Cardio-oncology最新文献

Background: Breast cancer is the most common malignancy among women globally and the second most frequently diagnosed cancer overall, with 2.3 million new cases reported in 2022. While advances in therapy have substantially improved survival, cardiovascular disease (CVD) has emerged as the leading cause of non-cancer mortality in this population. Real-world evidence on the incidence and trajectory of heart failure (HF) and treatment-related cardiotoxicity remains limited, with existing studies often constrained by small sample sizes or narrow therapeutic focus. This scoping review aimed to synthesise evidence on the incidence of HF, cardiovascular mortality, and all-cause mortality in individuals with breast cancer, map additional cardiovascular outcomes, and identify high-risk subgroups.

Methods: The review followed the Joanna Briggs Institute methodology, applying the Participant-Concept-Context framework to identify eligible studies. Inclusion criteria comprised peer-reviewed, observational studies in English published up to July 2024 that reported HF incidence in breast cancer patients; clinical trials, reviews, and prevalence studies were excluded. Comprehensive searches of PubMed, MEDLINE, CINAHL, and Embase were undertaken, with independent dual screening. Data were synthesised descriptively and thematically, and study quality was assessed using the CASP tool.

Results: Fifteen population-based cohort studies were included, with sample sizes ranging from 294 to 122,217 and follow-up durations of 3 to 19 years. Most cohorts included women with early-stage (I-III) disease and displayed heterogeneity in demographics, comorbidities, and treatments. Hypertension, diabetes, and dyslipidaemia were the most common comorbidities. Chemotherapy and radiotherapy were administered in up to 58% and 78.5% of patients, respectively. HF risk was significantly elevated (hazard ratios [HRs] up to 2.71), peaking within the first-year post-diagnosis and persisting for up to 17 years. All-cause mortality was consistently higher than in non-cancer controls (HRs > 3.0), whereas cardiovascular mortality findings were mixed. Younger age, cardiometabolic comorbidities, advanced cancer stage, and exposure to anthracyclines (HR 1.74) or trastuzumab (HR 2.34) were key risk factors. Additional cardiovascular outcomes-including ischaemic heart disease, atrial fibrillation, stroke, and thromboembolism-were frequently observed, particularly in early survivorship. Most studies were rated as high quality.

Conclusion: Breast cancer survivors face a substantial and sustained cardiovascular burden, particularly for HF and all-cause mortality. These findings emphasise the need for early CVD risk assessment, targeted cardioprotective interventions, and long-term surveillance. Large, prospective studies are essential to inform precision cardio-oncology and optimise survivorship outcomes.

Background: Electrocardiogram (ECG) analysis is crucial to detect cardiotoxicity. Manual methods are time-consuming and limited by inter-reader variability, highlighting the need for precise, reproducible and rapid semi-automated digital tools in clinical practice.

Objective: This study evaluates the triplicate concatenation method (TCM) using a semi-automated ECG software (CalECG-4.2, AMPS®) by assessing intra- and inter-reader variabilities in two distinct cardio-oncology populations: breast cancer patients receiving ribociclib (a QT-prolonging drug) and patients admitted with severe immune checkpoint inhibitors (ICI)-myocarditis, a condition marked by QRS alterations.

Methods: A total of 420 ECG from 31 patients (21 ribociclib, and 10 ICI-myocarditis) were independently analyzed by two readers. Variability was assessed using Bland-Altman analyses and intraclass correlation coefficients (ICC). Linear mixed-effects modelling quantified time-dependent changes in heart rate (HR), PR, QTc (Fridericia's HR correction), QRS duration and voltage (Sokolow-Lyon) accounting for inter-reader variability.

Results: Intra and inter-reader reproducibility was excellent (ICC > 0.98, including Sokolow-Lyon voltage; standard-deviation < 4 ms across all time-derived parameters). In ribociclib-treated patients (cycles of 21/28 days on drug), QTc peaked at day 14 (16 ± 1 ms, p < 0.001) before decreasing by day 28 (-6 ± 1 ms, p < 0.001) compared to baseline. In ICI-myocarditis, QRS duration increased at day 5 before returning to baseline starting day 28, while Sokolow-Lyon voltages increased progressively on immunosuppressive treatments, peaking at day 28 (458 ± 49 µV, p < 0.001) and remaining constant afterwards for the next month.

Conclusion: TCM with CalECG-4.2 ensures a high reproducibility while monitoring key parameters like QTc duration and Sokolow-Lyon voltage, making it a reliable and time-saving alternative for the ECG surveillance of drug toxicities in cardio-oncology.

Background: Chronic ischemic heart disease (IHD) is a leading cause of cardiovascular-related mortality worldwide, with a growing burden among cancer patients due to shared risk factors and treatment-related Cardiotoxicity. However, nationwide trends and disparities in IHD-related mortality among cancer patients remain unexplored.

Methodology: This study utilized CDC WONDER mortality data from 1999 to 2020, identifying U.S. adults (≥ 25 years) with cancer (ICD-10: C00-D48) who died from chronic IHD (ICD-10: I25) as the underlying cause. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated and stratified by gender, age, race, geographic region, and urbanization level.

