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IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/S2666-0873(24)00315-6

引用次数: 0

Cancer Survivors and Cardiovascular Risk: What Patients Should Know From the Perspective of Another Survivor 癌症幸存者与心血管风险：从另一位幸存者的角度看患者应知之事

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.08.002

Steven Petrow

引用次数: 0

Adiposity and Muscle Strength in Men With Prostate Cancer and Cardiovascular Outcomes 前列腺癌男性患者的脂肪含量和肌肉力量与心血管预后

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.011

Darryl P. Leong MBBS, MPH, MBiostat, PhD , Vincent Fradet MD, PhD , Tamim Niazi MD , Joseph B. Selvanayagam MBBS, DPhil , Robert Sabbagh MD, MSc , Celestia S. Higano MD , Steven Agapay BSc , Sumathy Rangarajan MSc , Rajibul Mian PhD , Carlos A.K. Nakashima MD, PhD , Negareh Mousavi MD , Ian Brown MD , Felipe H. Valle MD, PhD , Luke T. Lavallée MDCM, MSc , Bobby Shayegan MD , Kelvin K.H. Ng MBBS , Darin D. Gopaul MD , Germano D. Cavalli MD , Sonia Saavedra MD , Jose P. Lopez-Lopez MD , Jehonathan Pinthus MD, PhD

Background

There are limited data on the physical effects of androgen deprivation therapy (ADT) for prostate cancer (PC), and on the relationships of such measures of adiposity and strength to cardiovascular outcomes.

Objectives

The primary objective of this study was to evaluate the relationships of measures of adiposity and strength to cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, heart failure, arterial revascularization, peripheral arterial disease, and venous thromboembolism) in patients with PC. A secondary objective was to characterize the relationships between ADT use and 12-month changes in these physical measures.

Methods

This international, prospective cohort study included 3,967 patients with PC diagnosed in the prior 12 months or being treated with ADT for the first time. Median follow-up duration was 2.3 years.

Results

Participants’ mean age was 68.5 years, and 1,731 (43.6%) were exposed to ADT. ADT was associated with a 1.6% increase in weight, a 2.2% increase in waist circumference, a 1.6% increase in hip circumference, a 0.1% increase in waist-to-hip ratio, a 27.4% reduction in handgrip strength, and a 0.1% decrease in gait speed. High waist circumference and low handgrip strength were associated with adverse cardiovascular outcomes. Adjusting for age, education, race, tobacco and alcohol use, physical activity, cardiovascular disease, glomerular filtration rate, and ADT use, waist circumference above the highest quartile (110 cm) and handgrip strength below the lowest quartile (29.5 kg) were associated with higher likelihoods of a future cardiovascular event, with respective HRs of 1.40 (95% CI: 1.03-1.90; P = 0.029) and 1.59 (95% CI: 1.14-2.22; P = 0.006).

Conclusions

ADT was associated with increased adiposity and reduced strength over 12-month follow-up. High waist circumference and low baseline strength were associated with future adverse cardiovascular outcomes.

背景关于雄激素剥夺疗法（ADT）对前列腺癌（PC）患者的身体影响，以及这些脂肪和力量指标与心血管预后之间关系的数据十分有限。目标本研究的主要目标是评估PC患者的脂肪和力量指标与心血管预后（心血管死亡、心肌梗死、中风、心力衰竭、动脉血管再通、外周动脉疾病和静脉血栓栓塞）之间的关系。这项国际性前瞻性队列研究纳入了 3967 名在过去 12 个月内确诊为 PC 或首次接受 ADT 治疗的患者。结果参与者的平均年龄为68.5岁，其中1731人（43.6%）接受过ADT治疗。ADT与体重增加1.6%、腰围增加2.2%、臀围增加1.6%、腰臀比增加0.1%、手握力下降27.4%和步速下降0.1%有关。高腰围和低握力与不良心血管后果相关。在对年龄、教育程度、种族、吸烟和酗酒、体力活动、心血管疾病、肾小球滤过率和 ADT 使用情况进行调整后，腰围高于最高四分位数（110 厘米）和握力低于最低四分位数（29.结论在 12 个月的随访中，ADT 与肥胖增加和力量下降有关。高腰围和低基线力量与未来心血管不良后果有关。

