Pub Date : 2024-02-01DOI: 10.1016/j.jaccao.2023.11.006
Peter A. Kavsak PhD , Joshua O. Cerasuolo MSc , David Kirkwood MSc , Richard Perez MSc , Hsien Seow PhD , Jinhui Ma PhD , Andrew Worster MD, MSc , Dennis T. Ko MD, MSc , Sukhbinder Dhesy-Thind MD, MSc , Darryl Leong MBBS, MPH, PhD
{"title":"High-Sensitivity Cardiac Troponin I for Long-Term Cardiovascular Risk Stratification in a Cancer Clinic Population","authors":"Peter A. Kavsak PhD , Joshua O. Cerasuolo MSc , David Kirkwood MSc , Richard Perez MSc , Hsien Seow PhD , Jinhui Ma PhD , Andrew Worster MD, MSc , Dennis T. Ko MD, MSc , Sukhbinder Dhesy-Thind MD, MSc , Darryl Leong MBBS, MPH, PhD","doi":"10.1016/j.jaccao.2023.11.006","DOIUrl":"10.1016/j.jaccao.2023.11.006","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003526/pdfft?md5=7314a6cf983f336900162a8c3abecd7e&pid=1-s2.0-S2666087323003526-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638943","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 : 2024-02-01DOI: 10.1016/j.jaccao.2023.11.005
Stephen J. Foulkes PhD , Mark J. Haykowsky PhD , Todd Li MN, RN , Jing Wang PhD , Megan Kennedy BA, MLIS , Amy A. Kirkham PhD , Richard B. Thompson PhD , D. Ian Paterson MD , Andre La Gerche MBBS, PhD , Edith Pituskin PhD, RN
{"title":"Determinants of Impaired Peak Oxygen Uptake in Breast Cancer Survivors: JACC: CardioOncology Primer","authors":"Stephen J. Foulkes PhD , Mark J. Haykowsky PhD , Todd Li MN, RN , Jing Wang PhD , Megan Kennedy BA, MLIS , Amy A. Kirkham PhD , Richard B. Thompson PhD , D. Ian Paterson MD , Andre La Gerche MBBS, PhD , Edith Pituskin PhD, RN","doi":"10.1016/j.jaccao.2023.11.005","DOIUrl":"10.1016/j.jaccao.2023.11.005","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003496/pdfft?md5=aa70f13a5cb2b2a61eb4f26f4f707ebd&pid=1-s2.0-S2666087323003496-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194432","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 : 2024-02-01DOI: 10.1016/j.jaccao.2023.12.006
Laura De Michieli MD , Alberto Cipriani MD , Sabino Iliceto MD , Angela Dispenzieri MD , Allan S. Jaffe MD
Cardiac amyloidosis (CA) is an infiltrative disease caused by amyloid fibril deposition in the myocardium; the 2 forms that most frequently involve the heart are amyloid light chain (AL) and amyloid transthyretin (ATTR) amyloidosis. Cardiac troponin (cTn) is the biomarker of choice for the detection of myocardial injury and is frequently found to be elevated in patients with CA, particularly with high-sensitivity assays. Multiple mechanisms of myocardial injury in CA have been proposed, including cytotoxic effect of amyloid precursors, interstitial amyloid fibril infiltration, coronary microvascular dysfunction, amyloid- and non-amyloid-related coronary artery disease, diastolic dysfunction, and heart failure. Regardless of the mechanisms, cTn values have relevant prognostic (and potentially diagnostic) implications in both AL and ATTR amyloidosis. In this review, the authors discuss the significant aspects of cTn biology and measurement methods, potential mechanisms of myocardial injury in CA, and the clinical application of cTn in the management of both AL and ATTR amyloidosis.
