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Zatarain-Nicolas E, Perez-Ramirez S, De Castro J, Martin-Garcia A, Del Barco E, Mesa Rubio D, De La Haba J, Martinez Monzonis MA, Aguin Losada S, Lozano Palencia T, Martinez-Banaclocha N, Gomez-Rubin MC, Cortez-Castedo P, Martin P, Lopez-Fernandez T. Basal characteristics of the prospective spanish immunotherapy registry of cardiovascular toxicity: SIR-CVT. Eur Heart J 2022. [PMCID: PMC9619683 DOI: 10.1093/eurheartj/ehac544.2586] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The immune checkpoint inhibitors (ICI) have improved the prognosis of many cancers in the last years but concerning cardiovascular toxicity (CVtox) have been reported. Nowadays, specific surveillance protocols are lacking, and early diagnosis of toxicity may be challenging. Purpose To characterize the cardiovascular (CV) effects of immunotherapy and to seek for the mechanisms of CVtox of ICI in a protocolize surveillance program of cardio-oncology. Methods A multicentre national registry was developed by a research consortium of scientific societies of Cardiology and Oncology (SEC and SEOM) and the cardiovascular research centre (CNIC) in Spain (Figure 1). A total of 18 hospitals participate in recruiting since Q4 2021. A follow-up protocol was stablished with clinical, electrocardiographic (EKG), echocardiography, cardiac magnetic resonance (CMR) and laboratory assessment, including cardiac biomarkers, inflammatory panel and the expression of miR-721, a specific myocarditis biomarker. Toxicity management is performed at each institution following international guidelines. Results 53 patients were currently included. Median age was 68 [59, 75] years-old, 79% were male. 83% had at least 1 CV-risk factor (75% smoking history, 20% diabetes mellitus, 50% hyperlipemia, 57% hypertension, 19% chronic kidney injury) and up to34% had previous CV disease. 93% had at least one dose of COVID19 vaccine. Dyspnoea was referred by 23% of patients, 28% have abnormal EKG findings and one-third (33%) abnormal cardiac biomarkers (median Troponin I-hs 5.30 [2.60, 11.00]; NT-proBNP 199 [68, 736]). Mean LVEF (60% [56.15, 66.78]) and GLS (−18 [−19.75, −16]) were within the normal range but 26% showed LGE at baseline. Cancer characteristics are summarized in Table 1. Conclusion Real-world SIR-CVT patients show a high CV risk profile and frequent pre-existing CV diseases before ICI treatment. The prospective follow-up of this cohort will help to develop personalized surveillance protocols according to baseline CVtox risk and to define different grades of cardiotoxicity. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- E Zatarain-Nicolas
- University Hospital Gregorio Maranon, Cardiology department, CIBER-CV. , Madrid , Spain
| | - S Perez-Ramirez
- University Hospital Gregorio Maranon, Medical Oncology , Madrid , Spain
| | - J De Castro
- University Hospital La Paz, Medical Oncology , Madrid , Spain
| | - A Martin-Garcia
- University Hospital of Salamanca, Cardiology Department. IBSAL, CIBER-CV, USAL , Salamanca , Spain
| | - E Del Barco
- University Hospital of Salamanca, Medical Oncology , Salamanca , Spain
| | - D Mesa Rubio
- University Hospital Reina Sofia, Cardiology Department, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) , Cordoba , Spain
| | - J De La Haba
- University Hospital Reina Sofia, Medical Oncology , Cordoba , Spain
| | - M A Martinez Monzonis
- University Hospital of Santiago de Compostela, Cardiology Department , Santiago de Compostela , Spain
| | - S Aguin Losada
- University Hospital of Santiago de Compostela, Medical Oncology , Santiago de Compostela , Spain
| | - T Lozano Palencia
- “Doctor Balmis” General University Hospital, Cardiology Department , Alicante , Spain
| | - N Martinez-Banaclocha
- Dr. Balmis General University Hospital, Medical Oncology Department, Institute for Health and Biomedical Research (ISABIAL) , Alicante , Spain
| | | | | | - P Martin
- National Centre for Cardiovascular Research (CNIC), Vascular Pathophysiology Area , Madrid , Spain
