Jacc: Cardiooncology最新文献

英文中文

Probing the Anthracycline-Induced Myocardial Injury 探究蒽环类药物诱发的心肌损伤

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.04.008

引用次数: 0

Clonal Hematopoiesis Is Associated With Cardiomyopathy During Solid Tumor Therapy 克隆性造血与实体瘤治疗期间的心肌病有关

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.05.013

引用次数: 0

Optimizing Cardiovascular Risk Prediction From CT Imaging at the Radiation Oncology Point of Care 在放射肿瘤学治疗点通过 CT 成像优化心血管风险预测

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.07.003

引用次数: 0

Predictive Performance of Cardiovascular Risk Scores in Cancer Survivors From the UK Biobank 英国生物库癌症幸存者心血管风险评分的预测性能

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.05.015

Background

Cardiovascular preventive strategies are guided by risk scores with unknown validity in cancer cohorts.

Objectives

This study aimed to evaluate the predictive performance of 7 established cardiovascular risk scores in cancer survivors from the UK Biobank.

Methods

The predictive performance of QRISK3, Systematic Coronary Risk Evaluation 2 (SCORE2)/Systematic Coronary Risk Evaluation for Older Persons (SCORE-OP), Framingham Risk Score, Pooled Cohort equations to Prevent Heart Failure (PCP-HF), CHARGE-AF, QStroke, and CHA₂DS₂-VASc was calculated in participants with and without a history of cancer. Participants were propensity matched on age, sex, deprivation, health behaviors, family history, and metabolic conditions. Analyses were stratified into any cancer, breast, lung, prostate, brain/central nervous system, hematologic malignancies, Hodgkin lymphoma, and non-Hodgkin lymphoma. Incident cardiovascular events were tracked through health record linkage over 10 years of follow-up. The area under the receiver operating curve, balanced accuracy, and sensitivity were reported.

Results

The analysis included 31,534 cancer survivors and 126,136 covariate-matched controls. Risk score distributions were near identical in cases and controls. Participants with any cancer had a significantly higher incidence of all cardiovascular outcomes than matched controls. Performance metrics were significantly worse for all risk scores in cancer cases than in matched controls. The most notable differences were among participants with a history of hematologic malignancies who had significantly higher outcome rates and poorer risk score performance than their matched controls. The performance of risk scores for predicting stroke in participants with brain/central nervous system cancer was very poor, with predictive accuracy more than 30% lower than noncancer controls.

Conclusions

Existing cardiovascular risk scores have significantly worse predictive accuracy in cancer survivors compared with noncancer comparators, leading to an underestimation of risk in this cohort.

背景心血管预防策略是由癌症队列中有效性未知的风险评分指导的。目的本研究旨在评估英国生物库中 7 种已确立的癌症幸存者心血管风险评分的预测性能。方法计算QRISK3、系统性冠状动脉风险评估2（SCORE2）/老年人系统性冠状动脉风险评估（SCORE-OP）、弗雷明汉风险评分、预防心力衰竭的队列汇总方程（PCP-HF）、CHARGE-AF、QStroke和CHA2DS2-VASc在有癌症史和无癌症史参与者中的预测性能。根据年龄、性别、贫困程度、健康行为、家族病史和代谢状况对参与者进行了倾向匹配。分析分为任何癌症、乳腺癌、肺癌、前列腺癌、脑/中枢神经系统癌症、血液系统恶性肿瘤、霍奇金淋巴瘤和非霍奇金淋巴瘤。在 10 年的随访过程中，通过健康记录链接追踪了心血管事件的发生情况。结果分析包括 31,534 名癌症幸存者和 126,136 名共变量匹配对照。病例和对照组的风险评分分布几乎相同。与匹配的对照组相比，患有任何癌症的参与者所有心血管疾病的发病率都明显较高。癌症病例所有风险评分的性能指标均明显低于匹配对照组。最明显的差异出现在有血液系统恶性肿瘤病史的参与者身上，他们的预后率明显高于匹配对照组，风险评分的表现也较差。结论与非癌症对照组相比，现有的心血管风险评分对癌症幸存者的预测准确性明显较差，导致低估了该人群的风险。

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引用次数: 0

Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer 作为肺癌放射性心脏毒性生物标志物的基线心脏参数

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.05.009

Background

Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.

Objectives

The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying “high risk” patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).

Methods

The medical records of patients who underwent definitive RT for non–small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.

Results

Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.

Conclusions

The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.