心脏淀粉样变性(CA)是一种由淀粉样纤维沉积在心肌中引起的浸润性疾病;最常累及心脏的两种形式是淀粉样轻链(AL)和淀粉样转甲状腺素(ATTR)淀粉样变性。心肌肌钙蛋白(cTn)是检测心肌损伤的首选生物标志物,CA 患者的心肌肌钙蛋白经常升高,尤其是在高灵敏度检测中。CA 心肌损伤的机制有多种,包括淀粉样蛋白前体的细胞毒性作用、间质淀粉样纤维浸润、冠状微血管功能障碍、淀粉样蛋白和非淀粉样蛋白相关冠状动脉疾病、舒张功能障碍和心力衰竭。无论机制如何,cTn 值对 AL 和 ATTR 淀粉样变性都具有相关的预后(和潜在的诊断)意义。在这篇综述中,作者讨论了 cTn 生物学和测量方法的重要方面、CA 心肌损伤的潜在机制以及 cTn 在 AL 和 ATTR 淀粉样变性治疗中的临床应用。
{"title":"Cardiac Troponin in Patients With Light Chain and Transthyretin Cardiac Amyloidosis","authors":"Laura De Michieli MD , Alberto Cipriani MD , Sabino Iliceto MD , Angela Dispenzieri MD , Allan S. Jaffe MD","doi":"10.1016/j.jaccao.2023.12.006","DOIUrl":"https://doi.org/10.1016/j.jaccao.2023.12.006","url":null,"abstract":"<div><p>Cardiac amyloidosis (CA) is an infiltrative disease caused by amyloid fibril deposition in the myocardium; the 2 forms that most frequently involve the heart are amyloid light chain (AL) and amyloid transthyretin (ATTR) amyloidosis. Cardiac troponin (cTn) is the biomarker of choice for the detection of myocardial injury and is frequently found to be elevated in patients with CA, particularly with high-sensitivity assays. Multiple mechanisms of myocardial injury in CA have been proposed, including cytotoxic effect of amyloid precursors, interstitial amyloid fibril infiltration, coronary microvascular dysfunction, amyloid- and non-amyloid-related coronary artery disease, diastolic dysfunction, and heart failure. Regardless of the mechanisms, cTn values have relevant prognostic (and potentially diagnostic) implications in both AL and ATTR amyloidosis. In this review, the authors discuss the significant aspects of cTn biology and measurement methods, potential mechanisms of myocardial injury in CA, and the clinical application of cTn in the management of both AL and ATTR amyloidosis.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266608732400005X/pdfft?md5=449401755a316c5224b647d7d4abc80a&pid=1-s2.0-S266608732400005X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139915504","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}
Current guidelines recommend several direct oral anticoagulant agents (DOACs) equally for managing cancer-associated venous thromboembolism (VTE).
Objectives
The aim of this study was to assess the efficacy and safety of DOACs in patients with active cancer.
Methods
Literature searches were conducted in PubMed, Embase, and Cochrane Central in November 2022. Randomized controlled trials investigating anticoagulation strategies (vitamin K antagonists, parenteral anticoagulation [eg, low-molecular weight heparin], and DOACs) for VTE in patients with active cancer were identified for network meta-analysis. The outcomes included recurrent VTE, recurrent pulmonary embolism, recurrent deep venous thrombosis, major bleeding, clinically relevant nonmajor bleeding (CRNMB), and a composite outcome of major bleeding or CRNMB. Pooled HRs and 95% CIs were estimated using either the HR or relative risk provided from each study. Random-effects models were used for all the analyses.
Results
Seventeen randomized controlled trials involving 6,623 patients with active cancer were included. No significant differences were found among the DOACs for efficacy outcomes (recurrent VTE, pulmonary embolism, and deep venous thrombosis). In terms of major bleeding, apixaban was similarly safe compared with dabigatran and rivaroxaban but was associated with a decreased risk compared with edoxaban (HR: 0.38; 95% CI: 0.15-0.93). Regarding CRNMB, edoxaban was similarly safe compared with apixaban but was associated with a decreased risk compared with rivaroxaban (HR: 0.31; 95% CI: 0.10-0.91). Compared with parenteral anticoagulation, apixaban was associated with a reduced risk for recurrent VTE (HR: 0.60; 95% CI: 0.38-0.93) without increasing bleeding, edoxaban was associated with an increased risk for major bleeding or CRNMB (HR: 1.35; 95% CI: 1.02-1.79), and rivaroxaban was associated with an increased risk for CRNMB (HR: 3.76; 95% CI: 1.43-9.88).