| | - T Lopez-Fernandez
- La Paz University Hospital, Cardiology Department, IdiPAZ Research Institute , Madrid , Spain
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Nunez Martinez L, V-Ibarra N, Marin Ortuno F, Pernias Escrig V, Sandin Rollan M, Carrillo Aleman L, Candela Sanchez E, Lozano Palencia T, Esteve-Pastor MA, Orenes Pinero E, Rivera-Caravaca JM, Morillas Blasco P, Ruiz-Nodar JM. P3606Impact of diabetes mellitus on the selection of antiplatelet treatment and medium-term prognosis after acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0465] [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
Patients with diabetes mellitus (DM) have a higher atherothrombotic risk and higher rates of recurrent ischemic events compared with the non-diabetic population. Although current antiplatelet therapy strategies have been shown to be successful in improving outcomes in acute coronary syndrome (ACS), patients with DM continue to experience high rates of adverse cardiovascular events. Today, it is known that diabetic patients are characterized by a deregulation in different intracellular signaling pathways, which leads to an inadequate or suboptimal response to antiplatelets agents. The purpose of this study is to analyze the different therapeutic strategies, the use of new antiplatelet drugs and medium-term prognosis in diabetic patients compared with non-diabetic patients who have suffered an ACS.
Methods
It is an observational, prospective and multicenter registry of patients with ACS. The objective is to analyze the differences in the management of DM patients vs non-DM patients in the acute phase and their evolution during the first year after coronary event. Antiplatelet therapy administered will be evaluated, type of coronary injury and treatment performed, major adverse events as well as cardiovascular complications and mortality at one year of follow-up.
Results
Of a total of 1717 patients, 38% were diabetic. The diabetic population was older, with a higher prevalence of cardiovascular risk factors and higher rate of previous cardiovascular events (cerebrovascular, peripheral arterial disease and coronary disease). Patients with DM received less new antiplatelets drugs at admission (15.5% DM vs 26.5% non DM, p<0.001) and less in-hospital switch to new antiplatelet agents was performed. They were subjected to a lower number of catheterizations and at the time of revascularization, the drug-eluting stent was of choice. During admission, they developed more complications, both ischemic (refractory angina, reinfarction or CVA) and hemorrhagic. Following one year, DM had higher major cardiovascular events (MACE) and higher mortality (7.72% vs 5.14%, p=0.0039). Non-coronary revascularization, renal failure, and reduced ejection fraction were predictive variables of death in diabetic population. Treatment with new antiplatelet drugs was associated with a statistically significant decrease in total mortality an MACE without differences in major bleeding.
Conclusion
More than a third of patients with ACS are diabetic. These patients present with more severe coronary disease associating a greater number of cardiovascular events and a higher mortality rate after one year of ACS. However, despite this, they undergo less invasive tests and they were undertreated with the new antiplatelets therapies.
Acknowledgement/Funding
SEC
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Affiliation(s)
| | - N V-Ibarra
- General University Hospital of Elche, Cardiologia, Elche, Spain
| | | | | | - M Sandin Rollan
- General University Hospital of Alicante, Cardiologia, Alicante, Spain
| | - L Carrillo Aleman
- General University Hospital of Alicante, Cardiologia, Alicante, Spain
| | - E Candela Sanchez
- General University Hospital of Alicante, Cardiologia, Alicante, Spain
| | - T Lozano Palencia
- General University Hospital of Alicante, Cardiologia, Alicante, Spain
| | | | | | | | | | - J M Ruiz-Nodar
- General University Hospital of Alicante, Cardiologia, Alicante, Spain
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