Pub Date : 2024-10-01DOI: 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.
{"title":"Cardiovascular Considerations Before Cancer Therapy","authors":"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","doi":"10.1016/j.jaccao.2024.07.017","DOIUrl":"10.1016/j.jaccao.2024.07.017","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 631-654"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 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%.
{"title":"Prognosis After Withdrawal of Cardioprotective Therapy in Patients With Improved Cancer Therapeutics–Related Cardiac Dysfunction","authors":"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","doi":"10.1016/j.jaccao.2024.07.018","DOIUrl":"10.1016/j.jaccao.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>This study aims to assess the prognosis after CPT withdrawal in patients exhibiting improved CTRCD.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%; <em>P</em> = 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%; <em>P</em> < 0.001). The occurrence of composite major clinical events was notably higher in the WG (HR: 3.06; 95% CI: 1.51-7.73; <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>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%.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 699-710"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.07.013
Brian T. Joyce PhD
{"title":"Epigenomics of Cardio-Oncology","authors":"Brian T. Joyce PhD","doi":"10.1016/j.jaccao.2024.07.013","DOIUrl":"10.1016/j.jaccao.2024.07.013","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 743-745"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 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
{"title":"Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes for Preclinical Cardiotoxicity Screening in Cardio-Oncology","authors":"Kyle D. Shead MRes, Eline Huethorst PhD, Francis Burton PhD, Ninian N. Lang MBChB, PhD, Rachel C. Myles MBChB, PhD, Godfrey L. Smith PhD","doi":"10.1016/j.jaccao.2024.07.012","DOIUrl":"10.1016/j.jaccao.2024.07.012","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 678-683"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.07.008
Elena Wadden MD , Alexi Vasbinder PhD, RN , Vidhushei Yogeswaran MD , Aladdin H. Shadyab PhD , Nazmus Saquib MBBS, MPH, PhD , Yangbo Sun PhD , Lisa Warsinger Martin MD , Ramesh Mazhari MD , JoAnn E. Manson MD, DrPH , Marcia Stefanick PhD , Ana Barac MD, PhD , Michael S. Simon MD , Kerryn Reding PhD, MPH, RN , Richard K. Cheng MD, MS
Background
Relationships between lifestyle risk factors and cardiovascular disease (CVD) risk in women with breast cancer (BC) are underexplored.
Objectives
To evaluate the incidence of CVD in relation to the Life’s Essential 8 (LE8) score among women with BC.
Methods
Data from the Women’s Health Initiative were utilized. The primary exposure was the LE8 score assessed prior to BC diagnosis. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). The primary endpoint was a composite of incident CVD events, which included coronary heart disease, defined as myocardial infarction along with coronary revascularization, CVD death, and stroke. We calculated the cumulative incidence of CVD and estimated hazard ratios.
Results
Among 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% CI: 0.46-0.69) for moderate CVH and 0.34 (95% CI: 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD.
Conclusions
Higher LE8 scores were associated with a lower risk of incident CVD among women with BC in the United States.
{"title":"Life’s Essential 8 and Incident Cardiovascular Disease in U.S. Women With Breast Cancer","authors":"Elena Wadden MD , Alexi Vasbinder PhD, RN , Vidhushei Yogeswaran MD , Aladdin H. Shadyab PhD , Nazmus Saquib MBBS, MPH, PhD , Yangbo Sun PhD , Lisa Warsinger Martin MD , Ramesh Mazhari MD , JoAnn E. Manson MD, DrPH , Marcia Stefanick PhD , Ana Barac MD, PhD , Michael S. Simon MD , Kerryn Reding PhD, MPH, RN , Richard K. Cheng MD, MS","doi":"10.1016/j.jaccao.2024.07.008","DOIUrl":"10.1016/j.jaccao.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Relationships between lifestyle risk factors and cardiovascular disease (CVD) risk in women with breast cancer (BC) are underexplored.</div></div><div><h3>Objectives</h3><div>To evaluate the incidence of CVD in relation to the Life’s Essential 8 (LE8) score among women with BC.</div></div><div><h3>Methods</h3><div>Data from the Women’s Health Initiative were utilized. The primary exposure was the LE8 score assessed prior to BC diagnosis. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). The primary endpoint was a composite of incident CVD events, which included coronary heart disease, defined as myocardial infarction along with coronary revascularization, CVD death, and stroke. We calculated the cumulative incidence of CVD and estimated hazard ratios.</div></div><div><h3>Results</h3><div>Among 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% CI: 0.46-0.69) for moderate CVH and 0.34 (95% CI: 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD.</div></div><div><h3>Conclusions</h3><div>Higher LE8 scores were associated with a lower risk of incident CVD among women with BC in the United States.</div></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 746-757"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jaccao.2024.08.003
Tochi M. Okwuosa DO , Donald Lloyd-Jones MD
{"title":"Measuring “Cardiovascular Health” in Everyone Including Cancer Patients","authors":"Tochi M. Okwuosa DO , Donald Lloyd-Jones MD","doi":"10.1016/j.jaccao.2024.08.003","DOIUrl":"10.1016/j.jaccao.2024.08.003","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 5","pages":"Pages 758-760"},"PeriodicalIF":12.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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