Jacc: Cardiooncology最新文献

英文中文

Effects of Aerobic Exercise on Cardiorespiratory Fitness and Cardiovascular Risk Factors in Long-Term Breast Cancer Survivors 有氧运动对长期乳腺癌幸存者心肺健康和心血管危险因素的影响

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-06-01 DOI: 10.1016/j.jaccao.2025.04.006

Sara H. Johansen MSc , Mali Sæter MD , Sebastian I. Sarvari MD, PhD , Kristin V. Reinertsen MD, PhD , Elisabeth Edvardsen PhD , Torbjørn Wisløff PhD , Jessica M. Scott PhD , May Grydeland PhD , Truls Raastad PhD , Jostein Hallén PhD , Cecilie E. Kiserud MD, PhD , Hanne C. Lie PhD , Paul A. Solberg PhD , Kristina Hermann Haugaa MD, PhD , Johanne S.S. Jensen MSc , Line H. Vatningen MSc , Lene Thorsen PhD , Tormod S. Nilsen PhD

Background

Cancer treatment may impair physiological adaptations to exercise therapy, yet no study has directly compared exercise effects between cancer survivors and cancer-naive control subjects.

Objectives

This study sought to examine the effects of aerobic exercise in anthracycline-treated long-term survivors of breast cancer (BCS) and to compare the effects to cancer-naive women.

Methods

The CAUSE (CArdiovascUlar Survivors Exercise) trial was a 2-arm randomized controlled trial in which long-term BCS were assigned to thrice-weekly nonlinear aerobic exercise for 5 months (BCS exercise) or usual care (BCS usual care). A third group of similarly aged cancer-naive women completed the same exercise intervention. The primary outcome was cardiorespiratory fitness (CRF) (measured as

V

o_2peak). Secondary outcomes included cardiovascular risk factors (cardiometabolic biomarkers and body composition) and patient-reported outcomes (subjective vitality and life satisfaction).

Results

Between October 2020 and February 2023, 140 BCS (aged 59.0 ± 6.4 years; 11 ± 1 years after treatment) and 69 cancer-naive women (aged 57.8 ± 4.9 years) were enrolled. From baseline to post-exercise intervention, Vo_2peak increased by 1.2 ± 2.6 mL·kg⁻¹·min⁻¹ in the BCS exercise, by 0.01 ± 2.5 mL·kg⁻¹·min⁻¹ in the BCS usual care group (mean difference 1.3; 95% confidence interval [CI]: 0.5-2.1; P = 0.002), and by 2.6 ± 2.5 mL·kg⁻¹·min⁻¹ in non-cancer subjects (BCS exercise vs non-cancer subjects: mean difference −1.4; 95% CI: −2.2 to −0.5; P = 0.003). No changes in cardiovascular risk factors were observed. Compared with BCS usual care, the BCS exercise group reported improved subjective vitality (mean difference 2.56; 95% CI: 1.22-3.90; P < 0.001) and satisfaction with life (mean difference 1.68; 95% CI: 0.43-2.93; P = 0.009).

Conclusions

Although aerobic exercise improves CRF in anthracycline-treated long-term BCS, the response was less than one-half that observed in cancer-naive subjects.

癌症治疗可能会损害运动治疗的生理适应性，但没有研究直接比较癌症幸存者和癌症初发对照组之间的运动效果。目的：本研究旨在探讨有氧运动对蒽环类药物治疗的乳腺癌长期幸存者（BCS）的影响，并比较其对癌症早期妇女的影响。方法CAUSE（心血管幸存者运动）试验是一项两组随机对照试验，其中长期BCS被分配为每周三次的非线性有氧运动，持续5个月（BCS运动）或常规护理（BCS常规护理）。第三组同样年龄的未患癌症的妇女完成了同样的运动干预。主要终点为心肺适能（CRF）（以Vo2peak测量）。次要结局包括心血管危险因素（心脏代谢生物标志物和身体组成）和患者报告的结局（主观活力和生活满意度）。结果2020年10月~ 2023年2月，BCS 140例(年龄59.0±6.4岁；治疗后11±1年)和69名癌症初发妇女（年龄57.8±4.9岁）入组。从基线到运动干预后，BCS运动组的Vo2peak增加了1.2±2.6 mL·kg−1·min−1，BCS常规护理组的Vo2peak增加了0.01±2.5 mL·kg−1·min−1(平均差1.3；95%置信区间[CI]: 0.5-2.1；P = 0.002)，非癌症受试者减少2.6±2.5 mL·kg - 1·min - 1 (BCS运动与非癌症受试者：平均差异为- 1.4；95% CI:−2.2 ~−0.5；P = 0.003)。未观察到心血管危险因素的变化。与BCS常规护理相比，BCS运动组主观活力有所改善(平均差2.56；95% ci: 1.22-3.90；P & lt;0.001)和生活满意度(平均差1.68；95% ci: 0.43-2.93；P = 0.009)。结论：尽管有氧运动可以改善蒽环类药物治疗的长期BCS患者的CRF，但其反应不到癌症初发患者的一半。

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引用次数: 0

Exercise Training in Breast Cancer Survivors 乳腺癌幸存者的运动训练

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology

Pub Date : 2025-06-01 DOI: 10.1016/j.jaccao.2025.05.004

Simon Wernhart MD, PhD , Caterina Fiorentini MD , Martin Halle MD

引用次数: 0

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

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Jacc: Cardiooncology

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