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Hwang HJ, Han SA, Sohn IS. Breast Cancer and Therapy-Related Cardiovascular Toxicity. J Breast Cancer 2024; 27:147-162. [PMID: 38769686 PMCID: PMC11221208 DOI: 10.4048/jbc.2024.0085] [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: 04/02/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
The global incidence of breast cancer is on the rise, a trend also observed in South Korea. However, thanks to the rapid advancements in anticancer therapies, survival rates are improving. Consequently, post-treatment health and quality of life for breast cancer survivors are emerging as significant concerns, particularly regarding treatment-related cardiotoxicity. In this review, we delve into the cardiovascular complications associated with breast cancer treatment, explore surveillance protocols for early detection and diagnosis of late complications, and discuss protective strategies against cardiotoxicity in breast cancer patients undergoing anticancer therapy, drawing from multiple guidelines.
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Affiliation(s)
- Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Ah Han
- Department of Surgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
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2
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Suntheralingam S, Osataphan N, Power C, Steve Fan CP, Abdel-Qadir H, Amir E, Thavendiranathan P. Safety of Continuing Trastuzumab for Mild Cardiotoxicity: A Cardiovascular Magnetic Resonance Imaging Study. CJC Open 2024; 6:830-835. [PMID: 39022173 PMCID: PMC11250870 DOI: 10.1016/j.cjco.2024.03.007] [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: 02/06/2024] [Accepted: 03/16/2024] [Indexed: 07/20/2024] Open
Abstract
The safety of continuing human epidermal growth factor receptor 2 (HER2)-targeted therapy in women with mild cardiotoxicity remains unclear. We performed a retrospective matched cohort study of 14 patients with human epidermal growth factor receptor 2-positive breast cancer receiving sequential anthracycline and trastuzumab therapy, nested within the Evaluation of Myocardial Changes During Breast Adenocarcinoma Therapy to Detect Cardiotoxicity Earlier With MRI (EMBRACE-MRI) trial. Among patients who developed cardiotoxicity and were treated with heart failure therapy, we compared those who had trastuzumab therapy interrupted to a matched cohort who continued trastuzumab therapy. By a median of 2.5 years of follow-up, no significant differences were present between the groups in the proportion with magnetic resonance imaging-measured left ventricular ejection fraction < 40%, magnetic resonance imaging-measured left ventricular volumes, left ventricular ejection fraction, edema, fibrotic markers, cardiopulmonary fitness, or quality of life.
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Affiliation(s)
- Sivisan Suntheralingam
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nichanan Osataphan
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Coleen Power
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women’s College Hospital Toronto, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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3
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Chong JH, Chang WT, Chan JJ, Tan TJY, Chan JWK, Wong M, Wong FY, Chuah CTH. The cardioprotective potential of sodium-glucose cotransporter 2-inhibitors in breast cancer therapy-related cardiac dysfunction - A systematic review. Curr Probl Cardiol 2024; 49:102372. [PMID: 38281354 DOI: 10.1016/j.cpcardiol.2024.102372] [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: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2-inhibitors (SGLT2i) improve cardiovascular outcomes including reduction in risk of first hospitalisation for heart failure (HF), worsening HF and cardiovascular death regardless of HF or diabetes mellitus (DM) status. It is not known whether SGLT2i can prevent the development of incident HF or reduce the risk of HF in patients receiving trastuzumab with or without other concurrent anti-HER2 agent or sequential anthracycline for treatment of HER2 positive breast cancer. Patients with active malignancy or recent history of malignancy were excluded from participating in the main cardiovascular outcome trials involving SGLT2i. AIM A systematic review was performed to objectively assess published literature on the cardioprotective effects of SGLT2i in breast cancer treatment-related cardiotoxicity. METHODS Systematic searches of Embase, Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were performed. Titles and abstracts were screened separately by two cardio-oncologists (JHC, WTC). Full texts of potentially eligible records were then assessed separately by JHC and WTC before inclusion into review upon joint agreement. RESULTS 479 records were identified from 3 databases (MEDLINE=51, EMBASE=408, CENTRAL=13) and 1 registry (Clinicaltrials.gov=7). 460 records were excluded based on title and abstract (including duplicates). 19 full text reports were assessed for eligibility and included in review (basic science/animal study paper 2, Clinicaltrials.gov randomised controlled trial submission 1 (currently recruiting), basic science/animal study conference abstract 5, case report 2, review 3, editorial comment 2, clinical guidelines 1, retrospective/registry-based conference abstract 3). CONCLUSION Cardiotoxicity is the most common dose-limiting toxicity associated with trastuzumab. Discontinuation of trastuzumab however, can lead to worse cancer outcomes. There have been case reports, registry-based, retrospective cohort-based and mechanistic studies suggesting the cardioprotective potential of SGLT2i in cancer therapy-related cardiac dysfunction (CTRCD). Based on these, there is now a call for randomised controlled trials to be performed in this patient cohort to advise guideline-directed therapy for CTRCD, which will in turn also provide detailed safety information and improve cancer and cardiovascular outcomes.
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Affiliation(s)
- Jun Hua Chong
- National Heart Centre Singapore, Singapore General Hospital, 5 Hospital Dr, 169609 Singapore; Duke-NUS Medical School, 8 College Rd, 169857 Singapore.
| | - Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Jack Junjie Chan
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore
| | - Tira Jing Ying Tan
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore
| | - Johan Wai Kay Chan
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore
| | - Mabel Wong
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore
| | - Fuh Yong Wong
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore
| | - Charles Thuan Heng Chuah
- Duke-NUS Medical School, 8 College Rd, 169857 Singapore; National Cancer Centre Singapore, Singapore General Hospital, 30 Hospital Blvd, 168583 Singapore; Singapore General Hospital, Outram Road, 169608 Singapore
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Zhou S, Cirne F, Chow J, Zereshkian A, Bordeleau L, Dhesy-Thind S, Ellis PM, Mukherjee SD, Aghel N, Leong DP. Three-Year Outcomes Following Permissive Cardiotoxicity in Patients on Trastuzumab. Oncologist 2023; 28:e712-e722. [PMID: 37094996 PMCID: PMC10485282 DOI: 10.1093/oncolo/oyad086] [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: 12/08/2022] [Accepted: 03/08/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Cardiotoxicity, manifest by reduced left ventricular ejection fraction (LVEF), is the most common reason for the premature discontinuation of trastuzumab. While permissive cardiotoxicity (where mild cardiotoxicity is accepted to enable ongoing trastuzumab) has been shown feasible, the longer-term outcomes are unknown. We aimed to study the intermediate-term clinical outcomes of patients who underwent permissive cardiotoxicity. MATERIALS AND METHODS We performed a retrospective cohort study of patients referred to the cardio-oncology service at McMaster University from 2016 to 2021 for LV dysfunction following trastuzumab administration. RESULTS Fifty-one patients underwent permissive cardiotoxicity. The median (25th-75th percentile) follow-up time from cardiotoxicity onset was 3 years (1.3-4 years). Forty-seven (92%) patients completed trastuzumab; 3 (6%) developed severe LV dysfunction or clinical heart failure (HF) while on trastuzumab and prematurely discontinued therapy. One discontinued trastuzumab by patient choice. At final follow-up after therapy completion, 7 (14%) patients still had mild cardiotoxicity, including 2 who had clinical heart failure and stopped trastuzumab early. Among those with recovered LV function, 50% had normalized LVEF or GLS by 6 and 3 months, respectively, after initial cardiotoxicity. There was no difference in characteristics between those who did or did not recover their LV function. CONCLUSIONS Among patients exposed to permissive trastuzumab cardiotoxicity for HER2-positive breast cancer, 6% were unable to complete planned trastuzumab due to severe LV dysfunction or clinical HF. Although most patients recover their LV function after trastuzumab discontinuation or completion, 14% still have persistent cardiotoxicity by 3-year follow-up.
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Affiliation(s)
- Shijie Zhou
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Filipe Cirne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Justin Chow
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arman Zereshkian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Louise Bordeleau
- Department of Oncology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Peter M Ellis
- Department of Oncology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Som D Mukherjee
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Nazanin Aghel
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Darryl P Leong
- Population Health Research Institute and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ishii T, Watanabe T, Higashi T. Baseline cardiac function checkup in patients with gastric or breast cancer receiving trastuzumab or anthracyclines. Cancer Med 2022; 12:122-130. [PMID: 35689469 PMCID: PMC9844617 DOI: 10.1002/cam4.4929] [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: 04/26/2022] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although trastuzumab and anthracyclines are frequently used to treat breast cancer (BC) and gastric cancer (GC), cardiotoxicity is a serious concern. The cardiac function assessment is recommended at baseline before initiating treatment. However, the prevalence rates of baseline cardiac checkups are unknown. METHODS The national database of hospital-based cancer registries linked to the health services-utilization data was used to study patients with newly diagnosed stage IV BC and GC (n = 6271) who received trastuzumab (n = 4324, 69.0%) or anthracyclines between January 2012 and December 2015. The baseline ultrasound echocardiogram (UCG) performance rate and factors related to adequate UCG performance for all patients and those receiving trastuzumab were analyzed. RESULTS The adequate baseline UCG checkup rate was higher in patients treated with trastuzumab than in those treated with anthracyclines (71.8% vs 44.1%, respectively). Additionally, patients with GC were less likely to receive an adequate baseline UCG performance than those with BC (70.4% vs 75.0%, respectively). After adjusting for potential confounders, patients with anthracycline-treated BC and GC were less likely to receive adequate baseline UCG performance than those with trastuzumab-treated BC (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.20-0.28, and OR: 0.07, 95% CI: 0.03-0.16, respectively). Furthermore, patients with trastuzumab-treated GC were less likely to receive adequate baseline UCG performance than those with BC (OR: 0.65, 95% CI: 0.50-0.84). CONCLUSIONS The baseline UCG was less likely to be performed in patients receiving anthracyclines than in those receiving trastuzumab, as well as in patients with GC than in those with BC.
