1
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Lombardi P, Aimar G, Peraldo-Neia C, Bonzano A, Depetris I, Fenocchio E, Filippi R, Quarà V, Milanesio M, Cavalloni G, Gammaitoni L, Basiricò M, Cagnazzo C, Ostano P, Chiorino G, Aglietta M, Leone F. Fluoropyrimidine‑induced cardiotoxicity in colorectal cancer patients: a prospective observational trial (CHECKPOINT). Oncol Rep 2022; 49:31. [PMID: 36562382 PMCID: PMC9827273 DOI: 10.3892/or.2022.8468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Fluoropyrimidines (FP) are the backbone chemotherapy in colorectal cancer (CRC) treatment; however, their use is associated with cardiotoxicity, which is underreported. In the present study, it was aimed to prospectively determine the incidence rates and related risk factors of FP‑induced cardiotoxicity (FIC) in CRC patients and at identifying predictive biomarkers. A total of 129 consecutive previously untreated CRC patients underwent active cardiological monitoring, including 5‑items simplified questionnaire on symptoms, electrocardiogram (ECG) and plasma sample collection during FP chemotherapy. FIC was defined as the presence of ECG alterations and/or the arising of at least one symptom of chest pain, dyspnoea, palpitations or syncope. The primary objective was the evaluation of FIC incidence. Secondary objectives were the correlation of FIC with well‑known cardiological risk factors and the identification of circulating biomarkers (serum levels of troponin I, pro hormone BNP; miRNA analysis) as predictors of FIC. A total of 20 out of 129 (15.5%) patients experienced FIC. The most common symptoms were dyspnoea (60%) and chest pain (40%), while only 15% of patients presented ECG alterations, including one acute myocardial infarction. Retreatment with FP was attempted in 90% of patients with a favourable outcome. Despite 48% of patients having cardiological comorbidities, an increased FIC was not observed in this subgroup. Only the subgroup of females with the habit of alcohol consumption showed an increased risk of FIC. None of the circulating biomarkers evaluated demonstrated a clinical utility as FIC predictors. FIC can be an unexpected, life‑threatening adverse event that can limit the subsequent treatment choices in patients with CRC. In this prospective study, well‑known cardiological comorbidities were not related to higher FIC risk and circulating biomarkers predictive of toxicity could not be found. With careful monitoring, mainly based on symptoms, almost all patients completed the FP treatment.
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Affiliation(s)
- Pasquale Lombardi
- Department of Oncology, University of Turin, I-10124 Torino, Italy,Phase 1 Unit, Agostino Gemelli Foundation University Hospital IRCCS, I-00168 Roma, Italy
| | - Giacomo Aimar
- Department of Oncology, University of Turin, I-10124 Torino, Italy,Department of Oncology, S. Croce and Carle Hospital, I-12100 Cuneo, Italy
| | | | | | - Ilaria Depetris
- Division of Medical Oncology 1, AOU City of Health and Science of Turin, I-12126 Turin, Italy
| | - Elisabetta Fenocchio
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, I-10060 Candiolo, Italy
| | - Roberto Filippi
- Department of Oncology, University of Turin, I-10124 Torino, Italy,Division of Medical Oncology 1, AOU City of Health and Science of Turin, I-12126 Turin, Italy
| | - Virginia Quarà
- Department of Oncology, University of Turin, I-10124 Torino, Italy,Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, I-10060 Candiolo, Italy
| | | | - Giuliana Cavalloni
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, I-10060 Candiolo, Italy
| | | | - Marco Basiricò
- Department of Public Health and Pediatric Sciences, AOU City of Health and Science of Turin, Regina Margherita Hospital, I-10126 Torino, Italy
| | - Celeste Cagnazzo
- Department of Public Health and Pediatric Sciences, AOU City of Health and Science of Turin, Regina Margherita Hospital, I-10126 Torino, Italy
| | - Paola Ostano
- Laboratory of Cancer Genomics, Fondazione Edo ed Elvo Tempia, I-13900 Biella, Italy
| | - Giovanna Chiorino
- Laboratory of Cancer Genomics, Fondazione Edo ed Elvo Tempia, I-13900 Biella, Italy
| | - Massimo Aglietta
- Department of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, I-10060 Candiolo, Italy
| | - Francesco Leone
- Department of Medical Oncology, Infermi Hospital of Biella, Ponderano, I-13875 Biella, Italy,Correspondence to: Dr Francesco Leone, Department of Medical Oncology, Infermi Hospital of Biella, 2 Via dei Ponderanesi, Ponderano, I-13875 Biella, Italy, E-mail:
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2
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Galluzzo A, Gallo S, Pardini B, Birolo G, Fariselli P, Boretto P, Vitacolonna A, Peraldo-Neia C, Spilinga M, Volpe A, Celentani D, Pidello S, Bonzano A, Matullo G, Giustetto C, Bergerone S, Crepaldi T. Identification of novel circulating microRNAs in advanced heart failure by next-generation sequencing. ESC Heart Fail 2021; 8:2907-2919. [PMID: 33934544 PMCID: PMC8318428 DOI: 10.1002/ehf2.13371] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Risk stratification in patients with advanced chronic heart failure (HF) is an unmet need. Circulating microRNA (miRNA) levels have been proposed as diagnostic and prognostic biomarkers in several diseases including HF. The aims of the present study were to characterize HF‐specific miRNA expression profiles and to identify miRNAs with prognostic value in HF patients. Methods and results We performed a global miRNome analysis using next‐generation sequencing in the plasma of 30 advanced chronic HF patients and of matched healthy controls. A small subset of miRNAs was validated by real‐time PCR (P < 0.0008). Pearson's correlation analysis was computed between miRNA expression levels and common HF markers. Multivariate prediction models were exploited to evaluate miRNA profiles' prognostic role. Thirty‐two miRNAs were found to be dysregulated between the two groups. Six miRNAs (miR‐210‐3p, miR‐22‐5p, miR‐22‐3p, miR‐21‐3p, miR‐339‐3p, and miR‐125a‐5p) significantly correlated with HF biomarkers, among which N‐terminal prohormone of brain natriuretic peptide. Inside the cohort of advanced HF population, we identified three miRNAs (miR‐125a‐5p, miR‐10b‐5p, and miR‐9‐5p) altered in HF patients experiencing the primary endpoint of cardiac death, heart transplantation, or mechanical circulatory support implantation when compared with those without clinical events. The three miRNAs added substantial prognostic power to Barcelona Bio‐HF score, a multiparametric and validated risk stratification tool for HF (from area under the curve = 0.72 to area under the curve = 0.82). Conclusions This discovery study has characterized, for the first time, the advanced chronic HF‐specific miRNA expression pattern. We identified a few miRNAs able to improve the prognostic stratification of HF patients based on common clinical and laboratory values. Further studies are needed to validate our results in larger populations.