Conclusions
DOACs demonstrate comparable efficacy but exhibit different safety profiles. Apixaban may confer an antithrombotic benefit without an increased risk for bleeding, distinguishing it from other contemporary anticoagulation strategies in patients with active cancer and VTE.
{"title":"Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer","authors":"Tomohiro Fujisaki MD , Daisuke Sueta MD, PhD , Eiichiro Yamamoto MD, PhD , Conor Buckley MD , Guilherme Sacchi de Camargo Correia MD , Julia Aronson MD , Paulino Tallón de Lara MD, PhD , Koichiro Fujisue MD, PhD , Hiroki Usuku MD, PhD , Kenichi Matsushita MD, PhD , Roxana Mehran MD , George D. Dangas MD, PhD , Kenichi Tsujita MD, PhD","doi":"10.1016/j.jaccao.2023.10.009","DOIUrl":"10.1016/j.jaccao.2023.10.009","url":null,"abstract":"<div><h3>Background</h3><p>Current guidelines recommend several direct oral anticoagulant agents (DOACs) equally for managing cancer-associated venous thromboembolism (VTE).</p></div><div><h3>Objectives</h3><p>The aim of this study was to assess the efficacy and safety of DOACs in patients with active cancer.</p></div><div><h3>Methods</h3><p>Literature searches were conducted in PubMed, Embase, and Cochrane Central in November 2022. Randomized controlled trials investigating anticoagulation strategies (vitamin K antagonists, parenteral anticoagulation [eg, low-molecular weight heparin], and DOACs) for VTE in patients with active cancer were identified for network meta-analysis. The outcomes included recurrent VTE, recurrent pulmonary embolism, recurrent deep venous thrombosis, major bleeding, clinically relevant nonmajor bleeding (CRNMB), and a composite outcome of major bleeding or CRNMB. Pooled HRs and 95% CIs were estimated using either the HR or relative risk provided from each study. Random-effects models were used for all the analyses.</p></div><div><h3>Results</h3><p>Seventeen randomized controlled trials involving 6,623 patients with active cancer were included. No significant differences were found among the DOACs for efficacy outcomes (recurrent VTE, pulmonary embolism, and deep venous thrombosis). In terms of major bleeding, apixaban was similarly safe compared with dabigatran and rivaroxaban but was associated with a decreased risk compared with edoxaban (HR: 0.38; 95% CI: 0.15-0.93). Regarding CRNMB, edoxaban was similarly safe compared with apixaban but was associated with a decreased risk compared with rivaroxaban (HR: 0.31; 95% CI: 0.10-0.91). Compared with parenteral anticoagulation, apixaban was associated with a reduced risk for recurrent VTE (HR: 0.60; 95% CI: 0.38-0.93) without increasing bleeding, edoxaban was associated with an increased risk for major bleeding or CRNMB (HR: 1.35; 95% CI: 1.02-1.79), and rivaroxaban was associated with an increased risk for CRNMB (HR: 3.76; 95% CI: 1.43-9.88).</p></div><div><h3>Conclusions</h3><p>DOACs demonstrate comparable efficacy but exhibit different safety profiles. Apixaban may confer an antithrombotic benefit without an increased risk for bleeding, distinguishing it from other contemporary anticoagulation strategies in patients with active cancer and VTE.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003514/pdfft?md5=2ce5df874e0eb562fad50e31bceb4b25&pid=1-s2.0-S2666087323003514-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457130","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 : 2024-02-01DOI: 10.1016/j.jaccao.2023.11.007
Amin H. Nassar MD , Edward El-Am MD , Ryan Denu MD , Sarah Abou Alaiwi MD , Talal El Zarif MD , Walid Macaron MD , Noha Abdel-Wahab MD, PhD , Aakash Desai MD , Caleb Smith MD , Kaushal Parikh MD , Muhannad Abbasi MD , Elias Bou Farhat MD , James M. Williams MD , Jeremy D. Collins MD , Ahmad Al-Hader MD , Rana R. McKay MD , Carmel Malvar MD , Mohamad Sabra MD , Caiwei Zhong MS , Raquelle El Alam MD , Abdul Rafeh Naqash MD
Background
Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes.
