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Galan C, Vilchez-Tschischke JP, Lobo-Gonzalez M, Lopez GJ, Gavilan M, De Molina-Iracheta A, Perez-Martinez C, Villena-Gutierrez R, Oliver E, Fernandez-Jimenez R, Pizarro G, Fuster V, Sanchez-Gonzalez J, Ibanez B. P3108Microcirculation injury is involved in anthracycline-induced cardiac toxicity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0183] [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: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Cardiotoxicity (CT) is a major concern for cancer patients receiving anthracyclines. While the effect of anthracyclines on cardiomyocytes is well established, its impact on myocardial microcirculation has not been characterized.
Purpose
To evaluate the effect of low and high cumulative doses of doxorubicin (doxo) on anatomical and functional vasculature status evaluated by serial invasive Coronary Flow Reserve (CFR) and Cardiac Magnetic Resonance (CMR)-based quantitative perfusion in a large animal model.
Methods
Large-white male pigs (n=15, 30 kg) were distributed in 2 doxo regimes: Group 1) high cumulative dose (5 biweekly intracoronary (i.c) injections of 0.45 mg/kg of doxo) followed-up until week 16 (a time when severe left ventricular systolic dysfunction is present) and then sacrificed (N=5); Group 2) low cumulative dose of doxo (3 biweekly i.c. doses) followed-up until week 16 and then sacrificed (N=5)). Group 3) pigs sacrificed at 6 weeks (2 weeks after third doxo dose), N=5. Invasive catheter-based CFR was evaluated after i.c papaverine (0.5 mg/kg) while CMR quantitative rest perfusion maps were obtained after intravenous injection of gadolinium. CFR and CMR were performed before doxo, and at 0, 2, 4, 6 and 16 weeks thereafter. Cardiac vessels were evaluated ex vivo with trichrome staining. Statistical analysis was performed using one-way ANOVA with multiple pairwise comparisons (vs. baseline) and Bonferroni corrected p-value.
Results
CFR and CMR-quantitative myocardial perfusion were non-significantly reduced after 3 doxo doses despite myocardial vasculature was overtly injured on histology at this timepoint. Animals receiving 5 doxo doses suffered a progressive deterioration of CFR and CMR-perfusion until week 16 (1.41±0.23 vs 3.71±0.94 at baseline [p=0.014] and 65.4±18.2 ml/100g/min vs 154.9±56.3 ml/100g/min at baseline [p=0.046], respectively). At 16 weeks histology revealed extensive microvascular damage with media layer involvement and perivascular fibrosis. Pigs receiving 3 doxo doses showed less pronounced CFR reduction on long-term follow-up (3.13±0.82 vs 3.69±1.57 at baseline [p>0.05] but overt CMR-perfusion reduction (138.3±11.9 vs 197.8±37.1 at baseline [p=0.045]). On histology, damage of vasculature including arterioles was evidenced to a lesser extent than in the high cumulative doxo dose group with mild microvascular disruption and smooth muscle vacuolization.
Conclusions
Doxorubicin results in a progressive damage of the myocardial microcirculation. Even low cumulative doxo doses (resulting in no overt left ventricular dysfunction) results in vascular damage. The microcirculation status may serve as an early marker of doxorubicin cardiotoxicity.
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Affiliation(s)
- C Galan
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J P Vilchez-Tschischke
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - M Lobo-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - G J Lopez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - M Gavilan
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - A De Molina-Iracheta
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - C Perez-Martinez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - R Villena-Gutierrez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - E Oliver
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - R Fernandez-Jimenez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - G Pizarro
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - V Fuster
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J Sanchez-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
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Lobo Gonzalez M, Galan Arriola C, Vilchez-Tschischke JP, Lopez GJ, Gavilan-Santiago M, Fernandez-Jimenez R, Pizarro GJ, Sanchez-Gonzalez JP, Ibanez B. P6423Cardioprotective effect of metoprolol in myocardial ischemic/reperfusion injury: the role of total ischemic time. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1017] [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: 11/13/2022] Open
Abstract
Abstract
Background
Metoprolol administration before reperfusion has shown relevant cardioprotective effect in the AMI in preclinical setting. However, the translation to clinical arena has controversial results. The time at drug administration in the context of total duration of ischemia have been pointed as fundamental aspects to be studied.
Purpose
evaluate the cardioprotective effect of metoprolol administration regarding to the total time of ischemia, using a swine model of reperfused AMI.
Methods
50 pigs were subjected to 3 temporary protocols of left anterior descending (LAD) coronary artery occlusion followed by reperfusion. 30 pigs undergoing 40 minutes of ischemia (T40) were randomized 2:1 to intravenous placebo or metoprolol administrated 20 minutes after LAD occlusion.10 pigs undergoing 20 minutes of ischemia 20 (T20) and 10 pig undergoing 60 minutes of ischemia 60 (T60) were randomized 1:1 to intravenous placebo or metoprolol. Before reperfusion a CT study was performed to stablish the area at risk (AAR). CMR was performed at 7 and 45 days after AMI.
