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Differential cardiac impacts of hematological malignancies and solid tumors: a histopathological and biomarker study. 血液恶性肿瘤和实体肿瘤对心脏的不同影响:一项组织病理学和生物标志物研究。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-19 DOI: 10.1186/s40959-024-00285-3
Michael H Udin, Sunitha Shyam Sunder, Sarmila Nepali, Sharma Kattel, Amr Abdelradi, Scott T Doyle, Ciprian N Ionita, Qian Liu, Umesh C Sharma, Saraswati Pokharel

Background: Cancer patients are known to be associated with increased risk of cardiovascular disease. However, no studies have examined the differential impact of hematologic malignancies (HMs) and solid tumors (STs) on cardiac morphology at the tissue level.

Objective: We aimed to examine histopathological features alongside cardiovascular biomarkers in patients with HMs and STs who underwent post-mortem evaluation.

Methods: We analyzed cardiac changes in 198 patients with HMs and 164 patients with solid tumors STs. We compared demographics, echocardiogram data, exposure to various antineoplastic agents, and post-mortem findings. Additionally, cardiac histological validation was conducted on post-mortem cardiac specimens to examine cardiac tissue morphology, focusing on cardiomyocyte nuclear density, collagen content, and collagen fiber orientation.

Results: HM patients displayed significantly disordered collagen fiber alignment (0.71 vs 0.83, P = 0.027), and reduced cardiomyocyte nuclear density (56 vs 72, P = 0.002) compared to ST patients. Similarly, hemoglobin level was decreased (6.71 vs 8.06, P < 0.001) in HM patients compared to ST patients. HM patients also showed elevated B-type natriuretic peptide levels (2,275 vs 867, P < 0.001), without significant differences in creatine-kinase MB and cardiac troponin levels. Multivariate analysis identified increased right ventricular thickness, low diastolic blood pressure, and high cardiac troponin levels as risk factors for cardiac death in HM patients.

Conclusions: This study demonstrates that HM patients have fewer cardiomyocyte nuclei and poorly aligned collagen, with serum biomarker evidence of increased cardiac dysfunction. This supports the necessity for specialized cardiac care for these patients.

背景:已知癌症患者与心血管疾病的风险增加有关。然而,没有研究在组织水平上检查血液恶性肿瘤(HMs)和实体肿瘤(STs)对心脏形态的不同影响。目的:我们的目的是检查HMs和STs患者死后评估的组织病理学特征和心血管生物标志物。方法:我们分析了198例HMs患者和164例实体瘤性STs患者的心脏变化。我们比较了人口统计学、超声心动图数据、暴露于各种抗肿瘤药物和死后发现。此外,对死后心脏标本进行心脏组织学验证,以检查心脏组织形态学,重点关注心肌细胞核密度、胶原含量和胶原纤维取向。结果:与ST患者相比,HM患者表现出明显的胶原纤维排列紊乱(0.71 vs 0.83, P = 0.027),心肌细胞核密度降低(56 vs 72, P = 0.002)。同样,血红蛋白水平降低(6.71 vs 8.06, P)。结论:本研究表明HM患者心肌细胞核减少,胶原排列不良,血清生物标志物表明心功能障碍增加。这支持了对这些患者进行专门心脏护理的必要性。
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引用次数: 0
Challenges in the implementation of cardio-oncology trials: lessons learnt from investigating statins in the prevention of anthracycline cardiotoxicity. 实施心脏肿瘤学试验的挑战:从调查他汀类药物预防蒽环类药物心脏毒性中获得的经验教训。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-18 DOI: 10.1186/s40959-024-00292-4
John Lee, Sean Tan, Satish Ramkumar

Despite advanced in targeted cancer therapies, anthracyclines remain essential in treating various malignancies, albeit with risks of cancer therapy-related cardiac dysfunction (CTRCD). Out of the myriad of mitigation strategies for CTRCD, statins are an attractive preventive therapy for anthracycline associated CTRCD given their widespread availability, cheap costs and added benefit of atherosclerotic cardiovascular disease (ASCVD) risk reduction. Recent trials of PREVENT, SPARE-HF, and STOP-CA investigated atorvastatin's efficacy in preventing CTRCD, with mixed outcomes. While STOP-CA showed a significant reduction in CTRCD rates (22% vs. 8% in placebo), PREVENT and SPARE-HF found no statistical differences between statin and placebo groups. The trials faced challenges such as selection bias, exclusion of patients with comorbidities, and reliance on imaging-derived outcomes, which may not reflect clinically meaningful benefits. This calls for improved trial designs that prioritize diverse patient recruitment, longer follow-ups, and clinically relevant endpoints to enhance the translational impact of findings. Addressing these challenges collaboratively between oncology and cardiology will be crucial for optimizing patient outcomes in this vulnerable population. Future studies should emphasize both immediate cardioprotective effects and long-term cardiovascular benefits of statins, especially in the context of atherosclerotic cardiovascular disease in cancer survivors.

