Cardio-oncology最新文献

Background: Cardiac Amyloidosis (CA) remains highly underdiagnosed, especially among patients with causes of increased ventricular wall thickness, such as aortic stenosis (AS). The prevalence of CA throughout the spectrum of mild to severe AS is unknown and specific validated diagnostic parameters for this population are lacking. Here, we propose and prospectively evaluate a screening algorithm for CA among patients with mild to severe AS.

Methods: In this prospective, single-center study (NCT05010980), we included patients ≥ 65 years with mild to severe AS, an interventricular septum thickness > 11 mm, and at least one of the following criteria: Sokolow-Lyon-Index to left ventricular mass index ratio < 1.6 or stroke volume index < 35 ml/m2. Participants were prospectively screened for CA according to current guideline recommendations.

Results: After screening 2126 patients of whom 187 were eligible, 57 participants were enrolled and completed the diagnostic work-up. Mean age was 83 ± 0.7 years and 71% were male. 30% of the participants had mild, 37% had moderate and 33% had severe AS, respectively. Overall 26% of participants were diagnosed with CA. The prevalence of CA was higher among patients with mild AS (41%) compared to participants with moderate (24%) or severe AS (16%, p = 0.01). Within this preselected patient population, troponin (AUC:0.9, p < 0.0001) and NT-proBNP (AUC:0.86, p < 0.0001) further improved discrimination of patients with and without CA.

Conclusion: The prevalence of CA among AS patients fulfilling the preselected inclusion criteria was high, especially among those with mild to moderate AS. Implementing these criteria in clinical protocols could improve early diagnosis of CA.

Background: Carcinoid Heart Disease (CHD) primarily affects the right heart valves, while left heart involvement is rare and often associated with a patent foramen ovale (PFO). Early identification of a PFO in CHD can be critical to patient outcomes. A 61-year-old woman with metastatic neuroendocrine tumor presented with worsening breathlessness and hypoxemia. Imaging excluded pulmonary embolism and lung metastases. Transthoracic echocardiography revealed severe tricuspid regurgitation due to carcinoid valve involvement. Persistent hypoxemia prompted transesophageal echocardiography, which demonstrated a right-to-left shunt through a PFO. Right heart catheterization confirmed the findings excluding significant pulmonary hypertension. Percutaneous PFO closure improved oxygenation, but the patient deteriorated due to right ventricular failure and ultimately died from multiorgan failure despite later tricuspid valve replacement.

Conclusion: This case illustrates the importance of early detection of PFO in CHD, as delayed intervention can lead to poor outcomes. Simultaneous PFO closure and valve replacement may be preferable to a staged approach. A multidisciplinary strategy is vital for timely diagnosis and optimal treatment planning in such complex cases.

Aims: Adult survivors of haematological malignancies are at increased risk of long-term cardiovascular sequelae. Several echocardiographic metrics have been tested to detect subclinical myocardial dysfunction before it progresses toward cardiac events. Myocardial work (MW) is a load-independent echocardiographic index that conjugates non-invasive arterial blood pressure and global longitudinal strain (GLS).

Methods: Sixty-three disease-free survivors of Hodgkin Lymphoma (HL) [49% male, median age 42 (33,0-50,5) years], without known cardiovascular disease or reported cardiological symptoms, were included in this observational study. Myocardial work data from cancer survivors were compared with those from healthy subjects recruited in the EACVI NORRE Study.

Results: Mean left ventricular ejection fraction and GLS were, respectively, 57,0% (55,0-60,0) and - 18,0% (-19,2-17,1). Global work efficiency [GWE, 96% (94-97)], global work index (GWI, 1732 ± 340 mmHg%) and global wasted work [GWW, 78 (55-131) mmHg%] did not differ between male and female survivors; however, global constructive work (GCW, 2116 ± 386 mmHg%) was lower in males. Of importance, GWI and GCW were lower in cancer survivors compared to healthy subjects from the EACVI NORRE study (p = 0,0008 and p = 0,0324, respectively). When evaluating associations of MW indices with patients' characteristics, only systolic blood pressure and ejection fraction were independently associated with both GWI and GCW at multivariable analysis.