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Affiliation(s)
- Alessandro Galluzzo
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Ospedale Sant'Andrea, Vercelli, Italy
| | - Simona Gallo
- Department of Oncology, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Barbara Pardini
- Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.,Italian Institute for Genomic Medicine (IIGM), Turin, Italy
| | - Giovanni Birolo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Boretto
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Annapia Vitacolonna
- Department of Oncology, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Caterina Peraldo-Neia
- Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.,Laboratory of Cancer Genomics, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | | | - Alessandra Volpe
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dario Celentani
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Pidello
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carla Giustetto
- Department of Medical Sciences, University of Turin, Turin, Italy.,A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Serena Bergerone
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Tiziana Crepaldi
- Department of Oncology, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
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3
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Aimar G, Lombardi P, Quarà V, Milanesio M, Crespi V, Farinea G, Filippi R, Ferraris R, Bonzano A, Cavalloni G, Neia CP, Aglietta M, Leone F, Fenocchio E. 448P Predictive factor of cardiotoxicity in fluoropyrimidine-treated colorectal cancer patients: Interim analysis of the prospective observational CHECKPOINT trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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4
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Gallo S, Spilinga M, Albano R, Ferrauto G, Di Gregorio E, Casanova E, Balmativola D, Bonzano A, Boccaccio C, Sapino A, Comoglio PM, Crepaldi T. Activation of the MET receptor attenuates doxorubicin-induced cardiotoxicity in vivo and in vitro. Br J Pharmacol 2020; 177:3107-3122. [PMID: 32133617 PMCID: PMC7280013 DOI: 10.1111/bph.15039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Doxorubicin anti‐cancer therapy is associated with cardiotoxicity, resulting from DNA damage response (DDR). Hepatocyte growth factor (HGF) protects cardiomyocytes from injury, but its effective use is compromised by low biodistribution. In this study, we have investigated whether the activation of the HGF receptor—encoded by the Met gene—by an agonist monoclonal antibody (mAb) could protect against doxorubicin‐induced cardiotoxicity. Experimental Approach The mAb (5 mg·kg−1) was injected in vivo into C57BL/6J mice, before doxorubicin (three doses of 7 mg·kg−1). Cardiac functions were evaluated through MRI after treatment termination. Heart histological staining and mRNA levels of genes associated with heart failure (Acta1 and Nppa), inflammation (IL‐6), and fibrosis (Ctgf, Col1a2, Timp1, and Mmp9) were assessed. MAb (100 nM) was administered in vitro to H9c2 cardiomyoblasts before addition of doxorubicin (25 μM). DDR and apoptosis markers were evaluated by quantitative western blotting, flow cytometry, and immunofluorescence. Stattic was used for pharmacological inactivation of STAT3. Key Results In vivo, administration of the mAb alleviated doxorubicin‐induced cardiac dysfunction and fibrosis. In vitro, mAb mimicked the response to HGF by (a) inhibiting histone H2AX phosphorylation at S139, (b) quenching the expression of the DNA repair enzyme PARP1, and (c) reducing the proteolytic activation of caspase 3. The MET‐driven cardioprotection involved, at least in vitro, the phosphorylation of STAT3. Conclusion and Implications The MET agonist mAb provides a new tool for cardioprotection against anthracycline cardiotoxicity.
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Affiliation(s)
- Simona Gallo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Martina Spilinga
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
| | | | - Giuseppe Ferrauto
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Enza Di Gregorio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Elena Casanova
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | | | - Carla Boccaccio
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Anna Sapino
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Tiziana Crepaldi
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
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5
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Lombardi P, Aimar G, Depetris I, Bonzano A, Filippi R, Fenocchio E, Quarà V, Milanesio M, Ferraris R, Cagnazzo C, Neia CP, Basiricò M, Cavalloni G, Aglietta M, Leone F. Fluoropyrimidine-induced cardiotoxicity in colorectal cancer patients: Preliminary data from the prospective observational CHECKPOINT trial (NCT02665312). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Ghisoni E, Marandino L, Lombardi P, Bonzano A, Becco P, Aglietta M, Fizzotti M, Gay F, Rota Scalabrini D. Safe Use of Carfilzomib in a Patient with Multiple Myeloma and Intermittent Type 1 Brugada ECG Pattern: A Case Report. Acta Haematol 2019; 143:481-485. [PMID: 31553985 DOI: 10.1159/000502538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/31/2019] [Indexed: 12/09/2022]
Abstract
Cardiovascular adverse events (CVAEs) are of considerable importance in patients with multiple myeloma (MM), given the significant prevalence of coexisting cardiovascular risk factors and the potential treatment-induced toxicity. Brugada syndrome is a rare cardiological disease responsible for arrhythmia and potentially fatal cardiac arrest. Brugada phenocopies (BrP) are clinical entities which show an identical ECG patterns, but prompt resolution after treatment of the trigger event. A 65-year-old female newly diagnosed MM patient treated with a carfilzomib-based chemotherapy developed a type 1 Brugada ECG pattern during a hospitalization course for sepsis. As fever and the septic event resolved, further ECGs showed no abnormalities and carfilzomib-based treatment could be resumed with no further CVAEs. Though fever-induced BrP is a universally known phenomenon, to our knowledge this is the first case of BrP in a patient with MM during active treatment with carfilzomib.