尽管靶向癌症治疗取得了进展,蒽环类药物在治疗各种恶性肿瘤中仍然必不可少,尽管存在癌症治疗相关心功能障碍(CTRCD)的风险。在无数缓解CTRCD的策略中,他汀类药物是蒽环类药物相关CTRCD的一种有吸引力的预防治疗方法,因为他汀类药物广泛可用,成本低廉,并且具有降低动脉粥样硬化性心血管疾病(ASCVD)风险的额外益处。最近的prevention、SPARE-HF和STOP-CA试验研究了阿托伐他汀预防CTRCD的疗效,结果不一。STOP-CA显示CTRCD发生率显著降低(22% vs.安慰剂组8%),而PREVENT和SPARE-HF发现他汀类药物组和安慰剂组之间没有统计学差异。这些试验面临着选择偏倚、排除合并症患者以及依赖影像学结果等挑战,这可能无法反映有临床意义的益处。这就需要改进试验设计,优先考虑多样化的患者招募、更长的随访和临床相关的终点,以增强研究结果的转化影响。在肿瘤学和心脏病学之间合作解决这些挑战对于优化这一弱势群体的患者预后至关重要。未来的研究应强调他汀类药物的即时心脏保护作用和长期心血管益处,特别是在癌症幸存者的动脉粥样硬化性心血管疾病的背景下。
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引用次数: 0
Thrombo-inflammation linking androgen suppression with cardiovascular risk in patients with prostate cancer. 前列腺癌患者雄激素抑制与心血管风险相关的血栓炎症
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-05 DOI: 10.1186/s40959-024-00278-2
Antonia Beitzen-Heineke, David R Wise, Jeffrey S Berger

Androgen deprivation therapy (ADT), a key element of prostate cancer treatment, is associated with increased risk for cardiovascular morbidity and mortality. The underlying mechanisms include adverse metabolic alterations, but further mechanisms are likely. Animal studies suggest increased progression of atherosclerosis in androgen deprived conditions. Based on in vitro studies, lack of androgens may modulate immune cells including monocytes, macrophages, and T-cells towards a pro-inflammatory phenotype and pro-atherogenic function. As a novel aspect, this review summarizes existing data on the effect of androgens and androgen deprivation on platelet activity, which play a major role in inflammation and in the initiation and progression of atherosclerotic lesions. Testosterone modulates platelet aggregation responses which are affected by dose level, source of androgen, and age. Data on the effects of ADT on platelet activity and aggregation are limited and conflicting, as both increased and decreased aggregation responses during ADT have been reported. Gaps in knowledge about the mechanisms leading to increased cardiovascular risk during ADT remain and further research is warranted. Improved understanding of pathogenic pathways linking ADT to cardiovascular risk may help identify clinically useful diagnostic and prognostic biomarkers, and accelerate finding novel therapeutic targets, and thus optimize prostate cancer treatment outcomes.

雄激素剥夺疗法(ADT)是前列腺癌治疗的一个关键因素,与心血管疾病发病率和死亡率的增加有关。潜在的机制包括不利的代谢改变,但可能还有其他机制。动物研究表明,雄激素缺乏会增加动脉粥样硬化的进展。根据体外研究,缺乏雄激素可能会调节免疫细胞,包括单核细胞、巨噬细胞和t细胞,使其具有促炎表型和促动脉粥样硬化功能。作为一个新的方面,本文综述了雄激素和雄激素剥夺对血小板活性影响的现有数据,血小板活性在炎症和动脉粥样硬化病变的发生和进展中起着重要作用。睾酮调节血小板聚集反应受剂量水平、雄激素来源和年龄的影响。关于ADT对血小板活性和聚集的影响的数据有限且相互矛盾,因为ADT期间聚集反应的增加和减少都有报道。关于ADT期间导致心血管风险增加的机制的知识差距仍然存在,需要进一步研究。更好地了解ADT与心血管风险之间的致病途径可能有助于确定临床有用的诊断和预后生物标志物,并加速寻找新的治疗靶点,从而优化前列腺癌的治疗结果。
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引用次数: 0
A comprehensive review on the effects of sex hormones on chemotherapy-induced cardiotoxicity: are they lucrative or unprofitable? 性激素对化疗引起的心脏毒性影响的综合综述:它们是有利可图的还是无利可图的?
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-03 DOI: 10.1186/s40959-024-00293-3
Golnaz Kheradkhah, Mohammad Sheibani, Tina Kianfar, Zahra Toreyhi, Yaser Azizi