Objectives
The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs).
Methods
A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0.
Results
Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively (P < 0.0001), and median OS was 3.0 vs 24.0 months, respectively (P = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3.
Conclusions
Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity.
{"title":"Clinical Outcomes Among Immunotherapy-Treated Patients With Primary Cardiac Soft Tissue Sarcomas","authors":"Amin H. Nassar MD , Edward El-Am MD , Ryan Denu MD , Sarah Abou Alaiwi MD , Talal El Zarif MD , Walid Macaron MD , Noha Abdel-Wahab MD, PhD , Aakash Desai MD , Caleb Smith MD , Kaushal Parikh MD , Muhannad Abbasi MD , Elias Bou Farhat MD , James M. Williams MD , Jeremy D. Collins MD , Ahmad Al-Hader MD , Rana R. McKay MD , Carmel Malvar MD , Mohamad Sabra MD , Caiwei Zhong MS , Raquelle El Alam MD , Abdul Rafeh Naqash MD","doi":"10.1016/j.jaccao.2023.11.007","DOIUrl":"10.1016/j.jaccao.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><p>Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes.</p></div><div><h3>Objectives</h3><p>The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs).</p></div><div><h3>Methods</h3><p>A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0.</p></div><div><h3>Results</h3><p>Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively (<em>P</em> < 0.0001), and median OS was 3.0 vs 24.0 months, respectively (<em>P</em> = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3.</p></div><div><h3>Conclusions</h3><p>Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003563/pdfft?md5=7813d4cff51655f7ead57908a00e39dc&pid=1-s2.0-S2666087323003563-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632949","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 : 2024-02-01DOI: 10.1016/j.jaccao.2023.12.005
Chao-Yu Chen MD , Wei-Ting Chang MD , Hui-Wen Lin BSc , Sheng-Hsiang Lin PhD , Yi-Heng Li MD, PhD
{"title":"Statin Use Is Associated With Reduced Heart Failure and Risk of Death in Non-Hodgkin Lymphoma","authors":"Chao-Yu Chen MD , Wei-Ting Chang MD , Hui-Wen Lin BSc , Sheng-Hsiang Lin PhD , Yi-Heng Li MD, PhD","doi":"10.1016/j.jaccao.2023.12.005","DOIUrl":"https://doi.org/10.1016/j.jaccao.2023.12.005","url":null,"abstract":"","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324000048/pdfft?md5=a4a8dc27e1394367024626a31c1adc42&pid=1-s2.0-S2666087324000048-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914904","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}
The impact of recent consensus definitions of cancer therapy–related cardiac dysfunction (CTRCD) from the European Society of Cardiology cardio-oncology guidelines on the reported incidence of CTRCD has not yet been assessed.
Objectives
The aim of this study was to assess the: 1) cumulative incidence; 2) point prevalence during and after adjuvant therapy; and 3) prognostic value of CTRCD as defined by different asymptomatic CTRCD guideline criteria.
Methods
The cumulative incidence and point prevalence of CTRCD were retrospectively assessed in 118 patients participating in the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial. Asymptomatic CTRCD was assessed using alternative cardiac troponin (cTn) 99th percentile upper reference limits (URLs) to define cTnT and cTnI elevation.
Results
The cumulative incidence of moderate or severe CTRCD was low (1.7%), whereas the cumulative incidence of mild asymptomatic CTRCD was higher and differed markedly according to the biomarker criteria applied, ranging from 49.2% of patients when cTnT greater than the sex-specific 99th percentile URL was used to define cTn elevation to 9.3% when sex-neutral cTnI was used. The point prevalence of CTRCD was highest at the end of anthracycline therapy (47.8%) and was driven primarily by asymptomatic cTn elevation. CTRCD during adjuvant therapy was not prognostic for CTRCD at extended follow-up of 24 months (Q1-Q3: 21-29 months) after randomization.