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Affiliation(s)
- Eleonora Ghisoni
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Laura Marandino
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Pasquale Lombardi
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy,
- Department of Oncology, University of Turin, Turin, Italy,
| | | | - Paolo Becco
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Marco Fizzotti
- Medical Oncology, Candiolo Cancer Institute, FPO/IRCCS, Candiolo, Italy
| | - Francesca Gay
- Division of Hematology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
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7
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Martinello R, Becco P, Vici P, Airoldi M, Del Mastro L, Garrone O, Barone C, Pizzuti L, D'Alonzo A, Bellini E, Milani A, Bonzano A, Montemurro F. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25:444-449. [PMID: 30932296 DOI: 10.1111/tbj.13240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Significant and symptomatic cardiac comorbidity is a contraindication to adjuvant trastuzumab in breast cancer patients. However, some patients with asymptomatic, nonlimiting cardiac comorbidity and normal baseline left ventricular ejection fraction (LVEF) receive adjuvant trastuzumab in the clinical practice. We sought to describe the tolerability of trastuzumab in these patients. PATIENTS AND METHODS Retrospective analysis of patients with baseline asymptomatic, nonlimiting cardiac comorbidity receiving adjuvant trastuzumab at six Institutions between July 2007 and January 2016. RESULTS Thirty-seven patients with HER2-positive, surgery treated breast cancer at high risk of relapse were studied. Median age was 64 years (range 36-82), median baseline LVEF 61% (range 50%-85%). Thirteen patients (35%) received trastuzumab with adjuvant anthracycline and taxane-based regimens, 19 (51%) with taxane-based, three (8%) with off-label vinorelbine and two (5%) with off-label endocrine therapy. Most frequent cardiac comorbidities were ischemic heart disease (35%), valvular disease (30%), atrial fibrillation (19%), and conduction disorders (14%). Nine patients (24.3%) experienced a cardiac event: congestive heart failure (one patient, 3%), asymptomatic LVEF reduction (six patients, 16%), and rhythm disturbances (two patients, 5%). Trastuzumab had to be discontinued either permanently (five patients, 14%) or temporarily (two patients, 5%). At the time of last follow-up visit, all patients showed LVEF within normal limits, except one who had experienced a symptomatic cardiac event (LVEF value at last follow-up 46%). CONCLUSIONS Caution is needed in patients with significant ongoing cardiovascular risk factors, but when adjuvant trastuzumab is deemed beneficial on breast cancer outcomes, nonlimiting cardiac comorbidity should not preclude treatment.
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Affiliation(s)
| | - Paolo Becco
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Patrizia Vici
- Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Airoldi
- Medical Oncology 2, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | - Ornella Garrone
- Medical Oncology, S. Croce e Carle Teaching Hospital, Cuneo, Italy
| | - Carla Barone
- Medical Oncology, S. Lorenzo Hospital, Carmagnola, Turin, Italy
| | - Laura Pizzuti
- Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Elisa Bellini
- Medical Oncology 2, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Andrea Milani
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | | | - Filippo Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
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8
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Gallo S, Spilinga M, Ferrauto G, Di Gregorio E, Bonzano A, Comoglio P, Crepaldi T. HGF-mimic antibody administration to counteract doxorubicin cardiotoxicity. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F. Fluoropyrimidine-induced cardiotoxicity. Crit Rev Oncol Hematol 2018; 124:1-10. [PMID: 29548480 DOI: 10.1016/j.critrevonc.2018.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/04/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022] Open
Abstract
Fluoropyrimidines (5-fluorouracil and capecitabine) are antimetabolite drugs, widely used for the treatment of a variety of cancers, both in adjuvant and in metastatic setting. Although the most common toxicities of these drugs have been extensively studied, robust data and comprehensive characterization still lack concerning fluoropyrimidine-induced cardiotoxicity (FIC), an infrequent but potentially life-threatening toxicity. This review summarizes the current state of knowledge of FIC with special regard to proposed pathogenetic models (coronary vasospasm, endothelium and cardiomyocytes damage, toxic metabolites, dihydropyrimidine dehydrogenase deficiency); risk and predictive factors; efficacy and usefulness in detection of laboratory markers, electrocardiographic changes and cardiac imaging; and specific treatment, including a novel agent, uridine triacetate. The role of alternative chemotherapeutic options, namely raltitrexed and TAS-102, is discussed, and, lastly, we overview the most promising future directions in the research on FIC and development of diagnostic tools, including microRNA technology.