Chemotherapy is one of the routine treatment for preventing rapid growth of the tumor cells. However, chemotherapeutic agents, especially doxorubicin cause damages to the normal cells especially cardiomyocytes. Cardiotoxicity induced by chemotherapeutic drugs lead to the myocardial cell injury and finally causes left ventricular dysfunction. It seems that there were some differences in the severity of cardiovascular side effects of drugs used in the treatment of cancers. Sex hormones in male and female play crucial roles in cardiovascular development and physiological function of the heart and blood vessels. Gender differences and sex-specific hormones influence various aspects of cardiovascular health, including ventricular function, mitochondrial autophagy, and the development of abdominal aortic aneurysms. The most important gender related hormones are LH, FSH, testosterone, estrogen, progesterone, prolactin and oxytocin. They exert very important cardiovascular effects via different signaling mechanisms. Sex related hormones are also important in the cardiovascular side effects of chemotherapeutic agents, so that chronic cardiotoxicity induced by anthracyclines is more common in women. During different stages of life (before, during, and after sexual life), the levels of these hormones will be changed. This alterations can affect cardiovascular function during physiological conditions and pathological process. Because of the importance of the sex related hormones in the cardiac function, in this review we tried to comprehensively elucidate the role of these physiological hormones in cardiotoxicity induced by chemotherapeutic agents with emphasizing their signaling mechanisms.

化疗是防止肿瘤细胞快速生长的常规治疗方法之一。然而,化疗药物,特别是阿霉素对正常细胞,特别是心肌细胞造成损害。化疗药物引起的心脏毒性可导致心肌细胞损伤,最终导致左心室功能障碍。似乎在治疗癌症的药物中,心血管副作用的严重程度有所不同。性激素在男性和女性的心血管发育和心脏血管的生理功能中起着至关重要的作用。性别差异和性别特异性激素影响心血管健康的各个方面,包括心室功能、线粒体自噬和腹主动脉瘤的发展。最重要的与性别相关的激素是黄体生成素、卵泡刺激素、睾酮、雌激素、孕酮、催乳素和催产素。它们通过不同的信号机制发挥非常重要的心血管作用。性相关激素在化疗药物的心血管副作用中也很重要,因此蒽环类药物引起的慢性心脏毒性在女性中更为常见。在人生的不同阶段(性生活前、性生活中、性生活后),这些激素的水平会发生变化。这种改变可以在生理状态和病理过程中影响心血管功能。鉴于性激素在心功能中的重要作用,本文试图全面阐明这些生理激素在化疗药物引起的心脏毒性中的作用,并重点阐述其信号机制。
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引用次数: 0
A strain-guided trial of cardioprotection in early-stage breast cancer patients on anti-HER2 therapy (PROTECT HER2). 对接受抗 HER2 治疗的早期乳腺癌患者进行应变指导的心脏保护试验(PROTECT HER2)。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-27 DOI: 10.1186/s40959-024-00291-5
Fei Fei Gong, Eli Grunblatt, Woo Bin Voss, Vibhav Rangarajan, Sasan Raissi, Kimberly Chow, Lua Jafari, Nikita P Patel, Inga Vaitenas, Milica Marion, Haydee Ramirez, Manyun Zhao, Adin-Christian Andrei, Abigail S Baldridge, Gillian Murtagh, Kameswari Maganti, Vera H Rigolin, Nausheen Akhter

Background: Global longitudinal strain (GLS) has been used to identify patients at risk for cancer-therapy related cardiac dysfunction (CTRCD). However, there is limited data on the effectiveness of initiating cardioprotective therapy based on a strain-guided strategy in early stage HER2+ breast cancer patients. This randomized clinical trial assessed if treatment with carvedilol based on a strain-guided strategy can prevent development of CTRCD in HER2+ breast cancer patients on non-anthracycline based regimens.

Methods: Study participants were prospectively assigned to one of four arms. Patients with normal LVEF and GLS remained in Arm A. Patients whose GLS decreased by > 15% from baseline or to < -15% during follow up were randomized 1:1 to prophylactic carvedilol (Arm B) or no therapy (Arm C). Patients who developed CTRCD were assigned to Arm D. The primary endpoint was GLS stability. The secondary endpoints were development of CTRCD and rate of anti-HER2 treatment interruption.

Results: Among 110 patients who completed follow up, 84 were assigned to Arm A, 10 each were randomized to Arms B or C, and 6 were assigned to Arm D. At the end of the study period, there were no significant differences in GLS stability, development of CTRCD, or number of cancer therapy cycles completed between patients who did and did not receive cardioprotective therapy.

Conclusions: In this prospective randomized GLS-guided study of prophylactic carvedilol in early stage HER2+ breast cancer patients on non-anthracycline regimens, there were no significant difference between groups in GLS stability, CTRCD or trastuzumab cycles held. These findings may identify a low-risk group of patients who may be considered for less intensive cardiac surveillance.

Trial registration: https://clinicaltrials.gov/study/NCT02993198 . Start date: 4/2015. This trial included patients who were retrospectively registered.

