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, 41 Mall road, Burlington, MA 01805, USA; Cardio-Oncology and Adult Cancer Survivorship Program, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Rohan Parikh
- Department of Medicine, Western Reserve Health Education, 1350 East Market St, Warren, OH 44482, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiac MR/PET Program, Department of Radiology, Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
See Article Cammann et al.
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Affiliation(s)
| | - Carlo Uribe
- Department of CardiologyTexas Heart InstituteHoustonTX
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