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引用次数: 0

Carvedilol to Improve Cardiac Remodeling in Anthracycline-Exposed Childhood Cancer Survivors 卡维地洛改善受蒽环类药物影响的儿童癌症幸存者的心脏重塑状况

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.015

Saro H. Armenian DO, MPH , Melissa M. Hudson MD , Lanie Lindenfeld MA , Sitong Chen MS , Eric J. Chow MD, MPH , Steven Colan MD , Meagan Echevarria MPH , F. Lennie Wong PhD , Ming Hui Chen MD , Smita Bhatia MD, MPH

引用次数: 0

Cardiovascular Considerations Before Cancer Therapy 癌症治疗前的心血管注意事项

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.017

Zahra Raisi-Estabragh MBChB, PhD , Alexandra C. Murphy MBBS, PhD , Sivatharshini Ramalingam MBBS , Marielle Scherrer-Crosbie MD, PhD , Teresa Lopez-Fernandez MD , Kerry L. Reynolds MD , Marianne Aznar PhD , Amy E. Lin MD, PhD , Peter Libby MD , Raul Cordoba MD, PhD , Christine Bredsen-Masley MD, PhD , Ashu Wechalekar MBBS, MD , Jane Apperley MBBS, MD , Richard K. Cheng MD, MSc , Charlotte H. Manisty MBBS, PhD

Baseline cardiovascular assessment before the initiation of potentially cardiotoxic cancer therapies is a key component of cardio-oncology, aiming to reduce cardiovascular complications and morbidity in patients and survivors. Recent clinical practice guidelines provide both general and cancer therapy–specific recommendations for baseline cardiovascular toxicity risk assessment and management, including the use of dedicated risk scores, cardiovascular imaging, and biomarker testing. However, the value of such interventions in altering disease trajectories has not been established, with many recommendations based on expert opinion or Level of Evidence: C, studies with a potential for high risk of bias. Advances in understanding underlying mechanisms of cardiotoxicity and the increased availability of genetic and immunologic profiling present new opportunities for personalized risk assessment. This paper evaluates the existing evidence on cardiovascular care of cancer patients before cardiotoxic cancer therapy and highlights gaps in evidence and priorities for future research.

在开始使用具有潜在心脏毒性的癌症疗法之前进行基线心血管评估是心脏肿瘤学的一个关键组成部分，其目的是减少患者和幸存者的心血管并发症和发病率。最近的临床实践指南为心血管毒性基线风险评估和管理提供了一般建议和针对特定癌症疗法的建议，包括使用专门的风险评分、心血管成像和生物标志物检测。然而，这些干预措施在改变疾病轨迹方面的价值尚未得到证实，许多建议都是基于专家意见或证据等级：C，即可能存在高偏倚风险的研究。随着人们对心脏毒性潜在机制认识的不断深入，以及基因和免疫分析技术的日益普及，为个性化风险评估带来了新的机遇。本文评估了癌症患者在接受心脏毒性癌症治疗前进行心血管护理的现有证据，并强调了证据差距和未来研究的重点。

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引用次数: 0

Prognosis After Withdrawal of Cardioprotective Therapy in Patients With Improved Cancer Therapeutics–Related Cardiac Dysfunction 癌症治疗相关心功能障碍改善患者停用心脏保护疗法后的预后情况

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.018

Hyukjin Park MD , Nuri Lee MD , Cho Hee Hwang MPH , Sang-Geon Cho MD , Ga Hui Choi MD , Jae Yeong Cho MD , Hyun Ju Yoon MD , Kye Hun Kim MD , Youngkeun Ahn MD

Background

The long-term prognosis after the discontinuation of cardioprotective therapy (CPT) in patients with cancer therapeutics–related cardiac dysfunction (CTRCD) that has shown improvement remains unclear.

Objectives

This study aims to assess the prognosis after CPT withdrawal in patients exhibiting improved CTRCD.