背景:全球纵向应变(GLS)已被用于识别癌症治疗相关心功能障碍(CTRCD)的高危患者。然而,基于应变指导策略对早期 HER2+ 乳腺癌患者启动心脏保护治疗的有效性数据有限。这项随机临床试验评估了基于应变指导策略的卡维地洛治疗是否能预防接受非蒽环类药物治疗的HER2+乳腺癌患者发生CTRCD:研究参与者被前瞻性地分配到四组中的一组。随访期间GLS从基线下降>15%或降至<-15%的患者按1:1随机分配至预防性卡维地洛(B组)或不治疗(C组)。出现 CTRCD 的患者被分配到 D 组。次要终点是出现 CTRCD 和抗 HER2 治疗中断率:在完成随访的 110 名患者中,84 人被分配到 A 组,10 人被随机分配到 B 组或 C 组,6 人被分配到 D 组。在研究期结束时,接受和未接受心脏保护疗法的患者在 GLS 稳定性、CTRCD 发生率或完成癌症治疗周期数方面没有显著差异:在这项前瞻性随机GLS指导研究中,对使用非蒽环类疗法的早期HER2+乳腺癌患者进行预防性卡维地洛治疗后,各组间在GLS稳定性、CTRCD或曲妥珠单抗治疗周期方面没有明显差异。这些发现可能会确定一组低风险患者,可考虑对其进行强度较低的心脏监测。试验注册:https://clinicaltrials.gov/study/NCT02993198 。开始日期:2015 年 4 月。该试验包括回顾性登记的患者。
{"title":"A strain-guided trial of cardioprotection in early-stage breast cancer patients on anti-HER2 therapy (PROTECT HER2).","authors":"Fei Fei Gong, Eli Grunblatt, Woo Bin Voss, Vibhav Rangarajan, Sasan Raissi, Kimberly Chow, Lua Jafari, Nikita P Patel, Inga Vaitenas, Milica Marion, Haydee Ramirez, Manyun Zhao, Adin-Christian Andrei, Abigail S Baldridge, Gillian Murtagh, Kameswari Maganti, Vera H Rigolin, Nausheen Akhter","doi":"10.1186/s40959-024-00291-5","DOIUrl":"10.1186/s40959-024-00291-5","url":null,"abstract":"<p><strong>Background: </strong>Global longitudinal strain (GLS) has been used to identify patients at risk for cancer-therapy related cardiac dysfunction (CTRCD). However, there is limited data on the effectiveness of initiating cardioprotective therapy based on a strain-guided strategy in early stage HER2+ breast cancer patients. This randomized clinical trial assessed if treatment with carvedilol based on a strain-guided strategy can prevent development of CTRCD in HER2+ breast cancer patients on non-anthracycline based regimens.</p><p><strong>Methods: </strong>Study participants were prospectively assigned to one of four arms. Patients with normal LVEF and GLS remained in Arm A. Patients whose GLS decreased by > 15% from baseline or to < -15% during follow up were randomized 1:1 to prophylactic carvedilol (Arm B) or no therapy (Arm C). Patients who developed CTRCD were assigned to Arm D. The primary endpoint was GLS stability. The secondary endpoints were development of CTRCD and rate of anti-HER2 treatment interruption.</p><p><strong>Results: </strong>Among 110 patients who completed follow up, 84 were assigned to Arm A, 10 each were randomized to Arms B or C, and 6 were assigned to Arm D. At the end of the study period, there were no significant differences in GLS stability, development of CTRCD, or number of cancer therapy cycles completed between patients who did and did not receive cardioprotective therapy.</p><p><strong>Conclusions: </strong>In this prospective randomized GLS-guided study of prophylactic carvedilol in early stage HER2+ breast cancer patients on non-anthracycline regimens, there were no significant difference between groups in GLS stability, CTRCD or trastuzumab cycles held. These findings may identify a low-risk group of patients who may be considered for less intensive cardiac surveillance.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT02993198 . Start date: 4/2015. This trial included patients who were retrospectively registered.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"10 1","pages":"85"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clonal hematopoiesis of indeterminate potential is associated with increased risk of immune checkpoint inhibitor myocarditis in a prospective study of a cardio-oncology cohort. 在一项心脏病肿瘤学队列的前瞻性研究中,不确定潜能的克隆性造血与免疫检查点抑制剂心肌炎风险的增加有关。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.1186/s40959-024-00289-z
Rachel Jaber Chehayeb, Jaiveer Singh, Carlos Matute-Martinez, Nathan W Chen, Ana Ferrigno Guajardo, Derrick Lin, Ritujith Jayakrishnan, Anthos Christofides, Etienne Leveille, Yunju Im, Giulia Biancon, Jennifer VanOudenhove, Eiman Ibrahim, Anastasias Ardasheva, Alokkumar Jha, John Hwa, Stephanie Halene, Jennifer M Kwan

Background: Clonal hematopoiesis of indeterminate potential (CHIP) has been shown to increase all-cause mortality and risk of cardiomyopathy in patients with solid malignancies. CHIP has also been shown to increase T cell activation in heart failure patients. It is unclear whether CHIP can affect the risk of immune checkpoint inhibitor (ICI) myocarditis in patients with cancer treated with immunotherapy.