背景放疗引起的心脏毒性是肺癌治疗中的一项重大挑战，因为心脏与肺在解剖学上非常接近，再加上患者中心血管风险因素的高发率。本研究旨在评估常规临床和影像学心脏参数在确定放疗（RT）后发生重大心脏不良事件（MACE）和死亡率的 "高风险 "患者方面的预测价值。方法回顾性审查了 2015 年至 2020 年期间在一个中心使用现代计划技术接受非小细胞肺癌最终 RT 治疗的患者的病历。心脏事件由心脏病专家核实，死亡率数据由国家登记处确认。对RT计划扫描的心脏亚结构进行了自动分割，以进行回顾性结构和剂量分析，并研究了它们与临床因素的相关性。在考虑死亡竞争风险的同时，使用 Fine-Gray 模型来分析两者之间的关系。结果在纳入研究的 478 名患者中，77 人（16%）发生了 88 次 MACE，中位发生时间为 16.3 个月。原有心脏疾病负担越重，MACE累积发生率越高（55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P <0.001）。RT 计划扫描显示的左心房和左心室增大分别与 5 年后房性心律失常（14% [95% CI：9%-20%] vs 4% [95% CI：2%-8%]；P = 0.001）和心力衰竭（13% [95% CI：8%-18%] vs 6% [95% CI：3%-10%]；P = 0.007）的累积发生率相关。然而，心肌梗死与冠状动脉钙化无关（4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]；P = 0.094）。结论本研究结果表明，心脏病史和 RT 计划扫描参数可为前瞻性评估肺癌患者 RT 后的心脏毒性风险提供潜在的实用性。

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引用次数: 0

Atrial Fibrillation as a Prognostic Factor for All-Cause Mortality in Patients With Transthyretin Amyloid Cardiomyopathy 心房颤动是转甲状腺素淀粉样变性心肌病患者全因死亡率的预后因素之一

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.03.007

Background

Atrial fibrillation/atrial flutter (AF/AFL) are common manifestations of transthyretin amyloid cardiomyopathy (ATTR-CM) but have not been found to be predictive of mortality.

Objectives

This analysis aimed to examine whether baseline or historical AF/AFL at enrollment was prognostic for all-cause mortality.

Methods

In the ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), a 30-month study of tafamidis vs placebo for ATTR-CM, AF/AFL was evaluated as an independent prognostic factor for all-cause mortality using Cox proportional hazards modelling. The impact of AF/AFL on tafamidis efficacy was explored by adding an interaction term for AF/AFL status and treatment.

Results

ATTR-ACT enrolled 441 patients with ATTR-CM (median age 75 years; 90% male); 314 (71.2%) had baseline or historical AF/AFL at enrollment. AF/AFL was an independent prognostic factor for all-cause mortality after adjusting for covariates prespecified in the ATTR-ACT model (treatment, genotype, New York Heart Association functional class; HR: 0.550; 95% CI: 0.368-0.821) but not in an expanded stepwise model selection analysis including 23 covariates (blood urea nitrogen and N-terminal pro–B-type natriuretic peptide concentration, 6-minute walk test distance, genotype, treatment, and global longitudinal strain were prognostic [P < 0.01]). The interactions between tafamidis treatment and AF/AFL for all-cause mortality (P = 0.33) and changes in Kansas City Cardiomyopathy Questionnaire Overall Summary score (P = 0.83) and 6-minute walk test distance (P = 0.82) were not significant.

Conclusions

In ATTR-ACT, baseline or historical AF/AFL was prognostic for all-cause mortality in analyses with limited adjustment but not after accounting for additional indicators of disease severity. Baseline or historical AF/AFL did not impact the efficacy of tafamidis treatment. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889)

背景心房颤动/心房扑动（AF/AFL）是转甲状腺素淀粉样变性心肌病（ATTR-CM）的常见表现，但尚未发现其可预测死亡率。方法在为期 30 个月的 ATTR-ACT（Tafamidis in Transthyretin Cardiomyopathy Clinical Trial）研究中，使用 Cox 比例危险模型评估了 AF/AFL 作为全因死亡率的独立预后因素。结果ATTR-ACT共招募了441名ATTR-CM患者（中位年龄75岁；90%为男性），其中314人（71.2%）在入组时存在基线或历史性房颤/AFL。在调整 ATTR-ACT 模型中预设的协变量（治疗、基因型、纽约心脏协会功能分级；HR：0.550；95% CI：0.368-0.821）后，心房颤动/心房颤动是全因死亡率的独立预后因素，但在扩展模型中并非如此。HR：0.550；95 CI：0.368-0.821），但在包括 23 个协变量（血尿素氮和 N 末端前 B 型钠尿肽浓度、6 分钟步行测试距离、基因型、治疗和全局纵向应变）的扩展逐步模型选择分析中则不具有预后意义 [P<；0.01]）。结论在ATTR-ACT中，基线或历史房颤/AFL在有限调整的分析中是全因死亡率的预后因素，但在考虑了疾病严重程度的其他指标后则不是。基线或既往房颤/AFL对他法米迪的疗效没有影响。(塔法米地斯治疗转甲状腺素心肌病患者的安全性和疗效[ATTR-ACT]；NCT01994889）。