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Affiliation(s)
- Ilaria Depetris
- Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy; Department of Oncology, University of Turin, Italy
| | - Donatella Marino
- Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy; Department of Oncology, University of Turin, Italy.
| | | | - Celeste Cagnazzo
- Clinical Research Office, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy
| | - Roberto Filippi
- Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy; Department of Oncology, University of Turin, Italy
| | - Massimo Aglietta
- Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy; Department of Oncology, University of Turin, Italy
| | - Francesco Leone
- Medical Oncology, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy; Department of Oncology, University of Turin, Italy
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10
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Prati V, Ruatta F, Aversa C, Gernone A, Galizia D, Bonzano A, Torino S, Nuzzolese I, Marandino L, Aglietta M, Ortega C. Cardiovascular safety of abiraterone acetate in metastatic castration-resistant prostate cancer patients: a prospective evaluation. Future Oncol 2018; 14:443-448. [PMID: 29318908 DOI: 10.2217/fon-2017-0385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this study is to evaluate cardiotoxicity of abiraterone acetate (AA) in metastatic castration-resistant prostate cancer patients (pts) with cardiovascular comorbidities or coronary artery disease (CAD) risk factors. PATIENTS & METHODS We prospectively analyzed pts receiving AA in order to evaluate correlations between cardiotoxicity onset and CAD risk factors or cardiovascular comorbidities. RESULTS Eighty-seven pts were enrolled, with median treatment duration of 9 months (1-44). At baseline, 84 pts (96%) had CAD risk factors. During treatment four pts (4; 6%) developed hypertension and 26 pts (30%) worsened the preexisting hypertension. Median left ventricular ejection fraction were 64 and 63% at baseline and after treatment, respectively. CONCLUSION AA appears to be safe in pts with cardiovascular comorbidities or CAD risk factors.
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Affiliation(s)
- Veronica Prati
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy.,Medical Oncology, ASL CN 2, Alba e Bra, Cuneo, Italy
| | - Fiorella Ruatta
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Caterina Aversa
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | | | - Danilo Galizia
- Medical Oncology II, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Alessandro Bonzano
- Cardiology Unit, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Sofia Torino
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Imperia Nuzzolese
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Laura Marandino
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Massimo Aglietta
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy
| | - Cinzia Ortega
- Medical Oncology I, Fondazione Del Piemonte Per l'Oncologia, IRCCS Candiolo, Turin, Italy.,Medical Oncology, ASL CN 2, Alba e Bra, Cuneo, Italy
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11
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Martinello R, Becco P, Vici P, Airoldi M, Del Mastro L, Garrone O, Barone C, Pizzuti L, D'Alonzo A, Bellini E, Milani A, Bonzano A, Montemurro F. Trastuzumab-related cardiotoxicity in patients with non-limiting cardiac comorbidity. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12043 Background: Significant and symptomatic cardiac comorbidity (CC) is a contraindication to adjuvant trastuzumab (T) in breast cancer patients (pts). However, some pts with asymptomatic, non-limiting CC and normal baseline left ventricular ejection fraction (LVEF) receive T in the clinical practice. We sought to describe the tolerability of T in these pts. Methods: Retrospective analysis of pts with baseline asymptomatic non-limiting CC receiving adjuvant T with chemotherapy (CT) at 6 Institutions between Jul 2006 and Jan 2016. Results: Thirty-seven patients HER2-positive, operable BC at high risk of relapse BC were studied. Median age was 64y (range 36-82, 80% post-menopausal), median baseline LVEF was 61% (range 50-85%) and median BMI 26 (18-42, obesity 22%). Thirteen patients (35%) received T with adjuvant anthracycline and taxane-based, 19 (51%) taxane-based and 3 (8%) other adjuvant CT regimens (13 pts sequential, 22 pts concomitant with CT) and 2 (5%) with endocrine therapy. Prior non-limiting CC was ischemic heart disease (35%), valvular disease (30%), atrial fibrillation (19%), conduction disorders (13%), aortic aneurism (3%), and other (19%). Nine (29%) pts experienced TRC: congestive heart failure (1 pt, 3%), LVEF reduction (6 pts, 16%) and rhythm disturbances (1 pt, 3%). TRC occurred in pts with ongoing multiple cardiovascular risk factors (i.e. obesity and hypertension). Seven pts discontinued T because of TRC (19%), 5 permanently (14%) and 2 temporarily (5%). These latter pts, were able to resume and complete T after TRC resolution. At the end of adjuvant treatment, all pts showed LVEF within normal limits, except one of those who experienced a TRC (last FU value 46 %). Conclusions: This is the first analysis of TRC in pts receiving adjuvant T in the presence prior non-limiting CC. Despite the small size, our analysis shows that T is feasible in these pts and most of the TRC events were reversible at T withdrawal. Caution is needed in pts with significant ongoing cardiovascular risk factors, but when adjuvant T is deemed beneficial on breast cancer outcomes, non-limiting CC should not preclude treatment.
