Jacc: Cardiooncology最新文献

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Cardiac Safety of Reduced Cardiotoxicity Surveillance During HER2-Targeted Therapy her2靶向治疗期间降低心脏毒性监测的心脏安全性

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-06-01 DOI: 10.1016/j.jaccao.2025.05.006

Anthony F. Yu MD, MS , Chau T. Dang MD , Chaya S. Moskowitz PhD , Akriti Mishra Meza MS , Patricia DeFusco MD , Eric Oligino MD , Carol L. Chen MD , Rachel Sanford MD , Pamela Drullinsky MD , Jacqueline Bromberg MD, PhD , Serena Wong MD , Shanu Modi MD , Justine Jorgensen BS , Kevin C. Oeffinger MD , Richard M. Steingart MD , Jennifer E. Liu MD

Background

Echocardiograms are recommended every 3 months to monitor for cancer therapy–related cardiac dysfunction (CTRCD) among patients treated with HER2-targeted therapy, despite increasing use of safer regimens associated with low CTRCD risk.

Objectives

This study evaluated the cardiac safety of reduced CTRCD surveillance performed every 6 months during non-anthracycline HER2-targeted treatment.

Methods

This non-randomized clinical trial enrolled 190 patients with HER2-positive breast cancer treated with non-anthracycline HER2-targeted therapy. CTRCD surveillance by means of echocardiography was performed every 6 months. Key exclusion criteria were previous anthracycline exposure, significant cardiovascular disease, and uncontrolled hypertension. The primary outcome was the cardiac event rate, defined by heart failure or cardiovascular death at 1 year. Secondary outcomes included change in LVEF from baseline to 6 months and 1 year, incidence of asymptomatic CTRCD, incidence of HER2-targeted treatment interruption, and feasibility of reduced cardiac surveillance.

Results

The median age was 52 years (Q1-Q3: 45-60 years); 174 (91.6%) had stage I-III disease, and all were treated with a trastuzumab-based regimen. Cardiovascular risk factors included hypertension (20.0%) and diabetes (4.2%), and the mean left ventricular ejection fraction at baseline was 63.6 ± SE 0.3%. There were 0 (0%; 1-sided 97.5% CI: 0%-1.9%) cardiac events with a median follow-up of 17.5 months (Q1-Q3: 16.3-18.9 months). One patient developed asymptomatic CTRCD (0.5%; 95% CI: 0.01%-2.9%) but resumed therapy after a temporary treatment interruption. Adherence to the reduced CTRCD surveillance schedule every 6 months was 73.2% (intention-to-treat) and 79.9% (per-protocol).

Conclusions

Reduced CTRCD surveillance every 6 months is safe and feasible for patients at low risk for CTRCD and may be an appropriate strategy to consider during non-anthracycline HER2-targeted treatment regimens.

背景：在接受her2靶向治疗的患者中，尽管越来越多地使用与低CTRCD风险相关的更安全的方案，但建议每3个月进行一次超声心动图检查，以监测癌症治疗相关的心功能障碍（CTRCD）。目的：本研究评估在非蒽环类her2靶向治疗期间每6个月进行一次降低CTRCD监测的心脏安全性。方法本非随机临床试验纳入190例her2阳性乳腺癌患者，接受非蒽环类her2靶向治疗。超声心动图监测CTRCD每6个月一次。主要的排除标准是既往的蒽环类药物暴露、明显的心血管疾病和未控制的高血压。主要终点是心脏事件发生率，定义为心力衰竭或心血管死亡1年。次要结局包括LVEF从基线到6个月和1年的变化，无症状CTRCD的发生率，her2靶向治疗中断的发生率，以及降低心脏监测的可行性。结果中位年龄52岁（Q1-Q3: 45-60岁）；174例（91.6%）为I-III期疾病，所有患者均接受基于曲妥珠单抗的治疗方案。心血管危险因素包括高血压（20.0%）和糖尿病（4.2%），基线时平均左室射血分数为63.6±SE 0.3%。0 (0%；单侧97.5% CI: 0%-1.9%)，中位随访时间为17.5个月（Q1-Q3: 16.3-18.9个月）。1例患者出现无症状CTRCD (0.5%；95% CI: 0.01%-2.9%)，但在短暂治疗中断后恢复治疗。每6个月减少CTRCD监测计划的依从性为73.2%（意向治疗）和79.9%（每个方案）。结论减少每6个月的CTRCD监测对低风险CTRCD患者是安全可行的，可能是在非蒽环类her2靶向治疗方案中考虑的适当策略。