Results: Between 1999 and 2020, there were 246,664 Chronic IHD-related deaths among adult cancer patients. The AAMR declined significantly from 8.44 per 100,000 in 1999 to 3.71 in 2020. A steady decline occurred from 1999 to 2018 (APC: -3.85%; 95% CI: -4.01 to -3.72), followed by a slight increase from 2018 to 2020 (APC: 2.92%; 95% CI: 0.33 to 4.70). Men had higher AAMRs than women (8.16 vs. 3.25). The highest CMR were observed in older adults (24.19), with significantly lower rates in middle-aged (1.26) and young adults (0.04). Racial disparities revealed the highest AAMRs in non-Hispanic Black individuals (5.64), followed by non-Hispanic Whites (5.37), NH American Indian (3.59), Hispanics (3.28), and NH Asians (2.7). Geographic trends showed that the Northeast had the highest AAMRs (6.88), while urban areas had slightly higher mortality than rural areas (5.23 vs. 5.06).

Conclusions: This nationwide analysis highlights a significant decline in chronic IHD-related mortality among cancer patients, with persistent disparities by gender, age, race, and geographic location. The recent rise in AAMRs after 2018 suggests emerging risk factors that warrant further investigation. Addressing these disparities through targeted cardiovascular risk management in cancer patients is crucial to improving long-term outcomes.

Background: Racial disparities in all-cause mortality after breast cancer (BC) have been documented. While elevated risk of BC mortality experienced by Black women is clear, it is unclear the relative contribution of cardiovascular disease (CVD) mortality to the survival disparity in Black women.

Methods: This analysis from the Women's Health Initiative (WHI) included 8,410 women diagnosed with invasive BC during follow-up. Cardiovascular (CV) events were defined as adjudicated myocardial infarction, heart failure, or stroke. Cause of death was determined through adjudication by medical chart review, ICD codes, death certificate, and/or autopsy report. 10-year cumulative incidence rates were calculated for CV events, CVD mortality, and BC mortality, stratified by race. Sub-distribution hazards ratios (sHR) were calculated using Fine and Gray models to account for competing risks.

Results: In BC survivors (mean age = 70.9 years, median follow-up = 15.1 years), 8.5% self-reported as Black. Compared to White women, Black women had higher 10-year cumulative incidence of non-fatal CV events (10.9% vs. 8.2%, P = 0.001) and BC mortality (15.3% vs. 11.5%, P = 0.039). In contrast, White women had higher 10-year incidence of CVD mortality (7.2% vs. 10.1%, P = 0.001). BC mortality in Black women represented a higher proportion of death (35% vs. 20%), which was not true for White women.

Conclusion: Our study reinforces prior findings that racial disparities are experienced by Black women with BC. This may be in large part driven by BC mortality. However, if improvements in BC mortality are made to reduce this gap, disparities in CVD mortality may become more prominent due to racial disparities in CV events.

Introduction: This study aimed to evaluate the efficacy of the mean heart dose (MHD) as a predictor of radiation exposure to cardiac substructures and its association with markers of subclinical cardiotoxicity in breast cancer (BC) patients undergoing radiotherapy (RT). Although MHD provides an overall estimate of cardiac exposure, it does not capture the heterogeneous dose distribution across critical cardiac substructures.

Materials and methods: In an ambispective study design, dosimetric parameters, including MHD and dose-volume metrics for the left anterior descending artery (LAD), left circumflex artery (LCx), and left main coronary artery (LMCA), were analyzed in a cohort of BC patients receiving adjuvant RT. Early cardiotoxicity markers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction (EF), and the Tei index, were evaluated. The relationship between MHD and radiation doses to specific cardiac substructures, as well as their association with cardiac biomarker levels, was assessed.

Results: Among 104 patients, the overall MHD was 6.4 ± 5.4 Gy. Left-sided BC patients received a significantly higher MHD of 10.5 ± 4.37 Gy. The LAD mean dose was 16.12 ± 15.19 Gy for the entire cohort, increasing to 30.17 ± 5.74 Gy in left-sided cases. Patients with higher MHDs were more likely to receive elevated doses to the LMCA and LCx; however, a notable discrepancy was observed in LAD dose correlation. Regression analysis showed that MHD explained only 9.4% of the variance in LAD mean dose compared to 65% for LMCA. Receiver operating characteristic (ROC) analysis identified heart Dmax (43.12 Gy), heart V25 (13%), and LAD mean dose (28.92 Gy) as strong predictors of subclinical cardiotoxicity, whereas MHD was not.

Conclusion: Our findings confirm that MHD is an inadequate surrogate for predicting the heterogeneous dose distribution among cardiac substructures. Elevated NT-proBNP levels and reduced EF were significantly associated with higher substructure doses, highlighting the need for individualized, substructure-specific dose constraints in RT planning. These findings support the use of advanced cardiac-sparing techniques such as deep inspiration breath-hold (DIBH), intensity-modulated radiotherapy (IMRT), and proton therapy.