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Affiliation(s)
- Rossella Martinello
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | - Paolo Becco
- Medical Oncology, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Italy
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, A. O. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Ornella Garrone
- Medical Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Carla Barone
- Medical Oncology, S. Lorenzo Hospital, Carmagnola, Italy
| | - Laura Pizzuti
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Elisa Bellini
- 2nd Medical Oncology Division, A. O. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Milani
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
| | | | - Filippo Montemurro
- Investigative Clinical Oncology - Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy
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Prati V, Ruatta F, Gernone A, Aversa C, Galizia D, Torino S, Marandino L, Nuzzolese I, Bonzano A, Aglietta M, Ortega C. Prospective evaluation of the cardiovascular safety profile of abiraterone acetate (AA) in mCRPC patients (pts). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Veronica Prati
- Medical Oncology I Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo, Turin, Italy
| | - Fiorella Ruatta
- Medical Oncology I, Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo Italy, Candiolo, Italy
| | - Angela Gernone
- Medical Oncology Unit, Policlinico Hospital Bari, Bari, Italy
| | - Caterina Aversa
- Medical Oncology I Fondazione del Piemonte per l'Oncologia Irccs Candiolo, Candiolo (Turin), Italy
| | - Danilo Galizia
- Medical Oncology II, Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo, Candiolo (Turin), Italy
| | - Sofia Torino
- Medical Oncology I, Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo Italy, Candiolo (Turin), Italy
| | - Laura Marandino
- Medical Oncology I, Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo Italy, Candiolo, Italy
| | - Imperia Nuzzolese
- Medical Oncology I, Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo I, Candiolo, Italy
| | - Alessandro Bonzano
- Cardiology Unit Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo, Candiolo, Italy
| | - Massimo Aglietta
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | - Cinzia Ortega
- Medical Oncology I Fondazione del Piemonte per l'Oncologia-IRCCS Candiolo, Candiolo (Turin), Italy
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Montali N, Bobbio M, Cerrato E, Azzaro G, Bianchini B, Bonzano A, Calì MV, Cavaliere R, Correndo L, Deorsola A, Guillevin R, Mainardi L, Montagna L, Pistono M, Trevi GP. Management of heart failure in Piedmont Region. Monaldi Arch Chest Dis 2016; 70:214-20. [DOI: 10.4081/monaldi.2008.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
emerging problem in industrialized countries: it continues to be diagnosed at high rates and has an decreased survival time, raising new problems, such as the need of an adequate medical service organization and resource expenditure. Aim of this analysis was a quantitative evaluation of diagnostic and therapeutic resource use for CHF in outpatient departments in Piedmont, Italy. Methods. We performed a cross-sectional observational study, based on a two-month data collection in 12 outpatient departments dedicated to congestive heart failure. Information was obtained on each patient using a specific anonymous data collection form. Results. We obtained and analyzed for the study 547 forms. Mean patient age was 66.1 years, mean ejection fraction was 36.6%. Coronary artery disease accounted for 34.6% of congestive heart failure cases, followed by idiopathic etiology (26.4%). Main comorbidities were diabetes (22.3%) and chronic obstructive pulmonary disease (17.7%). Sixty-nine% of patients received a medical treatment with angiotensin-converting enzyme (ACE) inhibitors, 72.6% with β-blockers, 48.8% with aldosterone antagonists. As far as diagnostic resource use during a six-month period preceeding observation, 46.8% of patients underwent echocardiographic examination, 9.9% Holter ECG, 6.0% coronary angiography. Therapy was more often increased in patients who underwent an instrumental evaluation during the preceeding six-month period. Conclusions. Data suggests that in Piedmont outpatients with chronic heart failure receive a high drug prescription level and a small number of instrumental evaluations, as suggested in main international guidelines.
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Gallo S, Gatti S, Bonzano A, Albano R, Sala V, Comoglio P, Crepaldi T. Met activation for cardioprotection against anthracycline cardiotoxicity. Vascul Pharmacol 2015. [DOI: 10.1016/j.vph.2015.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kuzenko A, Sosso L, Montaruli B, Rovere M, Castagno I, Crema F, Napolitano E, Silvestro E, Bonzano A, Sciascia S, Bertero M. AB0691 Arterial APS (AAPS): clinical and laboratory findings in a cohort of 28 patients:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Prati V, Ortega C, Ballatore V, Galizia D, Ruatta F, Bonzano A, Aliberti S, Grignani G, Aglietta M. Hypertension and cardiotoxicity in metastatic renal cell carcinoma (mRCC) treated with sunitinib (SU). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15073 Background: Recent data have shown that cardiotoxicity (CHFcongestive heart failure, CADcoronary artery disease)could be an important side-effect in patients (pts) with RCC treated with tyrosine kinase inhibitors (TKIs). LVEF(Left ventricular ejection fraction)reduction may occur in up to 10% of pts treated with SU and uncontrolled hypertension could worse this side-effect. This complication is reversible with TKI interruption and appropriate antihypertensive therapy. Methods: We have prospectively analyzed patients receiving SU as a first-line treatment for mRCC. Between April 2007 and December 2011,31 consecutive pts, median age 67 yrs (41-80) were treated with SU at the standard dose of 50 mg/day,4 weeks on and 2 weeks off. We recorded for all pts CAD risk factors, preexisting hypertension,rhythm disturbances and heart failure. ECG, echocardiography and cardiology consultation were performed at baseline, and every three months until progression or permanent SU discontinuation. We searched correlations between cardiotoxicity onset and hypertension. Results were assessed with paired Student’s t-test and Chi-square test. Results: At baseline,we found 22 pts (71%) with hypertensive disease (HD). The median duration treatment was 8,3 months(22-0,4).On TKI therapy 6/22 pts (27.2%) worsened the preexisting HD, which was controlled with adequate treatment according to American Heart Association guidelines, without determining treatment discontinuation. Furthermore 6/31 pts (19%) developed this adverse event. In 14/31 pts (45%) we showed a median ≥ 10% LVEF reduction compared to baseline value (p=.001); 13/31 pts were asymptomatic and only one presented symptoms of CHF and discontinued the treatment. In this study, history of HD,worsening of preexisting HD or development of HD are not predictive for >10% LVEF reduction (p=ns). Conclusions: In pts with mRCC receiving SU as a first-line treatment, HD is not predictive for LVEF reduction. Moreover on TKI therapy there is a statistically significant LVEF reduction, but this adverse event does not determine a treatment discontinuation. A cardiovascular monitoring during SU treatment may reduce this event in order to allow an adequate treatment.