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Affiliation(s)
- Taisuke Ishii
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
| | - Tomone Watanabe
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
| | - Takahiro Higashi
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
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Evaluation of left atrial remodeling using cardiovascular magnetic resonance imaging in breast cancer patients treated with adjuvant trastuzumab. Eur Radiol 2022; 32:4234-4242. [PMID: 34993574 DOI: 10.1007/s00330-021-08466-9] [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: 08/27/2021] [Accepted: 11/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated left atrial (LA) remodeling using cardiac MRI (CMR) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer during and after trastuzumab therapy. METHODS In this prospective 2-center longitudinal study, 41 women with HER2-positive breast cancer received adjuvant trastuzumab for 12 months, in addition to standard chemotherapy. Serial CMRs were performed at baseline, 6, 12, and 18 months after initiation of trastuzumab. LA volumes were measured by a blinded reader. Linear mixed model was used to evaluate longitudinal changes. RESULTS Of 41 women (mean age 52 ± 11 [SD] years; 56% received anthracycline), one patient experienced trastuzumab-induced cardiotoxicity (TIC) for which trastuzumab was interrupted for one cycle. Mean baseline left ventricular ejection fraction (LVEF) was 68.0 ± 5.9% and LA ejection fraction (LAEF) was 66.0 ± 6.6%. Compared to baseline, LAEF decreased significantly at 6 months (62.7 ± 5.7%, p = 0.027) and 12 months (62.2 ± 6.1%, p = 0.003), while indexed LA minimum volume (LAmin) significantly increased at 12 months (11.6 ± 4.9 ml/m2 vs 13.8 ± 4.5 ml/m2, p = 0.002). At 18 months, all changes from baseline were no longer significant. From baseline to 6 months, change in LAEF correlated with change in LVEF (Spearman's r = 0.41, p = 0.014). No significant interactions (all p > 0.10) were detected between time and anthracycline use for LA parameters. CONCLUSIONS Among trastuzumab-treated patients with low incidence of TIC, we observed a small but significant decline in LAEF and increase in LAmin that persisted for the duration of therapy and recovered 6 months after therapy cessation. These findings suggest that trastuzumab has concurrent detrimental effects on atrial and ventricular remodeling. KEY POINTS • In trastuzumab-treated breast cancer patients evaluated by cardiac MRI, left atrial ejection fraction declined and minimum volume increased during treatment and recovered to baseline after trastuzumab cessation. • Changes in left atrial ejection fraction correlated with changes in left ventricular ejection fraction in the first 6 months of trastuzumab treatment. • Trastuzumab therapy is associated with concurrent detrimental effects on left atrial and ventricular remodeling.
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Cardiovascular Disease in Older Women. Clin Geriatr Med 2021; 37:651-665. [PMID: 34600729 DOI: 10.1016/j.cger.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiovascular disease is the major cause of death in women. Older women remain at risk for coronary artery disease/cardiovascular disease, but risk-modifying behavior can improve outcomes. Women have a different symptom profile and have been underdiagnosed and undertreated as compared with men. Although older women are underrepresented in trials, clinicians should be more attuned to the prevention, diagnosis, and treatment of cardiovascular disease in older women.
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Kim DY, Park MS, Youn JC, Lee S, Choi JH, Jung MH, Kim LS, Kim SH, Han S, Ryu KH. Development and Validation of a Risk Score Model for Predicting the Cardiovascular Outcomes After Breast Cancer Therapy: The CHEMO-RADIAT Score. J Am Heart Assoc 2021. [PMID: 34369199 DOI: 10.1161/jaha.121.02193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Cardiovascular disease is an important cause of mortality among survivors of breast cancer (BC). We developed a prediction model for major adverse cardiovascular events after BC therapy, which is based on conventional and BC treatment-related cardiovascular risk factors. Methods and Results The cohort of the study consisted of 1256 Asian female patients with BC from 4 medical centers in Korea and was randomized in a 1:1 ratio into the derivation and validation cohorts. The outcome measures comprised cardiovascular mortality, myocardial infarction, congestive heart failure, and transient ischemic attack/stroke. To correct overfitting, a penalized Cox proportional hazards regression was performed with a cross-validation approach. Number of cardiovascular diseases (myocardial infarction, peripheral artery disease, heart failure, and transient ischemic attack/stroke), number of baseline cardiovascular risk factors (hypertension, age ≥60, body mass index ≥30 kg/m2, estimated glomerular filtration rate <60 mL/min per 1.73 m2, dyslipidemia, and diabetes mellitus), radiation to the left breast, and anthracycline dose per 100 mg/m2 were included in the risk prediction model. The time-dependent C-indices at 3 and 7 years after BC diagnosis were 0.876 and 0.842, respectively, in the validation cohort. Conclusions A prediction score model, including BC treatment-related risk factors and conventional risk factors, was developed and validated to predict major adverse cardiovascular events in patients with BC. The CHEMO-RADIAT (congestive heart failure, hypertension, elderly, myocardial infarction/peripheral artery occlusive disease, obesity, renal failure, abnormal lipid profile, diabetes mellitus, irradiation of the left breast, anthracycline dose, and transient ischemic attack/stroke) score may provide overall cardiovascular risk stratification in survivors of BC and can assist physicians in multidisciplinary decision-making regarding the BC treatment.
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Affiliation(s)
- Do Young Kim
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Myung-Soo Park
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea.,Division of Cardiology Department of Internal Medicine Seoul St. Mary's HospitalCatholic Research Institute for Intractable Cardiovascular DiseaseCollege of MedicineThe Catholic University of Korea Seoul Republic of Korea
| | - Sunki Lee
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Jae Hyuk Choi
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Mi-Hyang Jung
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Lee Su Kim
- Division of Breast and Endocrine Surgery Hallym University Sacred Heart HospitalHallym University College of Medicine Anyang Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology Department of Internal Medicine Konkuk University HospitalSchool of MedicineKonkuk University Seoul Republic of Korea
| | - Seongwoo Han
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
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Kim DY, Park M, Youn J, Lee S, Choi JH, Jung M, Kim LS, Kim SH, Han S, Ryu K. Development and Validation of a Risk Score Model for Predicting the Cardiovascular Outcomes After Breast Cancer Therapy: The CHEMO-RADIAT Score. J Am Heart Assoc 2021; 10:e021931. [PMID: 34369199 PMCID: PMC8475066 DOI: 10.1161/jaha.121.021931] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/09/2021] [Indexed: 12/27/2022]
Abstract
Background Cardiovascular disease is an important cause of mortality among survivors of breast cancer (BC). We developed a prediction model for major adverse cardiovascular events after BC therapy, which is based on conventional and BC treatment-related cardiovascular risk factors. Methods and Results The cohort of the study consisted of 1256 Asian female patients with BC from 4 medical centers in Korea and was randomized in a 1:1 ratio into the derivation and validation cohorts. The outcome measures comprised cardiovascular mortality, myocardial infarction, congestive heart failure, and transient ischemic attack/stroke. To correct overfitting, a penalized Cox proportional hazards regression was performed with a cross-validation approach. Number of cardiovascular diseases (myocardial infarction, peripheral artery disease, heart failure, and transient ischemic attack/stroke), number of baseline cardiovascular risk factors (hypertension, age ≥60, body mass index ≥30 kg/m2, estimated glomerular filtration rate <60 mL/min per 1.73 m2, dyslipidemia, and diabetes mellitus), radiation to the left breast, and anthracycline dose per 100 mg/m2 were included in the risk prediction model. The time-dependent C-indices at 3 and 7 years after BC diagnosis were 0.876 and 0.842, respectively, in the validation cohort. Conclusions A prediction score model, including BC treatment-related risk factors and conventional risk factors, was developed and validated to predict major adverse cardiovascular events in patients with BC. The CHEMO-RADIAT (congestive heart failure, hypertension, elderly, myocardial infarction/peripheral artery occlusive disease, obesity, renal failure, abnormal lipid profile, diabetes mellitus, irradiation of the left breast, anthracycline dose, and transient ischemic attack/stroke) score may provide overall cardiovascular risk stratification in survivors of BC and can assist physicians in multidisciplinary decision-making regarding the BC treatment.