Methods: We enrolled patients with solid tumors in a prospective study, determined CHIP status at time of enrollment through blood whole exome sequencing, and assessed incidence of ICI myocarditis from time of enrollment through December 1st, 2023. We performed a competing risk cox regression to evaluate the role of CHIP in ICI myocarditis, accounting for patient demographics, cardiac comorbidities, cardiotoxic cancer therapy, and dual ICI use in our covariates. We also generated cumulative incidence curves using subdistribution hazards to evaluate development of ICI myocarditis stratified by CHIP vs no CHIP. Chart review was performed to evaluate patient co-morbidities, lab values, imaging findings and outcomes.

Results: Among the 88 patients receiving ICI therapy, average age was 67 ± 14 years, of which 50% harbored CHIP variants. Among all comorbidities, including diabetes, heart failure and obstructive coronary artery disease, only coronary artery calcifications were significantly increased in patients with CHIP. There were no statistically significant differences in cancer therapy or cardiovascular drugs between patients with and without CHIP. Among examined outcomes, patients with CHIP had a statistically higher rate of ICI myocarditis (overall: 57%, CHIP: 73% (32/44), no CHIP: 41% (18/44), p = 0.003) and death (CHIP: 60%, no CHIP 31%, p = 0.011). In a multivariate competing risk analysis, CHIP status doubled the risk of developing ICI myocarditis, similar to the risk of dual ICI use (CHIP status HR 2.74, 95% CI: 1.44-5.22, p = 0.002 vs dual ICI use HR 2.39, 95% CI: 1.11-5.14, p = 0.026).

Conclusions: This study is the first to show that CHIP independently increases risk of ICI myocarditis, with implications for risk stratification of patients prior to ICI initiation and frequency of cardiac monitoring.

背景:事实证明,不确定潜能克隆造血(CHIP)会增加实体恶性肿瘤患者的全因死亡率和心肌病风险。CHIP还被证明会增加心衰患者的T细胞活化。目前还不清楚CHIP是否会影响接受免疫疗法的癌症患者患免疫检查点抑制剂(ICI)心肌炎的风险:我们在一项前瞻性研究中招募了实体瘤患者,通过血液全外显子组测序确定了入组时的 CHIP 状态,并评估了入组至 2023 年 12 月 1 日期间 ICI 心肌炎的发病率。我们进行了竞争风险 cox 回归,以评估 CHIP 在 ICI 心肌炎中的作用,并在协变量中考虑了患者人口统计学特征、心脏合并症、心脏毒性癌症治疗和双 ICI 使用。我们还利用亚分布危险度生成了累积发病率曲线,以评估 ICI 心肌炎的发病情况,并将 CHIP 与无 CHIP 进行了分层。我们还对病历进行了审查,以评估患者的并发症、实验室值、影像学检查结果和预后:在88名接受ICI治疗的患者中,平均年龄为67±14岁,其中50%携带CHIP变异体。在所有合并症中,包括糖尿病、心力衰竭和阻塞性冠状动脉疾病,只有冠状动脉钙化在CHIP患者中明显增加。在癌症治疗或心血管药物方面,CHIP患者与非CHIP患者之间没有明显的统计学差异。在检查结果中,CHIP 患者发生 ICI 心肌炎(总体:57%,CHIP:73% (32/44),无 CHIP:41% (18/44),P = 0.003)和死亡(CHIP:60%,无 CHIP:31%,P = 0.011)的比例较高。在多变量竞争风险分析中,CHIP状态使患ICI心肌炎的风险增加一倍,与使用双重ICI的风险相似(CHIP状态HR 2.74,95% CI:1.44-5.22,p = 0.002 vs 使用双重ICI HR 2.39,95% CI:1.11-5.14,p = 0.026):本研究首次表明,CHIP 会独立增加 ICI 心肌炎的风险,这对 ICI 启动前患者的风险分层和心脏监测频率都有影响。
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引用次数: 0
Sternotomy and extracorporal circulation for fulminant Budd-Chiari syndrome due to leiomyosarcoma of the inferior vena cava. 下腔静脉利肌肉瘤导致的暴发性巴德-卡里综合征的截流术和椎体外循环。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-25 DOI: 10.1186/s40959-024-00287-1
Maciej Wiewiora, Hanna Wiewiora, Ewa Chmielik, Michal Jarzab, Michael Grynkiewicz, Marcin Kubeczko

Background: Budd-Chiari syndrome is a rare and severe vascular liver disease. We presented patient with fulminant liver failure secondary to leiomyosarcoma of the IVC and thrombosis.