Conclusions
Mild asymptomatic CTRCD during adjuvant breast cancer therapy was frequent and driven mainly by cTn elevation and was not prognostic of subsequent CTRCD. The incidence of mild, asymptomatic CTRCD differed markedly depending on the cTn assay and whether sex-neutral or sex-dependent URLs were applied. (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy [PRADA]; NCT01434134)
{"title":"Impact of the ESC Cardio-Oncology Guidelines Biomarker Criteria on Incidence of Cancer Therapy–Related Cardiac Dysfunction","authors":"Albulena Mecinaj MD , Geeta Gulati MD, PhD , Anne Hansen Ree MD, PhD , Berit Gravdehaug MD , Helge Røsjø MD, PhD , Kjetil Steine MD, PhD , Torbjørn Wisløff PhD , Jürgen Geisler MD, PhD , Torbjørn Omland MD, PhD, MPH , Siri Lagethon Heck MD, PhD","doi":"10.1016/j.jaccao.2023.10.008","DOIUrl":"10.1016/j.jaccao.2023.10.008","url":null,"abstract":"<div><h3>Background</h3><p>The impact of recent consensus definitions of cancer therapy–related cardiac dysfunction (CTRCD) from the European Society of Cardiology cardio-oncology guidelines on the reported incidence of CTRCD has not yet been assessed.</p></div><div><h3>Objectives</h3><p>The aim of this study was to assess the: 1) cumulative incidence; 2) point prevalence during and after adjuvant therapy; and 3) prognostic value of CTRCD as defined by different asymptomatic CTRCD guideline criteria.</p></div><div><h3>Methods</h3><p>The cumulative incidence and point prevalence of CTRCD were retrospectively assessed in 118 patients participating in the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial. Asymptomatic CTRCD was assessed using alternative cardiac troponin (cTn) 99th percentile upper reference limits (URLs) to define cTnT and cTnI elevation.</p></div><div><h3>Results</h3><p>The cumulative incidence of moderate or severe CTRCD was low (1.7%), whereas the cumulative incidence of mild asymptomatic CTRCD was higher and differed markedly according to the biomarker criteria applied, ranging from 49.2% of patients when cTnT greater than the sex-specific 99th percentile URL was used to define cTn elevation to 9.3% when sex-neutral cTnI was used. The point prevalence of CTRCD was highest at the end of anthracycline therapy (47.8%) and was driven primarily by asymptomatic cTn elevation. CTRCD during adjuvant therapy was not prognostic for CTRCD at extended follow-up of 24 months (Q1-Q3: 21-29 months) after randomization.</p></div><div><h3>Conclusions</h3><p>Mild asymptomatic CTRCD during adjuvant breast cancer therapy was frequent and driven mainly by cTn elevation and was not prognostic of subsequent CTRCD. The incidence of mild, asymptomatic CTRCD differed markedly depending on the cTn assay and whether sex-neutral or sex-dependent URLs were applied. (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy [PRADA]; <span>NCT01434134</span><svg><path></path></svg>)</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003502/pdfft?md5=222c8e1c81d50d738da39e4a93e38bb7&pid=1-s2.0-S2666087323003502-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635691","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 : 2024-02-01DOI: 10.1016/j.jaccao.2023.11.008
Hananeh Fonoudi PhD , Mariam Jouni PhD , Romina B. Cejas PhD , Tarek Magdy PhD , Malorie Blancard PhD , Ning Ge PhD , Disheet A. Shah PhD , Davi M. Lyra-Leite PhD , Achal Neupane PhD , Mennat Gharib BS , Zhengxin Jiang PhD , Yadav Sapkota PhD , Paul W. Burridge PhD
Background
Genome-wide association studies and candidate gene association studies have identified more than 180 genetic variants statistically associated with anthracycline-induced cardiotoxicity (AIC). However, the lack of functional validation has hindered the clinical translation of these findings.
Objectives
The aim of this study was to functionally validate all genes associated with AIC using human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs).
Methods
Through a systemic literature search, 80 genes containing variants significantly associated with AIC were identified. Additionally, 3 more genes with potential roles in AIC (GSTM1, CBR1, and ERBB2) were included. Of these, 38 genes exhibited expression in human fetal heart, adult heart, and hiPSC-CMs. Using clustered regularly interspaced short palindromic repeats/Cas9–based genome editing, each of these 38 genes was systematically knocked out in control hiPSC-CMs, and the resulting doxorubicin-induced cardiotoxicity (DIC) phenotype was assessed using hiPSC-CMs. Subsequently, functional assays were conducted for each gene knockout on the basis of hypothesized mechanistic implications in DIC.
