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Lorca R, Pascual I, Fernandez M, Alvarez-Velasco R, Colunga S, Muñiz M, Izquierdo M, Fernandez Y, Esteban E, Gomez J, Avanzas P, Lopez-Fernandez T. Concealed Inherited Cardiomyopathies Detected in Cardio-Oncology Screening. J Clin Med 2023; 13:2. [PMID: 38202009 PMCID: PMC10780282 DOI: 10.3390/jcm13010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Basal cardiovascular risk assessment in cardio-oncology is essential. Integrating clinical information, ECG and transthoracic echocardiogram can identify concealed inherited cardiomyopathies (ICMPs) with potential added risk of cardiotoxicity. We aimed to evaluate the impact of our Cardio-Oncology Unit design in detecting concealed ICMPs. METHODS We carried out a retrospective study of all consecutive breast cancer patients referred to the Cardio-Oncology Unit for cardiac evaluation (2020-2022). ICMPs diagnosis was provided according to ESC guidelines and underwent genetic testing. ICMPs prevalence in this cohort was compared to the highest and lowest frequency reported in the general population. RESULTS Among 591 breast cancer patients, we identified eight patients with ICMPs: one arrhythmogenic cardiomyopathy (ACM), three familial non-ischemic dilated cardiomyopathy (DCM), three hypertrophic cardiomyopathy (HCM) and one left ventricular non-compaction cardiomyopathy (LVNC), which has now been reclassified as non-dilated left ventricular cardiomyopathy. The number of ICMPs identified was within the expected range (neither overdiagnosed nor overlooked): ACM 0.0017 vs. 0.0002-0.001 (p 0.01-0.593); DCM 0.0051 vs. 0.002-0.0051 (p 0.094-0.676); HCM 0.005 vs. 0.0002-0.002 (p < 0.001-0.099); LVCN 0.0017 vs. 0.00014-0.013 (p 0.011-0.015). Genetic testing identified a pathogenic FLNC variant and two pathogenic TTN variants. CONCLUSION Opportunistic screening of ICMPs during basal cardiovascular risk assessment can identify high-risk cancer patients who benefit from personalized medicine and enables extension of prevention strategies to all available relatives at concealed high cardiovascular risk.
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Affiliation(s)
- Rebeca Lorca
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Departamento de Biología Funcional. Área de Fisiología, Universidad de Oviedo, 33003 Oviedo, Spain
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain;
| | - Maria Fernandez
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
| | - Rut Alvarez-Velasco
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Santiago Colunga
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Maria Muñiz
- Oncología Médica, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (M.M.); (M.I.); (Y.F.)
| | - Marta Izquierdo
- Oncología Médica, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (M.M.); (M.I.); (Y.F.)
| | - Yolanda Fernandez
- Oncología Médica, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (M.M.); (M.I.); (Y.F.)
| | - Emilio Esteban
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain;
- Oncología Médica, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (M.M.); (M.I.); (Y.F.)
| | - Juan Gomez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Unidad de Cardiopatías Familiares, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORs), 28029 Madrid, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central Asturias, 33011 Oviedo, Spain; (I.P.); (M.F.); (R.A.-V.); (S.C.); (P.A.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain;
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Teresa Lopez-Fernandez
- Cardiología, Hospital Universitario la Paz, IdiPAZ Research Institute, 28046 Madrid, Spain;
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