Methods

In this retrospective analysis of a single-center prospective cohort study, patients with improved CTRCD, defined as an increase in left ventricular ejection fraction (LVEF) ≥10 percentage points from the time of CTRCD diagnosis, were included. We analyzed their clinical outcomes, which included hospitalization for heart failure or a decrease in LVEF ≥10 percentage points within 2 years after CTRCD improvement, alongside echocardiographic changes.

Results

The cohort comprised 134 patients with improved CTRCD. The median follow-up duration after CTRCD diagnosis was 368.3 days (Q1-Q3: 160-536 days). After improvement, 90 patients continued CPT (continued group [CG]) and 44 withdrew CPT (withdrawn group [WG]). Among patients whose baseline LVEF at CTRCD diagnosis ranged from 45% to 55%, the final mean LVEF was comparable between both groups (CG: 64.9% ± 4.4% vs WG: 62.9% ± 4.2%; P = 0.059). However, for patients with a baseline LVEF <45%, the final mean LVEF was significantly lower in the WG (CG: 53.3% ± 6.4% vs WG: 48.2% ± 6.9%; P < 0.001). The occurrence of composite major clinical events was notably higher in the WG (HR: 3.06; 95% CI: 1.51-7.73; P = 0.002).

Conclusions

Patients who withdrew CPT after demonstrating improvement in CTRCD experienced worse clinical outcomes. Notably, a significant decrease in LVEF was observed after CPT withdrawal in patients with a baseline LVEF <45%.

背景癌症治疗相关心功能不全（CTRCD）患者停用心脏保护疗法（CPT）后的长期预后仍不明确。目的本研究旨在评估CTRCD改善患者停用CPT后的预后。方法在这项对单中心前瞻性队列研究的回顾性分析中，纳入了 CTRCD 改善的患者（定义为左室射血分数（LVEF）比 CTRCD 诊断时增加≥10 个百分点）。我们对他们的临床结果进行了分析，其中包括因心力衰竭住院或 CTRCD 改善后 2 年内 LVEF 下降≥10 个百分点，以及超声心动图的变化。CTRCD 诊断后的中位随访时间为 368.3 天（Q1-Q3：160-536 天）。病情好转后，90 名患者继续接受 CPT 治疗（继续治疗组 [CG]），44 名患者退出 CPT 治疗（退出治疗组 [WG]）。在确诊 CTRCD 时基线 LVEF 为 45% 至 55% 的患者中，两组的最终平均 LVEF 相当（CG：64.9% ± 4.4% vs WG：62.9% ± 4.2%；P = 0.059）。然而，对于基线 LVEF 为 45% 的患者，WG 组的最终平均 LVEF 明显较低（CG：53.3% ± 6.4% vs WG：48.2% ± 6.9%；P <0.001）。WG发生复合主要临床事件的比例明显更高（HR：3.06；95% CI：1.51-7.73；P = 0.002）。值得注意的是，基线 LVEF 为 45% 的患者在停用 CPT 后 LVEF 明显下降。

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引用次数: 0

Priorities in Cardio-Oncology 心脏肿瘤学的优先事项

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.09.002

Bonnie Ky MD, MSCE, FACC

引用次数: 0

Guiding Treatment With Recovered CTRCD 指导已康复的 CTRCD 治疗

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.09.003

Brian P. Halliday MBChB, PhD , Muhummad Sohaib Nazir MBBS, PhD

引用次数: 0

Epigenomics of Cardio-Oncology 心脏肿瘤表观基因组学

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.013

Brian T. Joyce PhD

引用次数: 0

Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes for Preclinical Cardiotoxicity Screening in Cardio-Oncology 用于心肿瘤临床前心脏毒性筛选的人类诱导多能干细胞衍生心肌细胞

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-10-01 DOI: 10.1016/j.jaccao.2024.07.012

Kyle D. Shead MRes, Eline Huethorst PhD, Francis Burton PhD, Ninian N. Lang MBChB, PhD, Rachel C. Myles MBChB, PhD, Godfrey L. Smith PhD

引用次数: 0

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