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Affiliation(s)
- Do Young Kim
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Myung‐Soo Park
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Jong‐Chan Youn
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
- Division of CardiologyDepartment of Internal MedicineSeoul St. Mary's HospitalCatholic Research Institute for Intractable Cardiovascular DiseaseCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Sunki Lee
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Jae Hyuk Choi
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Mi‐Hyang Jung
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Lee Su Kim
- Division of Breast and Endocrine SurgeryHallym University Sacred Heart HospitalHallym University College of MedicineAnyangRepublic of Korea
| | - Sung Hea Kim
- Division of CardiologyDepartment of Internal MedicineKonkuk University HospitalSchool of MedicineKonkuk UniversitySeoulRepublic of Korea
| | - Seongwoo Han
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
| | - Kyu‐Hyung Ryu
- Division of CardiologyDongtan Sacred Heart HospitalHallym University College of MedicineHwaseongRepublic of Korea
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Ordovas KG, Baldassarre LA, Bucciarelli-Ducci C, Carr J, Fernandes JL, Ferreira VM, Frank L, Mavrogeni S, Ntusi N, Ostenfeld E, Parwani P, Pepe A, Raman SV, Sakuma H, Schulz-Menger J, Sierra-Galan LM, Valente AM, Srichai MB. Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2021; 23:52. [PMID: 33966639 PMCID: PMC8108343 DOI: 10.1186/s12968-021-00746-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023] Open
Abstract
This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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Affiliation(s)
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, UK
- Bristol National Institute of Health Research (NIHR) Biomedical , Research Centre, Bristol, UK
- University Hospitals Bristol, Bristol, UK
- University of Bristol, Bristol, UK
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- Medical College of Wisconsin, Wisconsin, USA
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
- Kapodistrian University of Athens, Athens, Greece
| | - Ntobeko Ntusi
- University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University, Indianapolis, USA
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Mie, Japan
| | - Jeanette Schulz-Menger
- harite Hospital, University of Berlin, Berlin, Germany
- HELIOS-Clinics Berlin-Buch, Berlin, Germany
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Monitoring of anthracycline-induced myocardial injury using serial cardiac magnetic resonance: An animal study. Int J Cardiol 2020; 328:111-116. [PMID: 33359332 DOI: 10.1016/j.ijcard.2020.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the feasibility of using comprehensive serial cardiovascular MR (CMR) to evaluate bilateral ventricle mechanical changes and myocardial tissue characteristics, as well as correlations between the serial CMR and histology in a beagle model of anthracycline-induced cardiotoxicity. METHODS This animal study was approved by the institutional review board. Serial CMR imaging was performed in a total of fifteen beagles at baseline (n = 15), at week 16 (n = 10) and week 24 (n = 7) post-anthracycline. Feature-tracking CMR (FT-CMR) was applied to measure bilateral ventricular (left ventricle (LV) and right ventricle (RV)) global peak strain including radial (GRS), circumferential (GCS) and longitudinal (GLS) strain. The changes in strain, LV/RV functional parameters, native T1, extracellular volume fraction (ECV) and collagen volume fraction (CVF) were calculated. RESULTS Compared to baseline at weeks 16 and 24, significantly decreases to LV-GLS and native T1 were observed, while ECV significantly increased (all P < 0.05). LVEF significantly decreased and LV-EDV/ESV significantly increased at week 16 compared to baseline (all P < 0.05), but no further progression was seen at week 24. RV-GLS significantly decreased at week 16, but no further progression was seen at week 24, while RVEF was different until week 24. CVF increased significantly during modeling. Native T1 and ECV showed positive correlation with CVF (r = 0.645, P < 0.001), while LV-GLS showed negative correlation with CVF (r = -0.736, P < 0.05). CONCLUSION Cardiotoxicity affects the RV slightly and less progressively than the LV. FT-CMR-based GLS, native T1 and ECV may potentially be used as imaging biomarkers for early monitoring of anthracycline-induced myocardial Injury.
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12
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Blancas I, Martín-Pérez FJ, Garrido JM, Rodríguez-Serrano F. NT-proBNP as predictor factor of cardiotoxicity during trastuzumab treatment in breast cancer patients. Breast 2020; 54:106-113. [PMID: 32977298 PMCID: PMC7511727 DOI: 10.1016/j.breast.2020.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trastuzumab is a drug used in HER2-positive breast cancer that increases patient survival. Due to cardiotoxicity is the most important side effect of trastuzumab treatment, cardiac monitoring should be a priority. The purpose of this study is to evaluate plasma NT-proBNP level and major cardiovascular risk factors as possible early predictors of trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients. METHODS We conducted a retrospective observational study involving 66 patients with HER2-positive breast cancer treated with trastuzumab. Left ventricle ejection fraction (LVEF), NT-proBNP values, and the history of cardiovascular risk factors were collected. Cardiotoxicity was diagnosed considering a decrease of the LVEF from baseline or clinical manifestation of congestive heart failure. NT-proBNP cut-off points were considered to establish normal or abnormal values according to patient age. RESULTS 27.3% of the patients suffered cardiotoxicity during trastuzumab treatment. Most cases were diagnosed due to the appearance of cardiac symptomatology (66.7%). Logistic regression analysis showed a significant association of diabetes mellitus (OR 5.9, 95% CI 1.2-28.5, p = 0.028) and high NT-proBNP levels (OR 22.0, 95% CI 5.7-85.4, p < 0.0001) with the development of trastuzumab-induced cardiotoxicity. CONCLUSION NT-proBNP levels above the upper limit of the normal range adjusted to age or diabetes mellitus seem to be associated with a higher risk of developing cardiotoxicity. However, some limitations of the present study make necessary further studies aimed to clarify whether NT-proBNP and diabetes-associated markers determinations can be useful in the monitoring of cardiotoxicity risk in breast cancer patients undergoing trastuzumab therapy.
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Affiliation(s)
- Isabel Blancas
- Department of Medicine, School of Medicine, University of Granada, Granada, Spain; Department of Medical Oncology, San Cecilio University Hospital, Granada, Spain; Biosanitary Research Institute of Granada (ibs.GRANADA), Granada, Spain.
| | | | - José M Garrido
- Biosanitary Research Institute of Granada (ibs.GRANADA), Granada, Spain; Department of Surgery and Surgical Specialties, University of Granada, Granada, Spain; Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Granada, Spain
| | - Fernando Rodríguez-Serrano
- Biosanitary Research Institute of Granada (ibs.GRANADA), Granada, Spain; Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Granada, Spain
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13
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Chaulin AM, Abashina OE, Duplyakov DV. Pathophysiological mechanisms of cardiotoxicity in chemotherapeutic agents. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0305] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Certain success has been achieved in the treatment of cancer due to the development of various effective chemotherapeutic drugs. However, an increase in their effectiveness (aggressiveness) was associated with a growth of undesirable effects on the entire human body, in particular, on the cardiovascular system. The damage to the cardiovascular system from chemotherapy in many cases is more significant than from the underlying disease. In recent years, a new direction of medicine has been formed - cardio-oncology. The major groups of cardiotoxic chemotherapeutic agents are anthracyclines, inhibitors of epidermal growth factor receptor type 2 (anti-HER2), antimetabolites, microtubule inhibitors, proteasome inhibitors, platinum-based chemotherapeutic drugs, and angiogenesis inhibitors (inhibitors of vascular endothelial growth factor). This review discusses principal pathophysiological mechanisms of the cardiotoxicity of these chemotherapeutic drugs.
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14
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Bucciarelli-Ducci C, Ostenfeld E, Baldassarre LA, Ferreira VM, Frank L, Kallianos K, Raman SV, Srichai MB, McAlindon E, Mavrogeni S, Ntusi NAB, Schulz-Menger J, Valente AM, Ordovas KG. Cardiovascular disease in women: insights from magnetic resonance imaging. J Cardiovasc Magn Reson 2020; 22:71. [PMID: 32981527 PMCID: PMC7520984 DOI: 10.1186/s12968-020-00666-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement.This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted.
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Affiliation(s)
- Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Getingevägen 5, SE-22185 Lund, Sweden
| | | | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- University of Texas Medical Branch, Galveston, TX USA
| | | | | | | | - Elisa McAlindon
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
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15
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Fabiani I, Cipolla CM, Colombo N, Cardinale D. Cardioncological Approach for Trastuzumab Therapy in Breast Cancer Patients With Cardiotoxicity: Impact on Adherence and Clinical Outcome. Front Pharmacol 2020; 11:1190. [PMID: 32848791 PMCID: PMC7417864 DOI: 10.3389/fphar.2020.01190] [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: 03/30/2020] [Accepted: 07/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background Treatment with Trastuzumab is associated with cardiotoxicity. If Trastuzumab could be administered in a safe manner to patients who develop a reduced left ventricular ejection fraction (EF) of < 50% remains poorly understood. Objective To evaluate the impact of a cardioncological approach in terms of adherence and continuation of oncological therapy with Trastuzumab. Methods and Results Internal databases of candidates for trastuzumab chemotherapy with evidence of cardiotoxicity according to echocardiographic criteria were retrospectively evaluated. Eighty-four female patients (age 51.7 years, 95% CI 49.5–53.8), were finally included. Patients were divided to receive a standard (n 27) or cardioncological (n 57) scheme. Baseline EF values were within normal limits (60.9, 95% CI 60 - 61.9%; p=0.5 between groups). The nadir of EF observed during trastuzumab therapy was more pronounced in the standard care group (40.6, 95% CI 37.3–43.9% vs. 46.3, 95% CI 44.3–48.3%; p=0.002). At re-challenge, after cardiotoxicity detection, all patients in the cardioncological arm resumed and completed trastuzumab therapy (p<0.0001). An overall reduction of EF was observed at the final evaluation (p <0.0001 vs. baseline). Cardioncological approach was the only independent determinant of ΔEF from baseline to final evaluation (R20.12; p=0.004). We observed a total of 13 (15%) HF events, seven (26%) in the standard, and six (10%) in the cardioncological approach group (p =0.1). Patients in the cardioncological approach arm had a better outcome (Log Rank Chi-squared 4.89; p=0.02). Conclusions A targeted cardioncological approach, in patients with evidence of cardiotoxicity during HER-2 inhibitor therapy, could favorably influence the oncological management of breast cancer patients, reducing the adverse cardiovascular impact of chemotherapy.
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Affiliation(s)
- Iacopo Fabiani
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Carlo Maria Cipolla
- Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Nicola Colombo
- Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy
- Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy
- *Correspondence: Daniela Cardinale,
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16
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Prabhu N, Patel H, Golemi L, Fogg L, Cobleigh M, Okwuosa T. Trastuzumab‐induced cardiac toxicity: Is serial assessment of left ventricular ejection fraction during treatment necessary? Breast J 2020; 26:1085-1086. [DOI: 10.1111/tbj.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole Prabhu
- Department of Internal Medicine Rush University Medical Center Chicago Illinois
| | - Hena Patel
- Division of Cardiology Department of Internal Medicine Rush University Medical Center Chicago Illinois
| | | | - Louis Fogg
- Department of Community, Systems and Mental Health Nursing College of Nursing Rush University Medical Center Chicago Illinois
| | - Melody Cobleigh
- Division of Medical Oncology Department of Internal Medicine Rush University Medical Center Chicago Illinois
| | - Tochi Okwuosa
- Division of Cardiology Department of Internal Medicine Rush University Medical Center Chicago Illinois
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Abstract
PURPOSE OF REVIEW The number of cancer survivors is increasing, and cardiovascular events are a significant cause of morbidity and mortality in these patients. Preexisting cardiovascular conditions as well as the development of cancer therapeutics-related cardiac dysfunction (CTRCD), in particular left ventricular dysfunction and heart failure, limit the options for cancer therapies for these patients and contribute to reduced cancer survival. RECENT FINDINGS Recent guidelines and position statements from various cardiology and oncology societies provide an outline for the practicing physician for the management of CTRCD. However, this is largely based on data extrapolated from the general heart failure population (including patients without cancers) and is not based on strong evidence. There is now emerging evidence for the prevention and treatment of heart failure related to certain established chemotherapeutic drugs, whereas there is lack of trials for specific cardioprotective strategies to reduce cardiotoxicity of newer targeted cancer therapies. SUMMARY In this article, we discuss the most recent literature for the management of asymptomatic left ventricular dysfunction and heart failure related to chemotherapy, from prevention to the use of goal-directed medical therapies as well as discuss the role for advanced heart failure treatment in this population.