Case presentation: A 44-year-old female presented with fulminant liver failure secondary to inferior vena cava (IVC) thrombosis. Contrast-enhanced computed tomography subsequently revealed a thrombus within the IVC, extending cranially to the right atrium and caudally to the renal veins. The patient's condition, characterized by early comatose symptoms, necessitated surgical intervention. Under extracorporeal circulation, a right atriotomy with thrombus lesion removal and descending thrombectomy of the IVC was performed. Hepatic congestion resolved after the thrombus was removed. A pathological examination of the excised thrombus revealed the presence of high-grade leiomyosarcoma.

Conclusions: In cases where a thrombus extends from the IVC to the right atrium, urgent surgical intervention with extracorporeal circulation should be considered.

背景:巴德-恰里综合征是一种罕见的严重血管性肝病:布德-恰里综合征是一种罕见的严重血管性肝病。我们接诊了一名继发于下腔静脉癌和血栓形成的暴发性肝衰竭患者:一名 44 岁女性因下腔静脉(IVC)血栓形成而出现暴发性肝衰竭。随后,对比增强计算机断层扫描显示,下腔静脉内存在血栓,血栓头端延伸至右心房,尾端延伸至肾静脉。患者的病情以早期昏迷症状为特征,因此有必要进行手术治疗。在体外循环下,进行了右心房切开术,切除了血栓病灶,并对 IVC 进行了降支血栓切除术。血栓取出后,肝充血症状缓解。对切除的血栓进行病理检查后发现,存在高分化腺癌:结论:当血栓从内静脉延伸至右心房时,应考虑使用体外循环进行紧急手术治疗。
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引用次数: 0
Clinical and pathological characteristics of immune checkpoint inhibitor-related fulminant myocarditis. 免疫检查点抑制剂相关暴发性心肌炎的临床和病理特征
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-21 DOI: 10.1186/s40959-024-00288-0
Ryo Izumi, Toru Hashimoto, Hiroshi Kisanuki, Kei Ikuta, Wataru Otsuru, Soshun Asakawa, Shoei Yamamoto, Kayo Misumi, Takeo Fujino, Keisuke Shinohara, Shouji Matsushima, Kazuya Hosokawa, Shunsuke Katsuki, Taro Mori, Mikiko Hashisako, Yuki Tateishi, Takeshi Iwasaki, Yoshinao Oda, Shintaro Kinugawa, Kohtaro Abe

The advent of immune checkpoint inhibitors (ICIs) has significantly improved cancer treatment. With the increasing use of ICIs, ICI-related myocarditis has been recognized. However, an evidence-based therapeutic strategy has not been established because of the limited knowledge on ICI-related myocarditis. Here, we present four cases of ICI-related fulminant myocarditis (FM). Three of the four cases resulted in fatal outcomes despite aggressive treatment with mechanical circulatory support and immunosuppressive therapy with corticosteroids. Given the poor prognosis of ICI-FM, the establishment of rapid and adequate therapeutic interventions on the basis of clinical and pathological evaluation is imperative.

免疫检查点抑制剂(ICIs)的出现大大改善了癌症治疗。随着 ICIs 的使用越来越多,ICI 相关性心肌炎也被人们所认识。然而,由于对 ICI 相关心肌炎的了解有限,基于证据的治疗策略尚未确立。在此,我们介绍了四例与 ICI 相关的暴发性心肌炎(FM)病例。尽管患者接受了机械循环支持和皮质类固醇免疫抑制治疗,但四例病例中有三例最终死亡。鉴于 ICI-FM 的预后较差,根据临床和病理评估建立快速、适当的治疗干预措施势在必行。
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引用次数: 0
Cardiac arrhythmias during and after thoracic irradiation for malignancies. 恶性肿瘤胸部照射期间和之后的心律失常。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-14 DOI: 10.1186/s40959-024-00277-3
Markus B Heckmann, Jan P Münster, Daniel Finke, Hauke Hund, Fabian Schunn, Jürgen Debus, Christine Mages, Norbert Frey, Ann-Kathrin Rahm, Lorenz H Lehmann

Background: Cardiac arrhythmia has been reported as a significant complication of thoracic radiotherapy. Both bradyarrhythmias and tachyarrhythmias have been reported, highlighting the arrhythmia-modulating potential of radiation in certain oncologic therapies. This study aimed to analyse the arrhythmic burden in patients with cardiac implantable electrical devices (CIEDs) undergoing thoracic irradiation, examining both immediate effects of radiotherapy and long-term sequelae post-therapy.