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Affiliation(s)
- Veronica Prati
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Cinzia Ortega
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Valentina Ballatore
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Danilo Galizia
- Medical Oncology, Fondazione del Piemonte per l'Oncologia- Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Fiorella Ruatta
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Alessandro Bonzano
- Cardiology Unit-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Turin, Italy
| | - Sandra Aliberti
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Giovanni Grignani
- Medical Oncology-Fondazione del Piemonte per l'Oncologia-Institute for Cancer Research and Treatment, Candiolo, Italy
| | - Massimo Aglietta
- Medical Oncology, University of Torino, Institute for Cancer Research and Treatment, Candiolo, Italy
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Galizia D, Ortega C, Palesandro E, Prati V, Gallo S, D'Ambrosio L, Bonzano A, Rota Scalabrini D, Aliberti S, Grignani G, Aglietta M. Hypertension monitoring as a tool to predict congestive heart failure (CHF) during sunitinib (SU) therapy in GIST and renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVES Transesophageal echocardiography (TEE) is usually recommended in the evaluation of the patent foramen ovale (PFO). Our goal is to confirm the efficacy of contrast-enhanced transcranial Doppler (ce-TCD) in detecting residual significant right-to-left shunts (RLS) after PFO percutaneous closure. MATERIALS AND METHODS Sixty-eight patients with a previous transient ischemic attack, stroke and a large PFO were investigated for residual RLS after percutaneous closure. RESULTS Assuming TEE as the gold standard, the sensitivity and negative predictive value of ce-TCD was 100%, whereas the specificity was 75.8% and the positive predictive value was 28%. CONCLUSIONS ce-TCD appears to be the preferable technique to identify subjects with significant residual shunts after percutaneous closure of a PFO. In follow-up, if ce-TCD is negative, no further examination may be necessary; whereas if ce-TCD shows a residual shunt, it is advisable to perform a TEE investigation.
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Affiliation(s)
- F Orzan
- Department of Internal Medicine - Cardiology, University of Torino, Torino, Italy
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Pálinkeás A, Antonielli E, Pizzuti A, Gruber N, Varga A, Bonzano A, Csanády M, Forster T, Picano E. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Mol Cell Cardiol 2002. [DOI: 10.1016/s0022-2828(02)90917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Varga A, Pálinkás A, Antonielli E, Pizzuti A, Gruber N, Bonzano A, Csanády M, Forster T, Picano E. Clinical value of left atrial appendage flow velocity for prediction of success of electric cardioversion in patients with non-valvular atrial fibrillation of unknown duration. J Mol Cell Cardiol 2002. [DOI: 10.1016/s0022-2828(02)90991-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Antonielli E, Pizzuti A, Pálinkás A, Tanga M, Gruber N, Michelassi C, Varga A, Bonzano A, Gandolfo N, Halmai L, Bassignana A, Imran MB, Delnevo F, Csanády M, Picano E. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Am Coll Cardiol 2002; 39:1443-9. [PMID: 11985905 DOI: 10.1016/s0735-1097(02)01800-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined. METHODS Clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE) data--measured in AF lasting >48 h--of 186 consecutive patients (116 men, mean age: 65 +/- 9 years) with successful CV (electrical or pharmacologic) were analyzed for assessment of one-year maintenance of SR. RESULTS At one-year follow-up, 91 of 186 (49%) patients who underwent successful CV continued to have SR. Mean LAA peak emptying flow velocity was higher in patients remaining in SR for one year than in those with AF relapse (41.7 +/- 20.2 cm/s vs. 27.7 +/- 17.0 cm/s; p < 0.001). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity >40 cm/s (p = 0.0001; chi(2): 23.9, odds ratio [OR] = 5.2, confidence interval [CI] 95% = 2.7 to 10.1) and the use of preventive antiarrhythmic drug treatment (p = 0.0398; chi(2): 4.2; OR = 2.0, CI 95% = 1.0 to 3.8) predicted the continuous preservation of SR during one year, outperforming other univariate predictors such as absence of left atrial spontaneous echocardiographic contrast during TEE, the left atrial parasternal diameter <44 mm, left ventricular ejection fraction >46% and AF duration <1 week before CV. The negative and positive predictive values of the mean LAA peak emptying velocity >40 cm/s for assessing preservation of SR were 66% (CI 95% = 56.9 to 74.2) and 73% (CI 95% = 62.4 to 83.3), respectively. CONCLUSIONS In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.
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Pálinkás A, Antonielli E, Picano E, Pizzuti A, Varga A, Nyúzó B, Alegret JM, Bonzano A, Tanga M, Coppolino A, Forster T, Baralis G, Delnevo F, Csanády M. Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation. Eur Heart J 2001; 22:2201-8. [PMID: 11913482 DOI: 10.1053/euhj.2001.2891] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined. OBJECTIVE To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective. multicentre, international study. METHODS Four hundred and eight patients (257 males, mean age: 66 +/- 10 years) with non-valvular atrial fibrillation lasting more than 48 h but less than 1 year underwent transthoracic echocardiography and transoesophageal echocardiography before either electrical (n=324) or pharmacological (n=84) cardioversion. RESULTS Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emptying flow velocity was significantly higher in patients with successful than in those with unsuccessful cardioversion (32.4 +/- 17.7 vs 23.5 +/- 13.6 cm x s(-1); P<0.0001). At multivariate logistic regression analysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0.011, OR=4.9, CI 95%=1.9-12.7), the mean left atrial appendage flow velocity >31 cm x s(-1) (P=0.0013, OR=2.8, CI 95%=1.5-5.4) and the left atrial diameter <47 mm (P=0.093, OR=2.0, CI 95%=1.2-3.4). These independent predictors of cardioversion success outperformed other univariate predictors such as left ventricular end-diastolic diameter <58 mm, ejection fraction >56% and the absence of left atrial spontaneous echo contrast. CONCLUSION In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.