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18
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Peng J, Rushton M, Johnson C, Brezden-Masley C, Sulpher J, Chiu MG, Graham ID, Dent S. An international survey of healthcare providers' knowledge of cardiac complications of cancer treatments. CARDIO-ONCOLOGY 2019; 5:12. [PMID: 32154018 PMCID: PMC7048147 DOI: 10.1186/s40959-019-0049-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
Background Cardio-oncology is a young sub-specialty that addresses the needs of cancer patients at risk of, or who have experienced cancer therapy related cardiac dysfunction (CTRCD). This study assessed clinicians' understanding of cardio-oncology, opinions towards current practice, and approach to diagnosing and managing CTRCD. Methods A 45-question survey was administered online via Survey Monkey and WeChat to health care providers (HCPs) comprising of cardiologists, oncologists, and others from September 2017 to March 2018. Implementation of the survey followed a modified Dillman's Total Design Method. Results In total, 160 responses were collected from 22 countries; majority were from cardiologists (53.8%) and oncologists (32.5%). The remaining 13.7% identified themselves as "others," including general internists, cardio-oncologists, pediatric oncologists, radiation oncologists, cardiac rehabilitation therapists, nurse practitioners, research students, and pharmacists. In the setting of metastatic cancer, there was a difference in risk tolerance for cardiotoxicity between subspecialties. In this case, more cardiologists (36.7%) accepted a 5-10% risk of cardiotoxicity compared to oncologists (20.0%). Majority of cardiologists felt that cardiotoxicity should be monitored, even in asymptomatic cancer patients (55.8%). Only 12% of oncologists selected this response. In contrast, 50.0% of oncologists reported that cardiologists should be involved only when patients develop cardiotoxicity. In comparison, 6.5% of cardiologists selected this response. Majority of cardiologists stated that cardio-oncology clinics would significantly improve cancer patients' prognosis (88.3%); only 45.8% of oncologists shared this opinion. Of all respondents, 66.9% stated they were familiar with a variety of international guidelines for managing cardiotoxicity. Of all oncologists, 65.3% indicated that they referred to these guidelines for clinical decision making. Conclusions Despite the growth of cardio-oncology clinics, there are significant knowledge gaps regarding prevention and treatment strategies for CTRCD among health care providers. Knowledge translation from guidelines and collaboration between cardiologists and oncologists are needed to improve cardiovascular outcomes of cancer patients.
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Affiliation(s)
- J Peng
- 1Department of Medicine, University of Ottawa, Ottawa, ON Canada.,2Department of Internal Medicine, University of Calgary, Calgary, AB Canada
| | - M Rushton
- 3Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON Canada
| | - C Johnson
- 4Division of Cardiology, Department of Medicine, The Ottawa Hospital, Ottawa, ON Canada
| | - C Brezden-Masley
- 5Division of Medical Oncology, Department of Medicine, St. Michael's Hospital, Toronto, ON Canada
| | - J Sulpher
- 6Division of Medical Oncology, Department of Medicine, BC Cancer Agency, Victoria, BC Canada
| | - Miliyun G Chiu
- Director of Peony Solutions, Kwai Bo Industrial Building, 40 Wong Chuk Hang Road, Aberdeen, Hong Kong
| | - I D Graham
- 8School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - S Dent
- 3Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON Canada.,9Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina USA
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19
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Barron CC, Alhussein MM, Kaur U, Cosman TL, Tyagi NK, Brown M, Mukherjee SD, Ellis PM, Dhesy-Thind S, Leong DP. An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction. ACTA ACUST UNITED AC 2019; 26:240-246. [PMID: 31548803 DOI: 10.3747/co.26.4631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.
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Affiliation(s)
- C C Barron
- Department of Medicine, McMaster University, Hamilton, ON
| | - M M Alhussein
- Department of Medicine, McMaster University, Hamilton, ON
| | - U Kaur
- Department of Medicine, University of Western Ontario, London, ON
| | - T L Cosman
- Hamilton Health Sciences, Juravinski Hospital and Cancer Centre, Hamilton, ON.,School of Nursing, McMaster University, Hamilton, ON
| | - N K Tyagi
- Department of Oncology, McMaster University, Hamilton, ON
| | - M Brown
- Hamilton Health Sciences, Juravinski Hospital and Cancer Centre, Hamilton, ON
| | - S D Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON
| | - P M Ellis
- Department of Oncology, McMaster University, Hamilton, ON
| | - S Dhesy-Thind
- Department of Oncology, McMaster University, Hamilton, ON
| | - D P Leong
- Department of Medicine, McMaster University, Hamilton, ON.,The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
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20
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Barron CC, Tyagi NK, Alhussein MM, Mukherjee SD, Ellis PM, Dhesy-Thind S, Leong DP. Adjuvant Trastuzumab Therapy: Can We Balance Efficacy and Safety? Oncologist 2019; 24:1405-1409. [PMID: 31315962 DOI: 10.1634/theoncologist.2019-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/06/2019] [Indexed: 01/03/2023] Open
Abstract
Trastuzumab is an effective treatment for HER2-positive breast cancer. Current guidelines recommend withholding trastuzumab in patients experiencing a significant asymptomatic decline in left ventricular function. In this commentary, we discuss the survival benefits afforded by trastuzumab juxtaposed against the risk of trastuzumab-mediated cardiotoxicity. It is not known whether the net benefit of continuing trastuzumab in the setting of mild cardiotoxicity outweighs the associated risks. We describe a potential approach undertaken by our group, and others, and call for a randomized trial.
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Affiliation(s)
- Carly C Barron
- Departments of Medicine, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nidhi Kumar Tyagi
- Departments of Oncology, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Som D Mukherjee
- Departments of Oncology, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peter M Ellis
- Departments of Oncology, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Departments of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sukhbinder Dhesy-Thind
- Departments of Oncology, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Darryl P Leong
- Departments of Medicine, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Departments of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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21
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Leong DP, Cosman T, Alhussein MM, Kumar Tyagi N, Karampatos S, Barron CC, Wright D, Tandon V, Magloire P, Joseph P, Conen D, Devereaux PJ, Ellis PM, Mukherjee SD, Dhesy-Thind S. Safety of Continuing Trastuzumab Despite Mild Cardiotoxicity: A Phase I Trial. JACC: CARDIOONCOLOGY 2019; 1:1-10. [PMID: 34396157 PMCID: PMC8352338 DOI: 10.1016/j.jaccao.2019.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/03/2023]
Abstract
Objectives This study sought to evaluate the safety of continuing trastuzumab in patients with human epidermal growth factor receptor–positive breast cancer who developed mild cardiotoxicity. Background Cardiotoxicity is the most common dose-limiting toxicity associated with trastuzumab. Current standard of care is discontinuation of trastuzumab, which can lead to worse cancer outcomes. It is unknown whether it is safe to continue trastuzumab despite mild cardiotoxicity. Methods Patients were eligible for this phase I, prospective, single-arm trial if left ventricular ejection fraction (LVEF) was between 40% and the lower limit of normal or if it fell ≥15% from baseline. Participants were treated with angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers in a cardio-oncology clinic and were followed clinically and with serial echocardiograms for 1 year. The primary outcome was cardiac dose-limiting toxicity, defined as cardiovascular death, LVEF <40% together with any heart failure symptoms, or LVEF <35%. Results All 20 participants received ACE inhibitors and/or beta-blockers. A total of 18 participants (90%) received all planned trastuzumab doses. Two (10%) participants developed cardiac dose-limiting toxicity (heart failure with LVEF <40%). Their LVEF and heart failure symptoms improved to nearly normal following permanent trastuzumab discontinuation. There were no deaths. LVEF rose progressively from a mean of 49% at enrollment to 55% at 12 months (p < 0.001). Conclusions It may be feasible to continue trastuzumab despite mild cardiotoxicity in the setting of a cardio-oncology clinic, where ACE inhibitors and beta-blockers are administered. Approximately 10% of patients may develop moderate to severe heart failure using this approach. (Safety of Continuing Chemotherapy in Overt Left Ventricular Dysfunction Using Antibodies to Human Epidermal Growth Factor Receptor-2 [SCHOLAR]; NCT02907021)
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Affiliation(s)
- Darryl P Leong
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tammy Cosman
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Muhammad M Alhussein
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Nidhi Kumar Tyagi
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sarah Karampatos
- The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Carly C Barron
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Douglas Wright
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Vikas Tandon
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Patrick Magloire
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Philip Joseph
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peter M Ellis
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Som D Mukherjee
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sukhbinder Dhesy-Thind
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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22
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Moey MYY, Liles DK, Carabello BA. Concomitant use of renin-angiotensin-aldosterone system inhibitors prevent trastuzumab-induced cardiotoxicity in HER2+ breast cancer patients: an institutional retrospective study. CARDIO-ONCOLOGY 2019; 5:9. [PMID: 32154015 PMCID: PMC7048102 DOI: 10.1186/s40959-019-0043-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
Background Cardiotoxicity is an adverse effect of trastuzumab (TRA) in the treatment of human epidermal growth factor 2 positive (HER2+) breast cancer. Current literature on the cardioprotective effects of agents targeted against the renin-angiotensin-aldosterone system (RAAS) and beta-blockers (BB) in TRA-treated HER2+ breast cancer patients is conflicting. We hypothesized that concurrent use of RAAS inhibitors would prevent TRA-induced cardiotoxicity (TIC). Methods and materials Surveillance ejection fraction (EF) at 3-month intervals up to 36 months obtained from echocardiogram or multigated acquisition (MUGA) scans were retrospectively compared to baseline EF in TRA-treated HER2+ breast cancer patients between 2011 to 2016 at a tertiary cancer center. TIC was defined as a decrease of EF by more than 15 EF percentage points from baseline on surveillance imaging. Cardiac medications and comorbidities were compared between patients with reduced EF secondary to TIC (rEF) and patients who did not experience TIC (pEF). A published clinical risk score (CRS) was applied to the patient population with calculated sensitivity analyses to determine if the CRS could predict TIC. Results Of 127 patients with TRA-treated HER2+ breast cancer, 11% developed cardiotoxicity resulting in discontinuation of TRA. Cardiotoxicity with reduced EF was seen as early as 3 months and at subsequent 3-month follow up intervals up to the 15-month follow-up. Co-existing arrhythmia, coronary artery disease (CAD), hypertension (HTN) and diabetes mellitus (DM) tended to infer an increased risk for cardiotoxicity. Patients with pEF were found to be concurrently on a RAAS inhibitor more than the rEF group (OR of 0.24, 95% CI 0.05-1.11, p 0.06). The CRS high-risk cut-off had a sensitivity of 0.17 (95% CI 0.03-0.49), specificity of 0.89 (95% CI 0.82-0.94), positive predictive value of 0.14 (95% CI 0.03-0.44) and negative predictive value of 0.91 (95% CI 0.84-0.95). Conclusion Our data suggest that the concurrent use of a RAAS inhibitors during TRA treatment may provide a protective effect against TIC and warrants further investigation. The low sensitivity and positive predictive value demonstrated that the CRS has minimal utility as a screening tool for prediction of patients at high risk for TIC. Therefore, closer surveillance of patients receiving TRA is warranted for early detection of TIC.