Results
48 subjects comprised the 7-day CMR follow-up (1 dead in the metoprolol T40,1 dead in the placebo T40) while 41 subjects comprised the 45-day CMR follow-up (5 deceases in the placebo T40 group, and 2 in the placebo T60 group). AAR was similar among groups (Table 1, Panel B). At 7-day follow-up, IS washigher in the placebo groups as compared to the metoprolol groups, but only reach significant difference in the T40 (29,67% vs. 22,85%, p=0.04, Table 1, Panel A). LVEF measured at 45-day follow-up was higher in the metoprolol groups vs the control groups, but the differences were statistically significance in the T40 (32,76% vs 39,68% p=0.04, Panel C).
Table 1 20 mins. Ischemia (T20) 40 mins. Ischemia (T40) 60 mins. Ischemia (T60) P PLACEBO METOPROL P value PLACEBO METOPROL P value PLACEBO METOPROL P value AAR 32 (28.14–37.89) 33.41 (28.12–38.32) 0.82 32.99 (29.25–35.83) 31.42 (26.94–37.83) 0.72 33.28 (29.68–41.14) 33.93 (28.17–40.69) 0.80 0.98 IS 1.96 (0.92–3.61) 0 (0–0.65) 0.063 29.67 (27.23–35.35) 22.85 (14.53–28.10) 0.042 36.21 (33.55–40.91) 33.78 (39.36–35.39) 0.31 <0.001 LVEF 54.36 (49.75–58.97) 55.34 (53.14–60.88) 0.66 32.76 (26.91–36.10) 39.68 (35.45–45.28) 0.023 26.13 (22.40–31.25) 32.99 (31.32–35.19) 0.071 <0.001 Values are median (interquartile range). Bold indicates statistical significance. AAR = Area at Risk (% of Left ventricular). IS = Infartc Size (% of Left ventricular). LVEF = Left ventricular ejection fraction (%).
Conclusions
Metoprolol administrated early before reperfusion reduced IS and improved medium-term LVEF compared to placebo. But only T40 receiving metoprolol shownsignificant protection vs placebo. These findings suggest a relevant effect of metoprolol ischemic/reperfusion injury, but depending on the total ischemic time, establishing a potential temporary cardioprotection opportunity window.
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Affiliation(s)
- M Lobo Gonzalez
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | - C Galan Arriola
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | | | - G J Lopez
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | | | | | - G J Pizarro
- Complejo Hospitalario Ruben Juan Bravo, Servicio de Cardiologia, Madrid, Spain
| | | | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
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Lopez Ayala P, Rossello X, Fernandez-Jimenez R, Oliver E, Galan C, De Molina-Iracheta A, Aguero J, Lopez G, Lobo-Gonzalez M, Vilchez-Tschischke JP, Fuster V, Sanchez-Gonzalez J, Ibanez B. 23Quantification of post-reperfusion intramyocardial haemorrhage with cardiac magnetic resonance imaging in an ischemia/reperfusion pig model: T2* vs R2* vs R2". Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez111.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Lopez Ayala
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - X Rossello
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - R Fernandez-Jimenez
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - E Oliver
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - C Galan
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - A De Molina-Iracheta
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - J Aguero
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - G Lopez
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - M Lobo-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - J P Vilchez-Tschischke
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - V Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Ican School of Medicine at Mount Sinai, New York, United States of America
| | - J Sanchez-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
| | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Translational Laboratory for Cardiovascular Imaging and Therapy, Madrid, Spain
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Galan C, Ayaon-Albarran A, Lopez-Martin GJ, Lobo-Gonzalez M, Vilchez-Tschischke JP, Sanchez-Gonzalez J, Oliver E, Pizarro G, Aguero J, Fernandez-Jimenez R, Blazquez-Gonzalez JA, Fuster V, Ibanez B. P2784Anthracycline cardiotoxicity in the hypertrophic heart: testing a dual-hit hypothesis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Galan
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - A Ayaon-Albarran
- University Hospital La Paz, Adult Cardiac Surgery Department, Madrid, Spain
| | - G J Lopez-Martin
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - M Lobo-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J P Vilchez-Tschischke
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J Sanchez-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - E Oliver
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - G Pizarro
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J Aguero
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - R Fernandez-Jimenez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | | | - V Fuster
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
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Galan C, Lobo-Gonzalez M, Vilchez-Tschischke JP, Sanchez-Gonzalez J, Lopez-Martin GJ, Gavilan M, Oliver E, Pizarro G, Aguero J, Fernandez-Jimenez R, Fuster V, Ibanez B. P2785Early microcirculation impairment in a pig model of anthracycline cardiotoxicity: evaluation by cardiac magnetic resonance and coronary physiology assessment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Galan
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - M Lobo-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J P Vilchez-Tschischke
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J Sanchez-Gonzalez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - G J Lopez-Martin
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - M Gavilan
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - E Oliver
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - G Pizarro
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - J Aguero
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - R Fernandez-Jimenez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - V Fuster
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
| | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Myocardial Pathophysiology Departament, Madrid, Spain
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