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引用次数: 0

Lung Cancer and Cardiovascular Disease 肺癌和心血管疾病

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-06-01 DOI: 10.1016/j.jaccao.2025.05.003

Malak El-Rayes MD , Inbar Nardi Agmon MD, MPH , Christopher Yu MBBS, PhD , Nichanan Osataphan MD, PhD , Helena A. Yu MD , Andrew Hope MD , Adrian Sacher MD , Anthony F. Yu MD, MS , Husam Abdel-Qadir MD, PhD , Paaladinesh Thavendiranathan MD, SM

Among patients with cancer, those with lung cancer have the highest prevalence of pre-existing cardiovascular disease (CVD) and the highest risk of cardiovascular events postdiagnosis. This is driven by shared risk factors, particularly smoking and socioeconomic factors, and common biology. Furthermore, multimodality therapies for lung cancer, including surgery, radiation, chemotherapy, immunotherapy, and targeted therapy, are associated with CVD. Improvements in prevention, screening, and therapy for lung cancer have led to improved cancer survival, increasing the relevance of CVD for overall survival and quality of life. This review provides an overview of lung cancer and its treatment and discusses drivers of CVD, risk assessment, surveillance, prevention, and treatment strategies.

在癌症患者中，肺癌患者既往心血管疾病（CVD）患病率最高，诊断后心血管事件风险最高。这是由共同的风险因素驱动的，特别是吸烟和社会经济因素，以及共同的生物学。此外，肺癌的多模式治疗，包括手术、放疗、化疗、免疫治疗和靶向治疗，都与CVD有关。肺癌的预防、筛查和治疗的改进提高了癌症生存率，增加了心血管疾病与总体生存率和生活质量的相关性。本文综述了肺癌及其治疗，并讨论了CVD的驱动因素、风险评估、监测、预防和治疗策略。

引用次数: 0

Expanding Perspectives on Physical Activity and Cardiovascular Risk in Cancer Survivors 癌症幸存者的身体活动和心血管风险的扩展视角

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.01.013

Fan Zhang MD, Wenlong Yu MD, Mengchen Yin PhD

引用次数: 0

Quality-of-Care Measures for Cardio-Oncology 心脏肿瘤学的护理质量测量

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2024.11.003

Vijay U. Rao MD, PhD , Anita Deswal MD, MPH , Daniel Lenihan MD , Susan Dent MD , Teresa Lopez-Fernandez MD , Alexander R. Lyon MD , Ana Barac MD, PhD , Nicolas Palaskas MD , Ming Hui Chen MD, MMSc , Hector R. Villarraga MD , Diego Sadler MD , Courtney M. Campbell MD, PhD , Kerry Skurka RN, BSN , Matt J. Wagner , Matthias Totzeck MD, PhD , Kathryn J. Ruddy MD, MPH , Paul Heidenreich MD , Randal Thomas MD , Daniel Addison MD , Sarju Ganatra MD , Joerg Herrmann MD

This document serves as a perspective on quality assessments in the discipline of cardio-oncology. We aim to define the current landscape, identify needs for quality and outcome improvements, and propose a roadmap for establishing viable metrics to improve patient care. Specifically, this document: 1) addresses the current lack of measurable high-quality metrics in cardio-oncology and their implications; 2) highlights needs and topic-specific barriers; 3) illustrates the process and application of a measurable quality metric; and 4) provides a framework to demonstrate measurable value for the growing population of patients with cancer and cardiovascular diseases.

本文件是对心脏肿瘤学科质量评估的透视。我们旨在定义当前的状况，确定对质量和结果改进的需求，并提出建立可行指标的路线图，以改善患者护理。具体来说，本文件1）探讨目前心肿瘤学缺乏可衡量的高质量指标及其影响；2）强调需求和特定主题的障碍；3）说明可衡量质量指标的过程和应用；以及 4）提供一个框架，为日益增多的癌症和心血管疾病患者展示可衡量的价值。

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引用次数: 0

Intermuscular Fat and Physical Activity Levels Relative to Exercise Capacity Change During Breast Cancer Treatment 乳腺癌治疗期间肌间脂肪和体力活动水平与运动能力变化的关系

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.01.009

Lauren Daniel BS , Moriah P. Bellissimo PhD , Ralph B. D’Agostino Jr. PhD , Kristine C. Olson PhD , Amy C. Ladd PhD , Kerryn W. Reding PhD , Kathryn E. Weaver PhD , Glenn J. Lesser MD , Bonnie Ky MD, MSCE , W. Gregory Hundley MD , UPBEAT Study Team