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Affiliation(s)
- Melissa Y Y Moey
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
| | - Darla K Liles
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA.,2Department of Hematology and Oncology, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
| | - Blase A Carabello
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA.,3Department of Cardiology, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
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23
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Dhir V, Yan AT, Nisenbaum R, Sloninko J, Connelly KA, Barfett J, Haq R, Kirpalani A, Chan KKW, Petrella TM, Brezden-Masley C. Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study. Int J Cardiovasc Imaging 2019; 35:2085-2093. [PMID: 31197526 DOI: 10.1007/s10554-019-01648-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/08/2019] [Indexed: 02/07/2023]
Abstract
Little is known about the comparison of multiple-gated acquisition (MUGA) scanning with cardiovascular magnetic resonance (CMR) for serial monitoring of HER2+ breast cancer patients receiving trastuzumab. The association of cardiac biomarkers with CMR left ventricular (LV) function and volume is also not well studied. Our objectives were to compare CMR and MUGA for left ventricular ejection fraction (LVEF) assessment, and to examine the association between changes in brain natriuretic peptide (NT-BNP) and troponin-I and changes in CMR LV function and volume. This prospective longitudinal two-centre cohort study recruited HER2+ breast cancer patients between January 2010 and December 2013. MUGA, CMR, NT-BNP and troponin-I were performed at baseline, 6, 12, and 18 months after trastuzumab initiation. In total, 41 patients (age 51.7 ± 10.8 years) were enrolled. LVEF comparison between MUGA and CMR demonstrated weak agreement (Lin's correlation coefficient r = 0.46, baseline; r = 0.29, 6 months; r = 0.42, 12 months; r = 0.39, 18 months; all p < 0.05). Bland-Altman plots demonstrated wide LVEF agreement limits (pooled agreement limits 3.0 ± 6.2). Both modalities demonstrated significant LVEF decline at 6 and 12 months from baseline, concomitant with increased LV volumes on CMR. Changes in NT-BNP correlated with changes in LV diastolic volume at 12 and 18 months (p < 0.05), and LV systolic volume at 18 months (p < 0.05). Changes in troponin-I did not correlate with changes in LV function or volume at any timepoint. In conclusion, CMR and MUGA LVEF are not interchangeable, warranting selection and utility of one modality for serial monitoring. CMR is useful due to less radiation exposure and accuracy of LV volume measurements. Changes in NT-BNP correlated with changes in LV volumes.
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Affiliation(s)
- Vinita Dhir
- Division of Hematology/Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Joanna Sloninko
- Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Kim A Connelly
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Joseph Barfett
- Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Rashida Haq
- Division of Hematology/Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,University of Toronto, Toronto, ON, Canada
| | - Anish Kirpalani
- University of Toronto, Toronto, ON, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada
| | - Kelvin K W Chan
- University of Toronto, Toronto, ON, Canada.,Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,The Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada.,Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Christine Brezden-Masley
- Division of Hematology/Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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24
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Tini G, Spallarossa P. How Cardio-Oncology is called to prove its maturity. Int J Cardiol 2019; 288:130-131. [PMID: 30928260 DOI: 10.1016/j.ijcard.2019.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/16/2019] [Accepted: 03/21/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Giacomo Tini
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy.
| | - Paolo Spallarossa
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
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25
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Gong IY, Ong G, Brezden-Masley C, Dhir V, Deva DP, Chan KKW, Graham JJ, Chow CM, Thavendiranathan P, Dai D, Ng MY, Barfett JJ, Connelly KA, Yan AT. Early diastolic strain rate measurements by cardiac MRI in breast cancer patients treated with trastuzumab: a longitudinal study. Int J Cardiovasc Imaging 2018; 35:653-662. [PMID: 30390170 DOI: 10.1007/s10554-018-1482-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/20/2018] [Indexed: 01/03/2023]
Abstract
We evaluated temporal changes in early diastolic strain rates by cardiovascular magnetic resonance (CMR) as an early detector of trastuzumab-induced ventricular dysfunction. We conducted a prospective, multi-centre, longitudinal observational study of 41 trastuzumab-treated breast cancer women who underwent serial CMR (baseline, 6, 12, and 18 months). Two blinded readers independently measured left ventricular ejection fraction (LVEF), peak systolic strain parameters (global longitudinal strain [GLS] and global circumferential strain [GCS]), and early diastolic strain rate parameters (global longitudinal diastolic strain rate [GLSR-E], global circumferential diastolic strain rate [GCSR-E], and global radial diastolic strain rate [GRSR-E]), by feature tracking (FT-CMR) using CMR42. There was a significant decline in peak systolic strain GLS and GCS at 6 months (p = 0.024 and p < 0.001, respectively) and 12 months (p = 0.002 and p < 0.001, respectively), followed by recovery at 18 months, which paralleled decline in LVEF at 6 months (p = 0.034) and 12 months (p = 0.012). Conversely, early diastolic strain rates GLSR-E and GCSR-E did not significantly change over 18 months (p > 0.10), while GRSR-E was marginally significant at 12 months (p = 0.021). There was no significant correlation between changes at 6 months in LVEF and GLSR-E or GRSR-E (p > 0.10), and a marginally significant weak correlation between LVEF and GCSR-E (p = 0.046). Among trastuzumab-treated patients without overt cardiotoxicity, there was no consistent temporal change in FT-CMR-derived diastolic strain rate parameters up to 18 months, in contrast to decline in systolic strain and LVEF. Systolic strains by FT-CMR are likely more useful than diastolic strain rates for monitoring subclinical trastuzumab-related myocardial dysfunction.ClinicalTrials.gov identifier NCT01022086.
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Affiliation(s)
| | - Geraldine Ong
- Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Christine Brezden-Masley
- University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, St Michael's Hospital, Toronto, Canada
| | - Vinita Dhir
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, Canada
| | - Djeven P Deva
- University of Toronto, Toronto, Canada.,Department of Medical Imaging, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Kelvin K W Chan
- University of Toronto, Toronto, Canada.,Sunnybrook Odette Cancer Centre, Canadian Center for Applied Research in Cancer Control, Toronto, Canada
| | - John J Graham
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Chi-Ming Chow
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | | | - Day Dai
- University of Toronto, Toronto, Canada
| | - Ming-Yen Ng
- The University of Hong Kong, Hong Kong, China
| | - Joseph J Barfett
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Kim A Connelly
- University of Toronto, Toronto, Canada.,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Andrew T Yan
- University of Toronto, Toronto, Canada. .,Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada. .,Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Rm 6-030 Donnelly, Toronto, M5B 1W8, Canada.