Conclusion: For the first time, this report provides values of MW indices in asymptomatic HL survivors without cardiovascular disease. GWI and GCW were significantly lower in HL survivors compared to healthy subjects. MW metrics might serve as valuable markers of subclinical cardiac dysfunction in this population.

Background: Patients with primary central nervous system lymphoma (PCNSL) often require high-dose methotrexate (HD-MTX)-based regimens for effective disease control. However, the coexistence of heart failure with a reduced ejection fraction (HFrEF) poses significant challenges due to the increased risk of treatment-related cardiotoxicity and the potential exacerbation of cardiac dysfunction from fluid overload.

Main body: This review explores current PCNSL treatment modalities and their implications for patients with HFrEF. These findings emphasize the importance of multidisciplinary care, the cardiovascular risks associated with HD-MTX and adjunct therapies, and the strategies available to mitigate these risks.

Conclusion: Managing PCNSL in patients with HFrEF requires individualized therapy, vigilant monitoring, and strong collaboration between oncology and cardiology teams. Emerging therapies may reduce cardiotoxicity, but further evidence is needed to guide their safe use in this vulnerable population.

Cardiac fibrosis, a condition characterized by the deposition of excess collagen in the cardiac tissue, is a major complication of various cardiovascular diseases, including myocardial infarction, hypertension, and different types of cardiomyopathies. CAR T-cell therapy, a form of immunotherapy that involves the genetic modification of T cells to recognize and target specific antigens, has shown promise in the treatment of various cancers and autoimmune diseases. The rationale behind using CAR T-cell therapy to treat cardiac fibrosis lies in the fact that fibrosis is often driven by the activation of pro-fibrotic immune cells, such as myofibroblasts. By targeting these pro-fibrotic cells with CAR T-cells, it may be possible to reduce the severity of cardiac fibrosis. Enhancing CAR T-cell therapy through innovative nanoparticle delivery systems provides a comprehensive approach to treating cardiac fibrosis, with experimental evidence indicating potential in reducing fibrosis and improving cardiac function. Despite these benefits, significant challenges such as cardiotoxicity and cardiovascular complications remain. Therefore, this review explores the molecular mechanisms underlying cardiac fibrosis and the effects of CAR T-cell therapy on the heart, elucidating both its antifibrotic properties and associated cardiotoxic effects based on findings from recent studies.

Background: Anti-HER2 receptor monoclonal antibodies like trastuzumab are the mainstay of treatment in HER2-positive breast cancer but can result in cancer therapy-related cardiac dysfunction (CTRCD). Guidelines recommend cardiac surveillance prior to anti-HER2 therapy initiation, every 3 months during therapy, and within 1 year after therapy completion. Resource limitations in safety-net settings without cardio-oncology programs may impact cardiac surveillance and treatment patterns and contribute to disparities in cardiovascular health among patients with cancer. We aimed to characterize and compare patterns of cardiac surveillance and short-term cardiovascular outcomes among patients with breast cancer receiving trastuzumab in a safety-net versus a tertiary care system.

Methods: A retrospective cohort study was conducted on women diagnosed with stage I-III HER2-positive breast cancer between 2018 and 2020 in a safety-net and a tertiary care system. Clinical data from transthoracic echocardiograms, multigated acquisition scans, and cardiac magnetic resonance imaging one year out from trastuzumab initiation were collected. CTRCD was defined by decrements in left ventricular ejection fraction, global longitudinal strain changes, and symptoms of heart failure. Demographics and referral patterns were also assessed.

Results: A total of 235 patients were included (93 safety-net, 142 tertiary care). The safety-net population was 23% Black, 60% Hispanic, and 69% uninsured, while the tertiary care population was 64% White and 3.5% uninsured (p < 0.001). Baseline cardiac surveillance was obtained in 84% of safety-net patients and 89% of tertiary care patients, with mean surveillance interval of approximately 3 months. Only 54% of patients at each site obtained cardiac surveillance post-trastuzumab. CTRCD occurred in 12% of patients in the safety-net system and 19% in the tertiary care system, with most cases being asymptomatic (p = 0.143). High-risk patients were more likely to be referred to cardiology/cardio-oncology in the tertiary care system compared to the safety-net system (67% vs. 6.7%, p < 0.001).