引用次数: 0

Reassessing CAC Risk Post-RRSO 重新评估CAC风险后的rrso

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2024.12.008

Binglin Li MD, Yan Wang MD, Ruijuan Chen MD

引用次数: 0

Balancing Promise and Evidence 平衡承诺和证据

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.01.017

Paschalis Karakasis MD, PhD(c) , Dimitrios Patoulias MD, PhD , Nikolaos Fragakis MD, PhD

引用次数: 0

Outcomes and Predictors of Severity of Immunotherapy-Related Myocarditis 免疫治疗相关性心肌炎的预后和严重程度的预测因素

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.03.001

Dame Idossa MD , Joerg Herrmann MD , Kathryn J. Ruddy MD, MPH

引用次数: 0

Clinical Phenotype and Prognostic Significance of Frailty in Transthyretin Cardiac Amyloidosis 经甲状腺素型心脏淀粉样变性患者虚弱的临床表型及预后意义

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.01.018

Carlo Fumagalli MD , Adam Ioannou MBBS, BSc , Francesco Cappelli MD , Mathew S. Maurer MD , Yousuf Razvi MBChB , Aldostefano Porcari MD , Mattia Zampieri MD , Federico Perfetto MD, PhD , Muhammad U. Rauf MBBS , Ana Martinez-Naharro MD, PhD , Lucia Venneri MD, PhD , Aviva Petrie MSc , Carol Whelan MD , Ashutosh Wechalekar MD , Helen Lachmann MD , Philip N. Hawkins MD, PhD , Iacopo Olivotto MD , Raffaele Marfella MD, PhD , Andrea Ungar MD, PhD , Niccolò Marchionni MD , Marianna Fontana MD, PhD

Background

The prevalence and clinical impact of frailty in transthyretin cardiac amyloidosis (ATTR-CA) remains poorly characterized.

Objectives

This study aimed to evaluate the prevalence, clinical determinants, and prognostic significance of frailty in a large cohort of patients with ATTR-CA.

Methods

Frailty was assessed in 880 patients with ATTR-CA (median age 80 years [Q1-Q3: 75-84 years], 719 [81.7%] male) using the Clinical Frailty Scale (CFS). Frailty was analyzed as a continuous variable and categorized as CFS 1 to 3, CFS 4 or 5, CFS 6 or 7, and CFS 8 or 9.

Results

Frailty was observed in 502 (57.1%) patients (CFS 4 or 5: 364 [41.4%]; CFS 6 or 7: 129 [14.7%]; CFS 8 or 9: 9 [1.0%]). Independent predictors of worsening frailty included older age, female sex, non-p.(V142I) hereditary ATTR-CA variants, and National Amyloidosis Centre stage 3 disease. Mortality rates increased incrementally with frailty severity (deaths per 100 person-years: 2.9 vs 11.0 vs 21.1 vs 40.9; log-rank P < 0.001). Frailty was independently associated with higher mortality risk across all age groups, genotypes, and disease stages.

Conclusions

Frailty is common in ATTR-CA and is independently linked to increased mortality risk. Incorporating frailty assessment alongside traditional markers enhances prognostication across genotypes and disease severities, particularly for short-term risk estimation.

转甲状腺素型心脏淀粉样变性（atr - ca）的患病率和虚弱的临床影响仍然缺乏明确的特征。目的：本研究旨在评估atr - ca患者的患病率、临床决定因素和预后意义。方法采用临床衰弱量表（CFS）对880例atr - ca患者（中位年龄80岁[Q1-Q3: 75-84岁]，719例（81.7%）男性）进行衰弱评估。虚弱作为一个连续变量进行分析，并分类为CFS 1至3、CFS 4或5、CFS 6或7、CFS 8或9。结果502例（57.1%）患者出现虚弱(CFS 4、5:364例（41.4%）；CFS 6或7:129 [14.7%]；CFS 8或9:9[1.0%])。衰弱恶化的独立预测因素包括年龄较大、女性、非p （V142I）遗传性atr - ca变异和国家淀粉样变中心3期疾病。死亡率随着衰弱严重程度的增加而增加(每100人年死亡人数：2.9 vs 11.0 vs 21.1 vs 40.9；log-rank P <；0.001)。在所有年龄组、基因型和疾病分期中，虚弱与较高的死亡风险独立相关。结论：虚弱在atr - ca中很常见，并与死亡风险增加独立相关。将衰弱评估与传统标记结合起来，可以增强跨基因型和疾病严重程度的预测，特别是短期风险评估。

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引用次数: 0

Improving Long-Term Outcomes in ATTR-CM 改善atr - cm的长期预后

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-04-01 DOI: 10.1016/j.jaccao.2025.01.007

Nowell M. Fine MD, SM

引用次数: 0

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