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26
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Thavendiranathan P, Abdel-Qadir H, Fischer HD, Liu Y, Camacho X, Amir E, Austin PC, Lee DS. Risk-Imaging Mismatch in Cardiac Imaging Practices for Women Receiving Systemic Therapy for Early-Stage Breast Cancer: A Population-Based Cohort Study. J Clin Oncol 2018; 36:2980-2987. [DOI: 10.1200/jco.2018.77.9736] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PurposeTo assess prechemotherapy cardiac imaging practices in relation to patients’ heart failure (HF) risk.MethodsWe performed a population-based retrospective cohort study of women receiving chemotherapy for early-stage breast cancer in Ontario between 2007 and 2012. We surveyed for baseline cardiac imaging 6 months before chemotherapy or within 30 days thereafter. The proportion of patients who underwent imaging and cumulative incidence of major adverse cardiac event (MACE) rates was determined based on chemotherapy regimen and HF risk factors. Logistic regression was used to assess predictors of pretreatment cardiac imaging.ResultsWe studied 18,444 women who had been treated with chemotherapy (median age, 55 years). There was near-universal imaging of women treated with trastuzumab-containing regimens, including those without additional HF risk factors. Women who received anthracyclines without trastuzumab underwent imaging more frequently if they had additional HF risk factors (73.3% v 62.6%; P < .001). The 5-year incidence of MACE was two to six times higher in patients with HF risk factors across all treatment regimens. Patients with HF risk factors who received anthracyclines without trastuzumab had a higher 5-year incidence of MACE (4.5%) than patients without HF risk factors who received trastuzumab without anthracyclines (2.6%). However, cardiac imaging was less frequent in the former group (73.3% v 93.6%; P < .001). Logistic regression indicated that most variation in baseline imaging was related to chemotherapy, followed by physician-level factors. The odds of imaging were doubled with female physicians. Patient-specific factors, including HF risk factors, made minimal contribution to variation in imaging.ConclusionBaseline cardiac imaging was driven by chemotherapy regimen rather than HF risk. This risk-imaging mismatch is an impetus to reconsider current cardiac imaging practices in patients who receive chemotherapy for breast cancer.
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Affiliation(s)
- Paaladinesh Thavendiranathan
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Hadas D. Fischer
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Ying Liu
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Ximena Camacho
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Eitan Amir
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Austin
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Douglas S. Lee
- Paaladinesh Thavendiranathan and Douglas S. Lee, Toronto General Hospital, University Health Network; Husam Abdel-Qadir, Women’s College Hospital; Hadas D. Fischer, Ying Liu, Ximena Camacho, Peter C. Austin, and Douglas S. Lee, Institute for Clinical Evaluative Sciences; and Eitan Amir, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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27
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El-Sherbeny WS, Sabry NM, Sharbay RM. Prediction of trastuzumab-induced cardiotoxicity in breast cancer patients receiving anthracycline-based chemotherapy. J Echocardiogr 2018; 17:76-83. [PMID: 30099714 DOI: 10.1007/s12574-018-0394-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adjuvant trastuzumab improved overall survival and reduced the risk for disease recurrence in women with breast cancers, because of its potential cardiotoxicity, careful monitoring of left ventricular (LV) function during treatment is required. METHODS This study investigates, whether myocardial strain imaging and level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) could predict subsequent reduction in LVEF in breast cancer patients received adjuvant trastuzumab. 61 women with pathologically proven breast cancer HER-2 positive received AC (Doxorubicin-Cyclophosphamide) for 4 cycles, followed by paclitaxel with Trastuzumab were enrolled. Clinical, conventional echocardiographic parameters, myocardial strain imaging [global longitudinal peak systolic strain (GLS), radial and circumferential systolic strain] and level of NT pro-BNP were measured at baseline, after 3, 6, 9 and 12 months of trastuzumab therapy. RESULTS Of 61 patients, 18 patients (29.5%) developed trastuzumab-induced cardiomyopathy (CM) at 6 and 9 months of therapy (LVEF declines ≥ 10%), GLS and radial strain significantly decreased in CM group at 3 months of trastuzumab treatment, the value of GLS at 3 months was the strongest predictors of cardiotoxicity its area under the curve (AUC 0.98) with an optimal cut-off for GLS (- 18%) having 92.5% sensitivity and 83% specificity. NT-pro BNP levels were not predictive of later trastuzumab-induced cardiac dysfunction. CONCLUSION Myocardial strain imaging has been able to predict pre-clinical changes in LV systolic function and GLS is an independent early predictor of subsequent reduction in EF in breast cancer patients treated with trastuzumab.
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Affiliation(s)
- Wafaa S El-Sherbeny
- Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Nesreen M Sabry
- Clinical Oncology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Radwa M Sharbay
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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28
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Babiker HM, McBride A, Newton M, Boehmer LM, Drucker AG, Gowan M, Cassagnol M, Camenisch TD, Anwer F, Hollands JM. Cardiotoxic effects of chemotherapy: A review of both cytotoxic and molecular targeted oncology therapies and their effect on the cardiovascular system. Crit Rev Oncol Hematol 2018; 126:186-200. [DOI: 10.1016/j.critrevonc.2018.03.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/01/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022] Open
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29
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Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e30-e66. [PMID: 29437116 PMCID: PMC6722327 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.
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30
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Jain D, Russell RR, Schwartz RG, Panjrath GS, Aronow W. Cardiac Complications of Cancer Therapy: Pathophysiology, Identification, Prevention, Treatment, and Future Directions. Curr Cardiol Rep 2018; 19:36. [PMID: 28374177 DOI: 10.1007/s11886-017-0846-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Cardiotoxicity is an important complication of cancer therapy. With a significant improvement in the overall survival and prognosis of patients undergoing cancer therapy, cardiovascular toxicity of cancer therapy has become an important public health issue. Several well-established as well as newer anticancer therapies such as anthracyclines, trastuzumab, and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors, and thoracic irradiation are associated with significant cardiotoxicity. RECENT FINDINGS Cardiovascular imaging employing radionuclide imaging, echocardiography, and magnetic resonance imaging is helpful in early detection of the cardiotoxicity and prevention of overt heart failure. These techniques also provide important tools for understanding the mechanism of cardiotoxicity of these modalities, which would help develop strategies for the prevention of cardiac morbidity and mortality related to the use of these agents. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.
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Affiliation(s)
- Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College and Westchester Medical Center, 100 Woods Road, Valhalla, NY, USA.
| | - Raymond R Russell
- Rhode Island Cardiovascular Institute, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Gurusher S Panjrath
- Heart and Vascular Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Wilbert Aronow
- Section of Cardiovascular Medicine, New York Medical College and Westchester Medical Center, 100 Woods Road, Valhalla, NY, USA
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31
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Abstract
PURPOSE OF REVIEW Cardio-oncology focuses increased effort to decrease cancer treatment-related cardiotoxicity while continuing to improve outcomes. We sought to synthesize the latest in nuclear cardiology as it pertains to the assessment of left ventricular function in preventative guidelines and comparison to other modalities, novel molecular markers of pre-clinical cardiotoxicity, and its role in cardiac amyloid diagnosis. RECENT FINDINGS Planar ERNA (equilibrium radionuclide angiocardiography) provides a reliable and proven means of monitoring and preventing anthracycline cardiotoxicity, and SPECT ERNA using solid-state gamma cameras may provide reproducible assessments of left ventricular function with reduced radiation exposure. While certain chemotherapeutics have vascular side effects, the use of stress perfusion imaging has still not been adequately studied for routine use. Similarly, markers of apoptosis, inflammation, and sympathetic nerve dysfunction are promising, but are still not ready for uniform usage. SPECT tracers can assist in nonbiopsy diagnosis of cardiac amyloid. Nuclear cardiology is a significant contributor to the multimodality approach to cardio-oncology.
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Affiliation(s)
- Jorge A Alvarez
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Raymond R Russell
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
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32
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Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 99:769-776. [DOI: 10.1016/j.ijrobp.2017.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 01/23/2023]
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33
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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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34
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Jain D, Ahmad T, Cairo M, Aronow W. Cardiotoxicity of cancer chemotherapy: identification, prevention and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:348. [PMID: 28936442 DOI: 10.21037/atm.2017.06.35] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiotoxicity is an important complication of several cancer therapeutic agents. Several well established and newer anticancer therapies such as anthracyclines, trastuzumab and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors (TKIs), angiogenesis inhibitors, and checkpoint inhibitors are associated with significant cardiotoxicity. Cardiovascular imaging employing radionuclide imaging, echocardiography and magnetic resonance imaging are helpful in early detection and prevention of overt heart failure secondary to cardiotoxicity of cancer therapy. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.
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Affiliation(s)
- Diwakar Jain
- Section of Cardiovascular Medicine, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Tauseef Ahmad
- Section of Oncology and Hematology, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Mitchel Cairo
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert Aronow
- Section of Cardiovascular Medicine, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
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Abstract
The number of cancer survivors increases annually, because of advances in detection and treatment, and the aging and growth of the population. This increase has brought a concomitant increase in morbidity and mortality from other conditions related to the adverse effects of cancer treatments. Cardiovascular diseases, and in particular left ventricular dysfunction and heart failure, are among the most significant of these. There are no unified and universally accepted evidence-based practice guidelines on the management of heartfailure in this population. This article discusses the epidemiologic impact of cancer therapeutics-related cardiac dysfunction, and reviews its most significant mediators and provides a condensed but comprehensive synopsis on its evaluation and management.
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Affiliation(s)
- Jose Emanuel Finet
- Krannert Institute of Cardiology, Indiana University, IU Health Methodist Hospital, 1801 North Senate Boulevard, MPC-2, Suite 2000, Indianapolis, IN 46202, USA.