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引用次数: 0

Mediterranean Diet Is Associated With Lower All-Cause and Cardiovascular Mortality Among Long-Term Cancer Survivors 地中海饮食与癌症长期存活者较低的全因死亡率和心血管死亡率有关

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.05.012

引用次数: 0

Assessing the Certainty of Evidence on Efficacy and Safety of Anticoagulants for Cancer-Associated Thrombosis 评估抗凝剂治疗癌症相关血栓的疗效和安全性证据的确定性

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.03.014

引用次数: 0

Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy 左侧乳房放疗中的深吸气屏气法

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.04.009

Background

Deep inspiration breath hold (DIBH) is an effective technique for reducing heart exposure during radiotherapy for left-sided breast cancer. Despite its benefits, cost considerations and its impact on workflow remain significant barriers to widespread adoption.

Objectives

This study aimed to assess the cost-effectiveness of DIBH and compare its operational, financial, and clinical outcomes with free breathing (FB) in breast cancer treatment.

Methods

Treatment plans for 100 patients with left-sided breast cancer were generated using both DIBH and FB techniques. Dosimetric data, including the average mean heart dose, were calculated for each technique and used to estimate the cardiotoxicity of radiotherapy. A state-transition microsimulation model based on SCORE2 (Systematic Coronary Risk Evaluation) algorithms projected the effects of DIBH on cardiovascular outcomes and quality-adjusted life-years (QALYs). Costs were calculated from a provider perspective using time-driven activity-based costing, applying a willingness-to-pay threshold of €40,000 for cost-effectiveness assessment. A discrete event simulation model assessed the impacts of DIBH vs FB on throughput and waiting times in the radiotherapy workflow.

Results

In the base case scenario, DIBH was associated with an absolute risk reduction of 1.72% (95% CI: 1.67%-1.76%) in total cardiovascular events and 0.69% (95% CI: 0.67%-0.72%) in fatal cardiovascular events over 20 years. Additionally, DIBH was estimated to provide an incremental 0.04 QALYs (95% CI: 0.05-0.05) per left-sided breast cancer patient over the same time period. However, DIBH increased treatment times, reducing maximum achievable throughput by 12.48% (95% CI: 12.36%-12.75%) and increasing costs by €617 per left-sided breast cancer patient (95% CI: €615-€619). The incremental cost-effectiveness ratio was €14,023 per QALY.

Conclusions

Despite time investments, DIBH is cost-effective in the Belgian population. The growing adoption of DIBH may benefit long-term cardiovascular health in breast cancer survivors.

背景深吸气屏气（DIBH）是一种在左侧乳腺癌放疗期间减少心脏暴露的有效技术。本研究旨在评估 DIBH 的成本效益，并比较其与自由呼吸（FB）在乳腺癌治疗中的操作、财务和临床结果。方法使用 DIBH 和自由呼吸技术为 100 名左侧乳腺癌患者制定治疗计划。计算了每种技术的剂量数据，包括平均心脏剂量，并用于估算放疗的心脏毒性。基于 SCORE2（系统性冠状动脉风险评估）算法的状态转换微观模拟模型预测了 DIBH 对心血管预后和质量调整生命年（QALYs）的影响。从医疗服务提供者的角度出发，采用基于活动的时间驱动成本计算法计算成本，成本效益评估的支付意愿阈值为 40,000 欧元。离散事件模拟模型评估了DIBH与FB对放疗工作流程中吞吐量和等待时间的影响。结果在基础方案中，DIBH可使20年内总心血管事件的绝对风险降低1.72%（95% CI：1.67%-1.76%），致命心血管事件的绝对风险降低0.69%（95% CI：0.67%-0.72%）。此外，据估计，在同一时期内，DIBH可为每位左侧乳腺癌患者带来0.04 QALYs的增量（95% CI：0.05-0.05）。然而，DIBH增加了治疗时间，使最大可达到的治疗量减少了12.48%（95% CI：12.36%-12.75%），每位左侧乳腺癌患者的成本增加了617欧元（95% CI：615-619欧元）。结论尽管需要投入时间，但在比利时人群中，DIBH仍具有成本效益。越来越多的人采用 DIBH 可能有利于乳腺癌幸存者的长期心血管健康。

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引用次数: 0

Atrial Fibrillation in Transthyretin Amyloid Cardiomyopathy 转甲状腺素淀粉样变性心肌病的心房颤动

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2024-08-01 DOI: 10.1016/j.jaccao.2024.05.016

引用次数: 0

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