Methods and results: A retrospective cohort study was conducted involving patients with CIEDs who received thoracic radiotherapy between January 2012 and December 2022. Two distinct analyses were performed involving (1) daily CIED follow-ups during radiotherapy and (2) long-term arrhythmic outcomes post-therapy. For long-term outcomes, Patients were matched in a 1:2 ratio with non-irradiated controls based on age, sex, cardiovascular risk factors, cardiac disease, and beta-blocker use. Statistical analyses included negative binomial regression and propensity score matching. A total of 186 patients underwent daily CIED monitoring during radiotherapy, with 79 receiving thoracic irradiation. Thoracic irradiation was negatively associated with atrial arrhythmia (OR 0.11 [0.02;0.70, 95% CI], adjusted p = 0.0498) and there was a tendency towards less ventricular events (OR 0.14 [0.02;1.41, 95% CI], adjusted p = 0.3572) during radiotherapy in a univariate regression analysis. This association was not significant in the multivariate (OR 0.44 [0.10;1.80, 95%-CI], p = 0.16) model including a history of atrial fibrillation, diabetes and beta-blocker use. Coronary artery disease was associated with an increase in atrial and ventricular arrhythmia. For the long-term analysis, 122 patients were followed up after thoracic (N = 33) and non-thoracic radiation (N = 89) and compared to 244 matched controls drawn from approximately 10.000 CIED-patients. There was no significant increase in arrhythmic events compared to controls over a median follow-up of 6.6 months. A previous history of ventricular or atrial arrhythmic events was the strongest predictor for events during the follow-up.

Conclusion: Thoracic radiotherapy can be safely administered in patients with CIEDs. However, patients with a history of arrhythmia are more prone to arrhythmic events during and after radiation. These findings highlight the need for personalized arrhythmia management strategies and further research to understand the mechanisms underlying the antiarrhythmic effects of thoracic radiation.

背景:据报道,心律失常是胸部放疗的一个重要并发症。缓性心律失常和快速性心律失常均有报道,这凸显了放射治疗在某些肿瘤治疗中调节心律失常的潜力。本研究旨在分析接受胸部放射治疗的心脏植入式电子装置(CIED)患者的心律失常负担,同时检查放疗的直接影响和治疗后的长期后遗症:研究人员对2012年1月至2022年12月期间接受胸部放疗的CIED患者进行了回顾性队列研究。研究进行了两项不同的分析,分别涉及(1)放疗期间的每日 CIED 随访和(2)治疗后的长期心律失常后果。对于长期结果,根据患者的年龄、性别、心血管风险因素、心脏疾病和使用β-受体阻滞剂的情况,以1:2的比例将患者与未接受放疗的对照组进行配对。统计分析包括负二项回归和倾向评分匹配。共有186名患者在放疗期间接受了每日CIED监测,其中79人接受了胸部照射。在单变量回归分析中,胸部照射与房性心律失常呈负相关(OR 0.11 [0.02;0.70,95% CI],调整后 p = 0.0498),放疗期间室性心律失常事件呈减少趋势(OR 0.14 [0.02;1.41,95% CI],调整后 p = 0.3572)。在包括心房颤动病史、糖尿病和使用β-受体阻滞剂的多变量模型中,这种关联并不显著(OR 0.44 [0.10;1.80,95%-CI],p = 0.16)。冠状动脉疾病与房性和室性心律失常的增加有关。在长期分析中,对122名接受过胸部(33人)和非胸部放射(89人)治疗的患者进行了随访,并与从约10,000名CIED患者中抽取的244名匹配对照组进行了比较。在中位随访 6.6 个月期间,与对照组相比,心律失常事件没有明显增加。在随访期间,既往的室性或房性心律失常病史是预测心律失常事件的最有力因素:结论:CIEDs患者可以安全地接受胸部放疗。结论:CIEDs 患者可以安全地接受胸腔放疗,但有心律失常病史的患者在放疗期间和放疗后更容易发生心律失常事件。这些发现凸显了个性化心律失常管理策略和进一步研究了解胸部放疗抗心律失常作用机制的必要性。
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引用次数: 0
Coronary artery calcium on lung cancer radiation planning CT aids cardiovascular risk assessment. 肺癌放射规划 CT 上的冠状动脉钙化有助于心血管风险评估。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-12 DOI: 10.1186/s40959-024-00283-5
Matthew Lui, Noah Kim, Raja Zaghlol, Pouya Joolharzadeh, Elena Deych, Clifford Robinson, Shahed Badiyan, Pamela K Woodard, Joshua D Mitchell

Background: Patients with non-small cell lung cancer (NSCLC) undergoing thoracic radiation are at high cardiovascular risk. Semiquantitative assessment of coronary artery calcification (CAC) on baseline planning non-gated chest computed tomography (CT) scans may help further risk stratify patients.