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Mignot F, Ajgal Z, Xu H, Geraud A, Chen JY, Mégnin-Chanet F, Kirova Y. Concurrent administration of anti-HER2 therapy and radiotherapy: Systematic review. Radiother Oncol 2017; 124:190-199. [DOI: 10.1016/j.radonc.2017.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/22/2017] [Accepted: 07/04/2017] [Indexed: 12/18/2022]
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Barthur A, Brezden-Masley C, Connelly KA, Dhir V, Chan KKW, Haq R, Kirpalani A, Barfett JJ, Jimenez-Juan L, Karur GR, Deva DP, Yan AT. Longitudinal assessment of right ventricular structure and function by cardiovascular magnetic resonance in breast cancer patients treated with trastuzumab: a prospective observational study. J Cardiovasc Magn Reson 2017; 19:44. [PMID: 28395671 PMCID: PMC5387372 DOI: 10.1186/s12968-017-0356-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are limited data on the effects of trastuzumab on the right ventricle (RV). Therefore, we sought to evaluate the temporal changes in right ventricular (RV) structure and function as measured by cardiovascular magnetic resonance (CMR), and their relationship with left ventricular (LV) structure and function in breast cancer patients treated with trastuzumab. METHODS Prospective, longitudinal, observational study involving 41 women with HER2+ breast cancer who underwent serial CMR at baseline, 6, 12, and 18 months after initiation of trastuzumab. A single blinded observer measured RV parameters on de-identified CMRs in a random order. Linear mixed models were used to investigate temporal changes in RV parameters. RESULTS Of the 41 women (age 52 ± 11 years), only one patient experienced trastuzumab-induced cardiotoxicity. Compared to baseline, there were small but significant increases in the RV end-diastolic volume at 6 months (p = 0.002) and RV end-systolic volume at 6 and 12 months (p < 0.001 for both), but not at 18 months (p = 0.82 and 0.13 respectively). RV ejection fraction (RVEF), when compared to baseline (58.3%, 95% CI 57.1-59.5%), showed corresponding decreases at 6 months (53.9%, 95% CI 52.5-55.4%, p < 0.001) and 12 months (55%, 95% CI 53.8-56.2%, p < 0.001) that recovered at 18 months (56.6%, 95% CI 55.1-58.0%, p = 0.08). Although the temporal pattern of changes in LVEF and RVEF were similar, there was no significant correlation between RVEF and LVEF at baseline (r = 0.29, p = 0.07) or between their changes at 6 months (r = 0.24, p = 0.17). CONCLUSION In patients receiving trastuzumab without overt cardiotoxicity, there is a subtle but significant deleterious effect on RV structure and function that recover at 18 months, which can be detected by CMR. Furthermore, monitoring of LVEF alone may not be sufficient in detecting early RV injury. These novel findings provide further support for CMR in monitoring early cardiotoxicity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01022086 . Date of registration: November 27, 2009.
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Affiliation(s)
- Ashita Barthur
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Christine Brezden-Masley
- Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Kim A. Connelly
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Vinita Dhir
- Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Kelvin K. W. Chan
- Sunnybrook Health Sciences Centre, University of Toronto, Cancer Care Ontario, Canadian Center for Applied Research in Cancer Control, Toronto, ON Canada
| | - Rashida Haq
- Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Joseph J. Barfett
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
| | - Gauri R. Karur
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Djeven P. Deva
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Andrew T. Yan
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
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Li X, Liu M, Sun R, Zeng Y, Chen S, Zhang P. Cardiac complications in cancer treatment - A review. Hellenic J Cardiol 2016; 58:190-193. [PMID: 28011332 DOI: 10.1016/j.hjc.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/25/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022] Open
Abstract
Cardiac dysfunction is often associated with effective cancer treatment. A number of targeted therapies against cancer have been observed to cause cardiac dysfunction. In some instances, a patient may outlive his or her cancer but die due to heart failure. Recent research has been focused on the development of new avenues and technological advancements to monitor clinical cardiotoxicity and cardiac dysfunction due to anticancer treatment. These newer treatment options are also increasingly effective and are focused more on post-cancer life. The present review article expands the current view of cardiac complications involved in cancer treatment along with the recent developments in the area.
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Affiliation(s)
- Xianchi Li
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China
| | - Min Liu
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China
| | - Rongrong Sun
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China
| | - Yi Zeng
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China
| | - Shuang Chen
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China
| | - Peiying Zhang
- Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China; The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu Province, China; Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu Province, China; Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China.
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Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, Pagano JJ, Chow K, Thompson RB, Vos LJ, Ghosh S, Oudit GY, Ezekowitz JA, Paterson DI. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity. J Clin Oncol 2016; 35:870-877. [PMID: 27893331 DOI: 10.1200/jco.2016.68.7830] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The primary toxicity of trastuzumab therapy for human epidermal growth factor receptor 2-overexpressing (HER2-positive) breast cancer is dose-independent cardiac dysfunction. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. We hypothesized that angiotensin-converting enzyme inhibitors and β-blockers could prevent trastuzumab-related cardiotoxicity. Patients and Methods In this double-blinded, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF. Results Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. Baseline demographic, cancer, and cardiovascular profiles were similar between groups. Study drugs were well tolerated with no serious adverse events. After 17 cycles of trastuzumab, indexed left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups ( P = .001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis. Conclusion Perindopril and bisoprolol were well tolerated in patients with HER2-positive early breast cancer who received trastuzumab and protected against cancer therapy-related declines in LVEF; however, trastuzumab-mediated left ventricular remodeling-the primary outcome-was not prevented by these pharmacotherapies.
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Affiliation(s)
- Edith Pituskin
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Mackey
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheri Koshman
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder Jassal
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark J Haykowsky
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph J Pagano
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelvin Chow
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard B Thompson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa J Vos
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sunita Ghosh
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gavin Y Oudit
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin A Ezekowitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Ian Paterson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
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Zardavas D, Suter TM, Van Veldhuisen DJ, Steinseifer J, Noe J, Lauer S, Al-Sakaff N, Piccart-Gebhart MJ, de Azambuja E. Role of Troponins I and T and N-Terminal Prohormone of Brain Natriuretic Peptide in Monitoring Cardiac Safety of Patients With Early-Stage Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Receiving Trastuzumab: A Herceptin Adjuvant Study Cardiac Marker Substudy. J Clin Oncol 2016; 35:878-884. [PMID: 28199174 DOI: 10.1200/jco.2015.65.7916] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Women receiving trastuzumab with chemotherapy are at risk for trastuzumab-related cardiac dysfunction (TRCD). We explored the prognostic value of cardiac markers (troponins I and T, N-terminal prohormone of brain natriuretic peptide [NT-proBNP]) to predict baseline susceptibility to develop TRCD. We examined whether development of cardiac end points or significant left ventricular ejection fraction (LVEF) drop was associated with markers' increases. Patients and Methods Cardiac marker assessments were coupled with LVEF measurements at different time points for 533 patients from the Herceptin Adjuvant (HERA) study who agreed to participate in this study. Patients with missing marker assessments were excluded, resulting in 452 evaluable patients. A primary cardiac end point was defined as symptomatic congestive heart failure of New York Heart Association class III or IV, confirmed by a cardiologist, and a significant LVEF drop, or death of definite or probable cardiac causes. A secondary cardiac end point was defined as a confirmed significant asymptomatic or mildly symptomatic LVEF drop. Results Elevated baseline troponin I (> 40 ng/L) and T (> 14 ng/L), occurring in 56 of 412 (13.6%) and 101 of 407 (24.8%) patients, respectively, were associated with an increased significant LVEF drop risk (univariate analysis: hazard ratio, 4.52; P < .001 and hazard ratio, 3.57; P < .001, respectively). Few patients had their first elevated troponin value recorded during the study (six patients for troponin I and 25 patients for troponin T). Two patients developed a primary and 31 patients a secondary cardiac end point (recovery rate of 74%, 23 of 31). For NT-proBNP, higher increases from baseline were seen in patients with significant LVEF drop. Conclusion Elevated troponin I or T before trastuzumab is associated with increased risk for TRCD. A similar conclusion for NT-proBNP could not be drawn because of the lack of a well-established elevation threshold; however, higher increases from baseline were seen in patients with TRCD compared with patients without.
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Affiliation(s)
- Dimitrios Zardavas
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Thomas M Suter
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Dirk J Van Veldhuisen
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jutta Steinseifer
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johannes Noe
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sabine Lauer
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Nedal Al-Sakaff
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Martine J Piccart-Gebhart
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Evandro de Azambuja
- Dimitrios Zardavas, Breast International Group; Martine J. Piccart-Gebhart and Evandro de Azambuja, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Thomas M. Suter, Bern University Hospital, Bern; Jutta Steinseifer, Johannes Noe, Sabine Lauer, and Nedal Al-Sakaff, F. Hoffmann-La Roche, Basel, Switzerland; and Dirk J. Van Veldhuisen, University Medical Center Groningen, University of Groningen, The Netherlands
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Russell RR, Alexander J, Jain D, Poornima IG, Srivastava AV, Storozynsky E, Schwartz RG. The role and clinical effectiveness of multimodality imaging in the management of cardiac complications of cancer and cancer therapy. J Nucl Cardiol 2016; 23:856-84. [PMID: 27251147 DOI: 10.1007/s12350-016-0538-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 12/24/2022]
Abstract
With the increasing number of individuals living with a current or prior diagnosis of cancer, it is important for the cardiovascular specialist to recognize the various complications of cancer and its therapy on the cardiovascular system. This is true not only for established cancer therapies, such as anthracyclines, that have well established cardiovascular toxicities, but also for the new targeted therapies that can have "off target" effects in the heart and vessels. The purpose of this informational statement is to provide cardiologists, cardiac imaging specialists, cardio-oncologists, and oncologists an understanding of how multimodality imaging may be used in the diagnosis and management of the cardiovascular complications of cancer therapy. In addition, this document is meant to provide useful general information concerning the cardiovascular complications of cancer and cancer therapy as well as established recommendations for the monitoring of specific cardiotoxic therapies.
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Affiliation(s)
- Raymond R Russell
- Rhode Island Cardiovascular Institute, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 737, Providence, RI, 02903, USA.
| | - Jonathan Alexander
- Cardiology Division, Western Connecticut Medical Center at Danbury Hospital, Danbury, CT, USA
| | - Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Indu G Poornima
- Division of Cardiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ajay V Srivastava
- Division of Cardiovascular Medicine, Scripps Clinic, La Jolla, CA, USA
| | - Eugene Storozynsky
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Schwartz RG, Venci N. Can serial changes of diastolic dysfunction signal incremental risk of chemotherapy-induced heart failure missed by the timing of declining LV ejection fraction? J Nucl Cardiol 2016; 23:833-6. [PMID: 26204989 DOI: 10.1007/s12350-015-0194-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Nicholas Venci
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Abstract
Through the success of basic and disease-specific research, cancer survivors are one of the largest growing subsets of individuals accessing the healthcare system. Interestingly, cardiovascular disease is the second leading cause of morbidity and mortality in cancer survivors after recurrent malignancy. This recognition has helped stimulate a collaboration between oncology and cardiology practitioners and researchers, and the portmanteau cardio-oncology (also known as onco-cardiology) can now be found in many medical centers. This collaboration promises new insights into how cancer therapies impact cardiovascular homeostasis and long-term effects on cancer survivors. In this review, we will discuss the most recent views on the cardiotoxicity related to various classes of chemotherapy agents and radiation. We will also discuss broadly the current strategies for treating and preventing cardiovascular effects of cancer therapy.