Results
Knockout of 26 genes increased the susceptibility of hiPSC-CMs to DIC. Notable genes included efflux transporters (ABCC10, ABCC2, ABCB4, ABCC5, and ABCC9), well-established DIC-associated genes (CBR1, CBR3, and RAC2), and genome-wide association study–discovered genes (RARG and CELF4). Conversely, knockout of ATP2B1, HNMT, POR, CYBA, WDR4, and COL1A2 had no significant effect on the in vitro DIC phenotype of hiPSC-CMs. Furthermore, knockout of the uptake transporters (SLC28A3, SLC22A17, and SLC28A1) demonstrated a protective effect against DIC.
Conclusions
The present findings establish a comprehensive platform for the functional validation of DIC-associated genes, providing insights for future studies in DIC variant associations and potential mechanistic targets for the development of cardioprotective drugs.
{"title":"Functional Validation of Doxorubicin-Induced Cardiotoxicity-Related Genes","authors":"Hananeh Fonoudi PhD , Mariam Jouni PhD , Romina B. Cejas PhD , Tarek Magdy PhD , Malorie Blancard PhD , Ning Ge PhD , Disheet A. Shah PhD , Davi M. Lyra-Leite PhD , Achal Neupane PhD , Mennat Gharib BS , Zhengxin Jiang PhD , Yadav Sapkota PhD , Paul W. Burridge PhD","doi":"10.1016/j.jaccao.2023.11.008","DOIUrl":"10.1016/j.jaccao.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p>Genome-wide association studies and candidate gene association studies have identified more than 180 genetic variants statistically associated with anthracycline-induced cardiotoxicity (AIC). However, the lack of functional validation has hindered the clinical translation of these findings.</p></div><div><h3>Objectives</h3><p>The aim of this study was to functionally validate all genes associated with AIC using human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs).</p></div><div><h3>Methods</h3><p>Through a systemic literature search, 80 genes containing variants significantly associated with AIC were identified. Additionally, 3 more genes with potential roles in AIC (<em>GSTM1</em>, <em>CBR1</em>, and <em>ERBB2</em>) were included. Of these, 38 genes exhibited expression in human fetal heart, adult heart, and hiPSC-CMs. Using clustered regularly interspaced short palindromic repeats/Cas9–based genome editing, each of these 38 genes was systematically knocked out in control hiPSC-CMs, and the resulting doxorubicin-induced cardiotoxicity (DIC) phenotype was assessed using hiPSC-CMs. Subsequently, functional assays were conducted for each gene knockout on the basis of hypothesized mechanistic implications in DIC.</p></div><div><h3>Results</h3><p>Knockout of 26 genes increased the susceptibility of hiPSC-CMs to DIC. Notable genes included efflux transporters (<em>ABCC10</em>, <em>ABCC2</em>, <em>ABCB4</em>, <em>ABCC5</em>, and <em>ABCC9</em>), well-established DIC-associated genes (<em>CBR1</em>, <em>CBR3</em>, and <em>RAC2</em>), and genome-wide association study–discovered genes (<em>RARG</em> and <em>CELF4</em>). Conversely, knockout of <em>ATP2B1</em>, <em>HNMT</em>, <em>POR</em>, <em>CYBA</em>, <em>WDR4</em>, and <em>COL1A2</em> had no significant effect on the in vitro DIC phenotype of hiPSC-CMs. Furthermore, knockout of the uptake transporters (<em>SLC28A3</em>, <em>SLC22A17</em>, and <em>SLC28A1</em>) demonstrated a protective effect against DIC.</p></div><div><h3>Conclusions</h3><p>The present findings establish a comprehensive platform for the functional validation of DIC-associated genes, providing insights for future studies in DIC variant associations and potential mechanistic targets for the development of cardioprotective drugs.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":null,"pages":null},"PeriodicalIF":11.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087323003587/pdfft?md5=64731a0f6bc5639c4ff8968a4cdbb875&pid=1-s2.0-S2666087323003587-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638729","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}