Conclusions: While our data shows similar frequency of cardiac surveillance based on left ventricular ejection fraction at our safety-net and tertiary care center, the utilization of various imaging modalities and cardiology/cardio-oncology services were significantly different between the two institutions. These differences may result in underdiagnosis of CTRCD in vulnerable populations and contribute to inferior long-term cardiovascular outcomes.

Cardiotoxicity is a significant challenge associated with common first-line breast cancer (BC) anti-neoplastic (CTx) treatments including anthracyclines (AC) and targeted immunotherapies, such as anti-Her-2 therapy. Non-Hispanic black/African American (NHB) women are at higher risk for CTx induced cardiotoxicity compared to Non-Hispanic White (NHW) women. To date, most study efforts to mitigate cardiotoxicity target large vessels and cardiac damage. However, impaired microvascular function may also be implicated. Further, although exercise interventions reduce systemic inflammation and cardiovascular risk, few cardio-oncology studies examine the effect of exercise on CTx cardiotoxicity, and none have quantified microvascular endothelial function. An additional gap is the paucity of studies focused on racial disparities. The Discovery and Elimination of Cardio-Oncology Disparities for Equity in the Heartland (DECODE Heartland) Center addresses these gaps with three overarching goals to: (1) Test the feasibility and efficacy of the Take Charge during Treatment (TCT) exercise intervention designed to mitigate the adverse effects of CTx; (2) Quantify differences on exercise capacity and quality of life (QoL), endothelial function and molecular differences in inflammation in NHB versus NHW BC patients before and following CTx; and (3) Examine the influence of socio-ecological factors (individual, interpersonal, systemic, environmental) on inflammation, microvascular endothelial function, QoL in response to the exercise intervention. NHB and NHW women diagnosed with non-metastatic BC, scheduled to receive AC and/or anti-Her2 therapy, will be recruited and randomized to participate in the TCT intervention or usual care. TCT is a virtual exercise program with weekly coaching sessions, six of which include supervised exercise. Assessments include surveys, dual X-ray absorptiometry, flow-mediated dilation, pulse wave velocity and analysis, VO₂ peak cycling test, fat biopsy, venous puncture blood draw, geocoding of patient addresses, and measurement of neighborhood characteristics. Assessments will be captured prior to treatment, post-intervention (16-20 weeks), and at follow-up/study completion (12-18 months post-diagnosis). This study reflects a first step in a research trajectory to identify upstream determinants of disparities and discern how behavioral strategies can assist diverse BC survivors to move through treatment toward better health, including reduced rates of cardiotoxicity following anti-cancer treatment.

Background: Breast cancer survivors are at a high risk of developing cardiovascular disease (CVD) owing to cancer treatment. Breast cancer and CVD share common risk factors, necessitating CVD risk assessment along with cancer screening. This review aimed to explore the challenges and opportunities associated with promoting cardiovascular health in women with breast cancer.

Main text: Cardio-oncology is a rapidly developing discipline that focuses on identifying, monitoring, and managing CVD in cancer patients. Preventing and managing CVD in patients with breast cancer involves evaluating risk factors, initiating cardioprotective medications, and implementing cardio-oncology rehabilitation. Major barriers to cardio-oncology prevention and management include inadequate programs, sex/gender-specific issues, financial constraints, underutilization of cardiac rehabilitation (CR), determination of the appropriate time to begin CR, physical limitations, psychological issues, and social and racial disparities.

Conclusion: A preventive cardio-oncology approach; early identification of cardiotoxicity, CVD risk factors, anxiety, and depression; individualized CR programs; early CR referrals; home/community and virtual CR models; dedicated funding, resources, and personnel; a multidisciplinary team approach; and culturally tailored cardio-oncology care can be beneficial for addressing CVD health challenges and disparities in women with breast cancer.