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Affiliation(s)
- Carrie G Lenneman
- From the Department of Medicine, University of Louisville School of Medicine, KY (C.G.L.); and Cardiovascular Institute, Maine Medical Center, Portland (D.B.S.).
| | - Douglas B Sawyer
- From the Department of Medicine, University of Louisville School of Medicine, KY (C.G.L.); and Cardiovascular Institute, Maine Medical Center, Portland (D.B.S.)
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Curigliano G, Cardinale D, Dent S, Criscitiello C, Aseyev O, Lenihan D, Cipolla CM. Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management. CA Cancer J Clin 2016; 66:309-25. [PMID: 26919165 DOI: 10.3322/caac.21341] [Citation(s) in RCA: 435] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Answer questions and earn CME/CNE Cancer and heart disease are the leading causes of morbidity and mortality in the industrialized world. Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer; however, these gains can come at a cost. Patients may experience adverse cardiovascular events related to their cancer treatment or as a result of an exacerbation of underlying cardiovascular disease. With longer periods of survival, late effects of cancer treatment may become clinically evident years or decades after completion of therapy. Current cancer therapy incorporates multiple agents whose deleterious cardiac effects may be additive or synergistic. Cardiac dysfunction may result from agents that can result in myocyte destruction, such as with anthracycline use, or from agents that appear to transiently affect left ventricular contractility. In addition, cancer treatment may be associated with other cardiac events, such as severe treatment-induced hypertension and vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including QTc prolongation, that may be rarely life-threatening. Early and late effects of chest radiation can lead to radiation-induced heart disease, including pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease, valvular disease, and arrhythmias, in the setting of myocardial fibrosis. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of cancer patients, whether they are receiving active treatment or are long-term survivors. Strategies to prevent or mitigate cardiovascular damage from cancer treatment are needed to provide the best cancer care. This review will focus on the common cardiovascular issues that may arise during or after cancer therapy, the detection and monitoring of cardiovascular injury, and the best management principles to protect against or minimize cardiotoxicity during the spectrum of cancer treatment strategies. CA Cancer J Clin 2016;66:309-325. © 2016 American Cancer Society.
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Affiliation(s)
- Giuseppe Curigliano
- Director, Division of Experimental Therapeutics, Division of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Daniela Cardinale
- Director, Division of Cardiology, Cardio-Oncology Program, International Cardio-Oncology Society (ICOS), European Institute of Oncology, Milan, Italy
| | - Susan Dent
- Associate Professor and Postdoctoral fellow, The Ottawa Hospital Cancer Center, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carmen Criscitiello
- Director, Division of Experimental Therapeutics, Division of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Olexiy Aseyev
- Associate Professor and Postdoctoral fellow, The Ottawa Hospital Cancer Center, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Lenihan
- Director, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Carlo Maria Cipolla
- Director, Division of Cardiology, Cardio-Oncology Program, International Cardio-Oncology Society (ICOS), European Institute of Oncology, Milan, Italy
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Maurea N, Spallarossa P, Cadeddu C, Madonna R, Mele D, Monte I, Novo G, Pagliaro P, Pepe A, Tocchetti CG, Zito C, Mercuro G. A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 1:S93-S104. [PMID: 27183530 PMCID: PMC4927319 DOI: 10.2459/jcm.0000000000000383] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/21/2022]
Abstract
The US National Cancer Institute estimates that cardiotoxicity (CTX) from target therapy refers mostly to four groups of drugs: epidermal growth factor receptor 2 inhibitors, angiogenic inhibitors, directed Abelson murine leukemia viral oncogene homolog inhibitors, and proteasome inhibitors. The main cardiotoxic side-effects related to antiepidermal growth factor receptor 2 therapy are left ventricular systolic dysfunction and heart failure. Angiogenesis inhibitors are associated with hypertension, left ventricular dysfunction/heart failure, myocardial ischemia, QT prolongation, and thrombosis. Moreover, other agents may be related to CTX induced by treatment. In this study, we review the guidelines for a practical approach for the management of CTX in patients under anticancer target therapy.
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Affiliation(s)
- Nicola Maurea
- Division of Cardiology, Istituto Nazionale per lo Studio e la Cura dei Tumori ‘Fondazione Giovanni Pascale’ – IRCCS, Naples
| | | | - Christian Cadeddu
- Department of Medical Sciences ‘Mario Aresu’, University of Cagliari, Cagliari
| | - Rosalinda Madonna
- Institute of Cardiology, Center of Excellence on Aging, ‘G. d’Annunzio’ University, Chieti
| | - Donato Mele
- Cardiology Unit, University Hospital of Ferrara, Ferrara
| | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania
| | - Giuseppina Novo
- Chair and Division of Cardiology, University of Palermo, Palermo
| | - Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Turin, Turin
| | - Alessia Pepe
- U.O.C. Magnetic Resonance Imaging, Fondazione G. Monasterio C.N.R., Pisa
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Concetta Zito
- U.O.C. Cardiology Intensive Unit, A.O.U. Policlinico ‘G. Martino’, University of Messina, Messina, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences ‘Mario Aresu’, University of Cagliari, Cagliari
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Influence of the HER2 Ile655Val polymorphism on trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients: a meta-analysis. Pharmacogenet Genomics 2016; 25:388-93. [PMID: 26049584 DOI: 10.1097/fpc.0000000000000149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The HER2 655 A>G genetic variant has recently been associated with trastuzumab-induced cardiotoxicity in HER2 breast cancer patients. Considering previous results, the aim of our study was to validate the role of this polymorphism as a predictor of the cardiac toxicity of trastuzumab in breast cancer patients. METHODS Our study population was composed of 78 HER2 breast cancer patients receiving trastuzumab. The HER2 655 A>G (rs1136201) genetic variant was genotyped using TaqMan allelic discrimination technology. Patients were classified on the basis of the occurrence of cardiotoxic events or the absence of cardiotoxic events during 1 year after the first infusion. RESULTS The HER2 655 A>G polymorphism was significantly associated with cardiotoxicity: AG versus AA [P=0.012, odds ratio (OR)=5.12, 95% confidence interval (CI) 1.43-18.36], AG+GG versus AA (P=0.01, OR=5.72, 95% CI 1.50-21.76), AG versus AA+GG (P=0.005, OR=7.17, 95% CI 1.82-28.29). A meta-analysis combining these data with the results from previous studies confirmed this association. CONCLUSION Our results support the role of the HER2 655 A>G polymorphism as a genetic marker of trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients.
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Hamo CE, Bloom MW, Cardinale D, Ky B, Nohria A, Baer L, Skopicki H, Lenihan DJ, Gheorghiade M, Lyon AR, Butler J. Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions. Circ Heart Fail 2016; 9:e002843. [PMID: 26839395 PMCID: PMC4743885 DOI: 10.1161/circheartfailure.115.002843] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.
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Affiliation(s)
- Carine E Hamo
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Michelle W Bloom
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniela Cardinale
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Bonnie Ky
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Anju Nohria
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Lea Baer
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Hal Skopicki
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniel J Lenihan
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Mihai Gheorghiade
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Alexander R Lyon
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Javed Butler
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
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Sivagnanam K, Rahman ZU, Paul T. Cardiomyopathy Associated With Targeted Therapy for Breast Cancer. Am J Med Sci 2016; 351:194-9. [PMID: 26897275 DOI: 10.1016/j.amjms.2015.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/22/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chemotherapeutic agents directed against human epidermal growth factor receptor 2 (HER-2) have significantly improved the prognosis of patients who are positive for this receptor. However, cardiomyopathy remains as a common adverse effect of using these agents. MATERIALS AND METHODS Literature search was conducted via PubMed using the keywords of "Trastuzumab Cardiomyopathy," "Lapatinib Cardiomyopathy" and "Pertuzumab Cardiomyopathy," which provided 104 results. These articles were then screened for relevance to the targeted subject based on their title and abstracts. Case reports and articles that were not discussing any aspect of cardiomyopathy secondary to targeted therapy for breast cancer and articles not in English were eliminated. After elimination, a bibliography search among selected articles was done and a total of 46 articles were identified. The collected articles were then meticulously analyzed and summarized. RESULTS The use of human epidermal growth factor receptor 2 (HER-2) receptor targeted chemotherapy in breast cancer is limited because of a higher incidence (19-22%) of cardiomyopathy. The incidence of cardiomyopathy is not dose dependent and in most cases it is reversible after discontinuation of the drug and treatment with heart failure medications. Severe adverse outcomes including death or permanent disability are rare. CONCLUSION HER-2 targeted chemotherapy for breast cancer has a higher incidence of associated reversible cardiomyopathy. Patients should be monitored by serial echocardiography starting at the beginning of the treatment and followed by every 3 months until the completion of chemotherapy. Co-ordination between oncologists and cardiologists is needed to develop evidence-based protocols to prevent, identify, monitor and treat trastuzumab-induced cardiomyopathy.
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Affiliation(s)
- Kamesh Sivagnanam
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee
| | - Zia U Rahman
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Timir Paul
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee.
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50
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Van Decker WA. Imaging and chemotherapy cardiotoxicity: A long-playing story still seeking precision and improved outcomes/management data. J Nucl Cardiol 2016; 23:98-100. [PMID: 26338429 DOI: 10.1007/s12350-015-0274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 01/03/2023]
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