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Affiliation(s)
- A Pálinkás
- 2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical Faculty, University of Sciences, Szeged, Hungary
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De Felice F, Gostoli E, Russo M, Bonzano A, Recanzone P, Moretti C, Pinneri F, Borello G. Significance of T-wave changes during early dobutamine stress echocardiography in patients with Q-wave acute myocardial infarction. Am J Cardiol 1999; 84:535-9. [PMID: 10482151 DOI: 10.1016/s0002-9149(99)00373-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The relation between T-wave changes and regional contraction during dobutamine stress echocardiography at low (5 to 10 microg/kg/min) and high (20 to 40 microg/kg/min) doses in 43 consecutive patients, early (7+/-2 days) after first recent Q-wave acute myocardial infarction has been evaluated. T-wave changes detected in > or =2 infarct-related electrocardiographic leads during dobutamine infusion were defined as follow: (1) negative T waves becoming positive, (2) positive T waves becoming upright > or =2 mm, and (3) negative T waves becoming upright > or =2 mm from baseline. Wall motion score index (WMSI) was defined as the sum of the echocardiographic scores of 16 segments divided by total segments considered at baseline, and at low and peak doses of dobutamine. Patients were classified according to the absence or presence of dobutamine T-wave changes. Those without T-wave changes had a significantly higher WMSI at rest (1.68+/-0.23 vs 1.50+/-0.21; p <0.05) and at peak (1.77+/-0.34 vs 1.51+/-.30 p <0.05) of dobutamine stress testing, without higher incidence of viability, homozonal, and heterozonal ischemia and chest pain. The angiographic patterns were similar between groups. Regression analysis showed a significant correlation between WMSI and T-wave amplitude at baseline (R = 0.38, p = 0.01) and at peak dobutamine stress testing (R = 0.50, p = 0.0006). The sensitivity sensitivity, specificity, and accuracy of T-wave changes to detect myocardial viability were 0.27, 0.84, and 0.70, respectively. The sensitivity, specificity, and accuracy of T-wave changes to detect homozonal ischemia were 0.76, 0.27, and 0.46, respectively. In conclusion, dobutamine-induced T-wave changes are associated with a greater extent of wall motion abnormalities both at rest and at peak stress echocardiography, but they are of little value in predicting myocardial viability when analyzed early after myocardial infarction.
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Affiliation(s)
- F De Felice
- Division of Cardiology, Ospedale Civico di Chivasso, Torino, Italy
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Caruzzo C, Liboni W, Bonzano A, Bobbio M, Bongioanni S, Caruzzo E, Civaia F. Effect of lipid-lowering treatment on progression of atherosclerotic lesions--a duplex ultrasonographic investigation. Angiology 1995; 46:269-80. [PMID: 7726447 DOI: 10.1177/000331979504600401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Prevenzione Aterosclerosi Studio Torino (P.A.S.T.) was a prospective, randomized trial testing the effect on carotid and femoral atherosclerotic lesions of lipid-lowering therapy, as assessed by duplex scanning (DS) technique, in 85 patients (12 women, 73 men), forty-five to fifty-five years old, with ischemic heart disease (IHD), and randomly assigned to a hypolipidemic diet or diet + 250 mg acipimox (a nicotinic acid compound) two to three times/day. Forty-one patients, without inclusion criteria, were compared with the randomized groups as a reference population. All three groups were submitted to DS and to hematic monitoring of lipid levels at the beginning and at the end of the study. During three years of treatment, there was a significant reduction (-6.5%) in total plasma cholesterol in the diet + drug group (P = 0.04) and a simultaneous elevation of high-density lipoprotein cholesterol, significant in the treatment groups (respectively, +15% P = 0.02 in the diet and +16% P = 0.016 in the diet + drug group). Every group showed a trend toward the increasing number of lesions in all explored areas and toward the progression in size of the already existing ones. Whereas in the initial DS the prevalence of lesions was significantly lower in the nonrandomized group in every site, at the end of the study the total number of lesions did not differ among groups, and there was a significant increase of plaques in carotid area in the nonrandomized group in comparison with the treatment groups. The final number of stable plaques was greater in the treatment groups as compared with the nonrandomized group (P = 0.01 diet vs nonrandomized, P = 0.03 diet + drug vs nonrandomized). In conclusion, lipid-lowering treatment, with diet and with diet + drug, was useful in slowing the natural progression of atherosclerosis; particularly, it reduced the development of new lesions in the carotid and femoral arteries and increased the stability of the already existing ones. In these patients, diet was equivalent to diet + drug in regard to progression of lesions. The most favorable results in the treatment groups seem to correlate with high-density lipoprotein cholesterol, significantly increased in comparison with the nonrandomized group.
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Affiliation(s)
- C Caruzzo
- Institute of Medicine and Cardiovascular Surgery, University of Turin, Italy
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Conte MR, Orzan F, Brusca A, De Benedictis M, Bonzano A, Bobbio M. [Does coexistence of involvement of the right dominant coronary artery differentiate clinical features of disease of the common trunk from disease of 3 coronary vessels?]. Cardiologia 1994; 39:773-6. [PMID: 7736476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have studied clinical and ECG stress features of 119 patients with left main disease and 113 matched patients with three vessels coronary disease. Clinical features and ECG stress test do not differentiate the two groups as a whole. Exercise time duration was shorter, ST criteria were more positive, and peak heart rate was lower in the subgroups of patients with left main and involvement of a right dominant coronary artery. However due to a large overlap these criteria do not seem to be clinically useful. In conclusion, in an individual patient angina and stress ECG criteria do not differentiate the patients with left main from those with three vessels coronary artery disease.