Objectives: This study aimed to characterize the association between CAC and major adverse cardiovascular events (MACE; myocardial infarction or stroke) and assess the utility of semiquantitative assessment of CAC.

Methods: Patients with NSCLC with non-contrast planning chest CT scans were evaluated for CAC. Planning scans were visually graded using the CAC-DRS method, stratifying patients into no, mild, moderate, and severe CAC groups. Demographics, comorbidities, and radiation treatment characteristics were gathered, and CAC groups were assessed for the incidence of MACE after initiation of radiation therapy.

Results: Out of 137 patients, 39 patients had no CAC, and 98 patients had any CAC (38 with mild CAC, 34 with moderate CAC, and 26 with severe CAC). There was 1 MACE event in the no CAC group and 11 in patients with any CAC. The presence of CAC was associated with increased MACE compared to no CAC (p = 0.034). Semiquantitative CAC analysis correlated with formal CAC scoring.

Conclusion: There is a significantly lower incidence of MACE in patients with no CAC on planning CT compared to patients with higher burdens of CAC. CAC burden is an important risk factor for adverse cardiovascular events in patients with NSCLC undergoing thoracic radiation. Semiquantitative CAC scoring may be a useful proxy when formal CAC scoring is unavailable.

背景:接受胸部放射治疗的非小细胞肺癌(NSCLC)患者具有较高的心血管风险。在基线计划非门控胸部计算机断层扫描(CT)上对冠状动脉钙化(CAC)进行半定量评估有助于进一步对患者进行风险分层:本研究旨在描述冠状动脉钙化与主要不良心血管事件(MACE;心肌梗死或中风)之间的关系,并评估对冠状动脉钙化进行半定量评估的效用:方法:对接受非对比规划胸部 CT 扫描的 NSCLC 患者进行 CAC 评估。使用 CAC-DRS 方法对规划扫描进行视觉分级,将患者分为无、轻度、中度和重度 CAC 组。收集人口统计学资料、合并症和放疗特征,并评估CAC组在放疗开始后MACE的发生率:在137名患者中,39名患者无CAC,98名患者有任何CAC(38名轻度CAC,34名中度CAC,26名重度CAC)。无CAC组有1例MACE事件,有任何CAC的患者有11例MACE事件。与无CAC相比,CAC的存在与MACE的增加有关(p = 0.034)。半定量CAC分析与正式CAC评分相关:结论:与CAC负担较重的患者相比,规划CT时无CAC的患者MACE发生率明显较低。CAC负荷是接受胸部放射治疗的NSCLC患者发生不良心血管事件的重要风险因素。在没有正式的 CAC 评分时,半定量 CAC 评分可能是一个有用的替代指标。
{"title":"Coronary artery calcium on lung cancer radiation planning CT aids cardiovascular risk assessment.","authors":"Matthew Lui, Noah Kim, Raja Zaghlol, Pouya Joolharzadeh, Elena Deych, Clifford Robinson, Shahed Badiyan, Pamela K Woodard, Joshua D Mitchell","doi":"10.1186/s40959-024-00283-5","DOIUrl":"10.1186/s40959-024-00283-5","url":null,"abstract":"<p><strong>Background: </strong>Patients with non-small cell lung cancer (NSCLC) undergoing thoracic radiation are at high cardiovascular risk. Semiquantitative assessment of coronary artery calcification (CAC) on baseline planning non-gated chest computed tomography (CT) scans may help further risk stratify patients.</p><p><strong>Objectives: </strong>This study aimed to characterize the association between CAC and major adverse cardiovascular events (MACE; myocardial infarction or stroke) and assess the utility of semiquantitative assessment of CAC.</p><p><strong>Methods: </strong>Patients with NSCLC with non-contrast planning chest CT scans were evaluated for CAC. Planning scans were visually graded using the CAC-DRS method, stratifying patients into no, mild, moderate, and severe CAC groups. Demographics, comorbidities, and radiation treatment characteristics were gathered, and CAC groups were assessed for the incidence of MACE after initiation of radiation therapy.</p><p><strong>Results: </strong>Out of 137 patients, 39 patients had no CAC, and 98 patients had any CAC (38 with mild CAC, 34 with moderate CAC, and 26 with severe CAC). There was 1 MACE event in the no CAC group and 11 in patients with any CAC. The presence of CAC was associated with increased MACE compared to no CAC (p = 0.034). Semiquantitative CAC analysis correlated with formal CAC scoring.</p><p><strong>Conclusion: </strong>There is a significantly lower incidence of MACE in patients with no CAC on planning CT compared to patients with higher burdens of CAC. CAC burden is an important risk factor for adverse cardiovascular events in patients with NSCLC undergoing thoracic radiation. Semiquantitative CAC scoring may be a useful proxy when formal CAC scoring is unavailable.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"10 1","pages":"80"},"PeriodicalIF":3.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Cardio-oncology
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