1
|
Solomou E, Ioakimidis N, Terentes-Printzios D, Koutagiar I, Pouli A, Sioni A, Giannouli S, Kafouris P, Metaxas M, Kalikakis G, Aggeli K, Tousoulis D, Tsioufis K, Anagnostopoulos CD, Vlachopoulos C. Arterial stiffness improves with effective chemotherapy in patients with lymphoma. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2884] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Arterial stiffness independently predicts cardiovascular risk and has been associated with the presence of inflammation. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. There is extensive literature describing the cardiotoxic effects of anti-cancer treatment on left ventricular systolic function, that may be the result of direct effects of the cancer treatment on heart function, or due to an indirect acceleration of atherosclerosis. However there is only little evidence regarding chemotherapy effects on arterial elastic properties. The gold standard for measuring arterial stiffness is carotid femoral pulse wave velocity (cfPWV) and it is calculated as a function of transit time and distance of the pulse wave derived from the carotid and femoral arteries.
Purpose
Our aim was to investigate the effect of chemotherapy in aortic stiffness in patients with lymphoma, a malignancy with known high metabolic burden.
Methods
Sixty-six patients (22 male, mean age 56 years) with Hodgkin (n=34) or non-Hodgkin lymphoma (n=32) were enrolled in the study. Patients with Hodgkin Lymphoma underwent therapy with Doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD). The interim of their treatment was set at 1 to 3 days prior to initiating the 3rd chemotherapy cycle. Patients with non Hodgkin Lymphoma underwent therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone+rituximab (R-CHOP). Blood pressure (BP) and carotid-femoral pulse wave velocity (c-f PWV) were measured at baseline, interim and after completion of chemotherapy.
Results
Changes in systolic and diastolic BP from baseline, to interim phase and 6 weeks post therapy were insignificant (decrease by 3.87±1.37 mmHg p-0.277 and 3.05±0.92 mmHg p-0.422 respectively). Figure illustrates c-f PWV changes from baseline to interim and 6 weeks after completion of chemotherapy. As figure shows, c-f PWV progressively decreased at the interim phase and at 6–8 weeks after chemotherapy completion (by 0.37±0.14 m/s), (overall P-0.010, by ANOVA) The progressive decrease in c-f PWV remained statistically significant after adjustment for age, systolic BP and diabetes (F=5.173, P-0.009). Patients' baseline characteristics are demonstrated in table 1.
Conclusion
Carotid-Femoral PWV decreased at 6–8 weeks post chemotherapy in patients with lymphoma, suggesting that aortic elastic properties improve with chemotherapy in these patients. Considering that aortic stiffness increases due to systemic inflammation and that lymphomas are increased metabolic burden tumors, the significant improvement in arterial stiffness implies that the presence of inflammation caused by the malignancy may play a significant role in the arterial stiffness progression.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- E Solomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - N Ioakimidis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Terentes-Printzios
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - I Koutagiar
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - A Pouli
- Agios Savvas General Oncology Hospital, Athens, Greece
| | - A Sioni
- Agios Savvas General Oncology Hospital, Athens, Greece
| | - S Giannouli
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - P Kafouris
- Academy of Athens Biomedical Research Foundation, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundatio, Athens, Greece
| | - M Metaxas
- Academy of Athens Biomedical Research Foundation, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundatio, Athens, Greece
| | - G Kalikakis
- Academy of Athens Biomedical Research Foundation, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundatio, Athens, Greece
| | - K Aggeli
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - C D Anagnostopoulos
- Academy of Athens Biomedical Research Foundation, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundatio, Athens, Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
2
|
Daraki V, Koukouraki S, Velegrakis G, Mamalaki E, Haniotis VT, Kalikakis G, Stathaki MI, Karkavitsas N, Papavasiliou SS. Rare presentation of occult medullary carcinoma of the thyroid as a mediastinal mass. Hormones (Athens) 2012; 11:210-4. [PMID: 22801569 DOI: 10.14310/horm.2002.1350] [Citation(s) in RCA: 2] [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: 11/20/2022]
Abstract
OBJECTIVE To describe a rare case of occult (<1 cm in diameter) medullary thyroid carcinoma (MTC) in a 45-year-old woman, presenting as an asymptomatic mediastinal mass. DESIGN The diagnostic methodology included laboratory measurements of relevant biochemical and hormonal parameters including calcitonin (CT), carcinoembryonic antigen (CEA) and chromogranin A, and imaging techniques including ultrasound (U/S), computed tomography (C/T), magnetic resonance imaging (MRI) and radio labeled somatostatin analog ((111)In-DTPA-octreotide). RESULTS Chest CT revealed a mediastinal mass measuring 5 cm in diameter abutting the right thyroid lobe. CEA was elevated and an association with thyroid malignancies was considered. CT was found to be markedly elevated, pointing to the diagnosis of MTC metastatic to the mediastinum. The patient underwent total thyroidectomy, lymph node dissection and removal of the mediastinal mass. Histological examination revealed MTC of the right thyroid lobe measuring 0.5 cm, metastatic to regional and superior mediastinal lymph nodes. CONCLUSIONS Occult MTC can infrequently present as an asymptomatic mediastinal mass. Elevated serum CT and CEA along with imaging techniques leads to the correct diagnosis and surgical management of the disease.
Collapse
Affiliation(s)
- Vasiliki Daraki
- Department of Endocrinology, Diabetes Mellitus and Metabolic Disorders, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|