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Affiliation(s)
- M R Conte
- Istituto di Medicina e Chirurgia Cardiovascolare, Università degli Studi, Torino
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Maggio C, Bonzano A, Conte E, Libertucci D, Panarelli M, Bobbio M, Pintor PP. Preoperative evaluation in non-cardiac surgery: cardiac risk assessment. Qual Assur Health Care 1992; 4:217-24. [PMID: 1391792 DOI: 10.1093/oxfordjournals.intqhc.a036722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nine hundred and ninety patients, ages 20 years or older, undergoing non-cardiac elective surgery were prospectively studied to identify high cardiac risk preoperative factors in a case-mix population and to assess cardiological risk. The prevalence of major cardiac complications was 2.3%, including 0.8% mortality. Univariate analysis showed that: age; history of chest pain; dyspnea; hypertension; presence of systolic murmur and third sound; diastolic pressure greater than 95 mmHg; electrocardiogram left ventricular hypertrophy; cardiothoracic ratio greater than 0.5 and valvular calcifications are associated with cardiac complications (p = 0.001-0.02), with low sensitivity (range: 14-38%) and high specificity (range: 85-98%). Cardiological referral was required for 169 patients (17%) that showed a higher prevalence of cardiovascular diseases (85%) and of cardiac complications (5.3%). Cardiologists required further tests for 13 patients (7.7%) and modified therapy for 93 (55%). High cardiac risk patients are identified preoperatively in current practice and cardiological referral is frequent; further studies are mandatory to evaluate the most effective and efficacious procedures.
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Affiliation(s)
- C Maggio
- Arturo Pinna Pintor Foundation, Torino, Italy
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Steffenino G, Di Leo M, Orzan F, Bergerone S, Fontana V, Bonzano A, Defilippi G, Brusca A. Intracoronary streptokinase in unstable angina: a prospective randomised study. G Ital Cardiol 1991; 21:1159-66. [PMID: 1809619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Results of our prospective, randomised pilot trial to evaluate the clinical effects and the angiographic correlates of early thrombolysis in patients with unstable angina are reported. Sixty-seven patients had coronary angiography 10 +/- 8 (median 7) hours after an episode of transient chest pain at rest with reversible ischaemic changes on the electrocardiogram. Patients with left main disease (4), or diffuse coronary disease and unidentified ischemia-producing lesions (13) were excluded, as were those without severe (greater than or equal to 70%) stenosis (10). Intracoronary thrombus was identified at angiography in 7 patients (17%) and complex coronary lesions in 5 (12%) of the remaining 40 patients who were randomised to either intracoronary streptokinase 250,000 IU followed by intravenous heparin along with conventional treatment (20 patients), or to conventional treatment alone (20 patients). All patients received Aspirin. No differences between the streptokinase and the conventional treatment groups were observed with respect to demographic and clinical characteristics at admission to the study. During observation in the intensive care unit for 3 +/- 1 days, 8 patients (40%) with streptokinase and 10 (50%) with conventional treatment were free from angina and infarction (p = 0.75; 95% confidence interval for the difference in response rates = -20 to 40%). There were no bleeding complications and no patient died. Patients enrolled in our study had fewer coronary thrombi at angiography than currently reported. Our data did not show that adjunct treatment with streptokinase and heparin is superior to conventional treatment alone in these patients.
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Affiliation(s)
- G Steffenino
- Institute of Cardiovascular Medicine and Surgery, University of Turin, Italy
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Caruzzo C, Liboni W, Sechi A, Bonzano A, Bobbio M, Scrocca I, Marengo C, Caruzzo E. [Comparison between Doppler CW and Duplex-Scanning in the assessment of silent peripheral vascular lesions in a population of ischemic heart disease patients]. Minerva Cardioangiol 1989; 37:269-72. [PMID: 2812444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A recent ultrasound technique, Duplex Scanning (D-S), endowed with significant sensitivity, specificity and accuracy has been used to screen atherosclerotic disease in subjects at risk. Within the context of a transverse investigation aimed at identifying the multi-district nature of atherosclerotic plaques, the sensitivity and specificity values and the concordance index of Doppler C.W. (D-CW) have been checked using the D-S in carotid districts as a reference test in 205 patients suffering from ischaemic cardiopathy, asymptomatic for carotid vasculopathy, aged between 45 and 55. 170 patients had the D-CW and the D-S in 340 carotid vessels. D-CW revealed atherosclerotic changes in 122 carotids (prevalence 36%) while the D-S in 119 districts (prevalence 35%) revealed plaques greater than simple thickening, of which 89 (26%) with stenosis less than 30% and 30 (9%) with stenosis greater than 30%. Of the latter, 25 were greater than 60% and 5 less than 60%: one of them provoked a stenosis greater than 75%, the limit beyond which the change becomes haemodynamically significant. D-CW showed 46% sensitivity, a specificity of 70% and a concordance percentage of 59% with respect to D-S. D-CW sensitivity proved apparently low as did the concordance percentage between C-CW and D-S. However, considering that the lesions encountered were prevalently all haemodynamically non-significant, these values may become acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Caruzzo C, Riba U, Gillio S, Sechi A, Bonzano A. [Correlations between risk factors and morphology of carotid atherosclerotic lesions studied with the Duplex-Scanner]. Minerva Cardioangiol 1986; 34:171-81. [PMID: 3523285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Riba U, Gillio S, Caruzzo C, Sechi A, Bonzano A. [Correlations between risk factors and atherosclerotic disease of the carotid arteries. Investigation with the Duplex scanner]. Minerva Cardioangiol 1986; 34:87-97. [PMID: 3520387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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