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Association between QT prolongation and cardiovascular mortality in cancer patients. 癌症患者 QT 间期延长与心血管疾病死亡率之间的关系。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-12 DOI: 10.1186/s40959-024-00271-9
Cheng-Han Chan, Chih-Min Liu, Pei-Fen Chen, Li-Lien Liao, I-Chien Wu, Yu-Feng Hu

Background: Cancer patients' vulnerability to QT prolongation contradicts certain anti-cancer drug usage. Until now, the QT prolongation's impact on CV mortality in cancer patients remains unclear, potentially biasing therapeutic decisions.

Methods: This retrospective observational cohort included adult cancer patients with an electrocardiogram (ECG) performed in a tertiary hospital in Taiwan. The first performed ECGs after cancer diagnosis (n = 59,568) were analyzed. The corrected QT intervals by Bazett (QTcB), Fridericia (QTcFri), and Framingham (QTcFra) formulae were used to predict the 90-day and one-year CV mortality according to the Taiwan death registry.

Results: The AUC of QTcB (90 days: 0.70, 1 year: 0.68) for predicting CV mortality was better than QTcFri and QTcFra (90 days: 0.63 and 0.50, 1 year: 0.65 and 0.56). Using the restricted cubic spline regression model adjusted by age and comorbidities, QTcB increased a significant but trivial risk of CV mortality at 90 days (hazard ratio, 1.007, P = 0.02) and one year (1.006, P < 0.01). Compared to those with QTcB < 500ms, the patients with QTcB ≥ 500ms were older and had more comorbidities and mortalities within one year. The incidence of sudden death and ventricular arrhythmias was only 0.2%. After adjusting for comorbidities, QTcB was neither associated with 90-day nor one-year CV mortality. In the patients already with QTcB ≥ 500ms, the patients receiving the unexpected uses of QT-prolonging drugs were not associated with higher one-year CV mortality than those without (P = 0.14).

Conclusions: Rather than a prolonged QT interval per se, comorbidities contributed to CV mortality and irreversible outcomes in cancer patients.

背景:癌症患者容易出现 QT 间期延长,这与某些抗癌药物的使用相矛盾。迄今为止,QT 间期延长对癌症患者心血管疾病死亡率的影响仍不明确,可能会使治疗决策产生偏差:这项回顾性观察队列包括在台湾一家三甲医院接受心电图检查的成年癌症患者。分析了癌症确诊后的首次心电图(n = 59,568)。根据台湾死亡登记资料,采用巴泽特(QTcB)、弗里德里希(QTcFri)和弗莱明汉(QTcFra)公式校正 QT 间期,预测 90 天和一年的心血管疾病死亡率:结果:QTcB(90 天:0.70,1 年:0.68)预测 CV 死亡率的 AUC 优于 QTcFri 和 QTcFra(90 天:0.63 和 0.50,1 年:0.65 和 0.56)。使用经年龄和合并症调整的限制性三次样条回归模型,QTcB 在 90 天(危险比为 1.007,P = 0.02)和 1 年(1.006,P 结论:QTcB 显著增加了心血管疾病的死亡风险,但微不足道:在癌症患者中,并不是QT间期延长本身会导致心血管疾病死亡和不可逆转的结果,而是合并症。
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引用次数: 0
Predictors of trastuzumab-induced cardiotoxicity among racially and ethnically diverse patients with HER2-positive breast cancer. 不同种族和族裔的 HER2 阳性乳腺癌患者中曲妥珠单抗诱发心脏毒性的预测因素。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-12 DOI: 10.1186/s40959-024-00272-8
Anna Vaynrub, Leila Mishalani, Jayant Raikhelkar, Katherine D Crew

Background: While trastuzumab has been shown to improve disease-free and overall survival in patients with HER2-positive breast cancer, it may also cause trastuzumab-induced cardiotoxicity (TIC). Although racial and ethnic minorities are at higher risk for cardiovascular disease (CVD) compared to non-Hispanic Whites (NHW), limited data exists on TIC incidence in diverse multi-ethnic populations. Our objective was to assess racial and ethnic differences in TIC and left ventricular ejection fraction (LVEF) recovery among patients with HER2-positive breast cancer.

Methods: We conducted a retrospective cohort study including patients diagnosed with stage I-III HER2-positive breast cancer between 2007 and 2022 who had received adjuvant trastuzumab. We analyzed associations between sociodemographic factors, tumor characteristics, treatment regimens, and CVD risk factors with the primary outcomes of TIC and LVEF recovery, using multivariable logistic regression models. TIC was defined as > 10% decrease in LVEF to an overall LVEF < 50%; LVEF recovery as a return to a LVEF > 50%.

Results: Among 496 evaluable patients, median age was 53 years (IQR: 45.0-62.0) with 36.6% NHW, 15.8% non-Hispanic Black (NHB), 27.8% Hispanic, and 19.8% Other. Fifty-three (10.6%) patients developed TIC, half of whom experienced LVEF recovery. Compared to NHW, NHB had a higher rate of TIC (9.3% vs. 17.7%, respectively) and lower rate of LVEF recovery (70.6% vs. 21.4%, respectively), however, race/ethnicity was not a significant predictor of TIC after adjusting for confounders. Increasing age, lower baseline LVEF, anthracycline use, and presence of hypertension or coronary artery disease were significantly associated with TIC in multivariable analysis.

Conclusions: TIC was more common among NHB compared to NHW, however, Black race was not consistently associated with TIC after adjustment for CVD risk factors. This suggests that CVD comorbidities (e.g., hypertension) that more frequently affect racial and ethnic minorities and are modifiable may explain differences in TIC incidence and recovery.

背景:虽然曲妥珠单抗已被证明能提高HER2阳性乳腺癌患者的无病生存率和总生存率,但它也可能引起曲妥珠单抗诱导的心脏毒性(TIC)。虽然与非西班牙裔白人(NHW)相比,少数种族和族裔患心血管疾病(CVD)的风险更高,但有关不同多种族人群中 TIC 发生率的数据却很有限。我们的目的是评估 HER2 阳性乳腺癌患者中 TIC 和左心室射血分数(LVEF)恢复的种族和民族差异:我们进行了一项回顾性队列研究,研究对象包括 2007 年至 2022 年期间确诊为 I-III 期 HER2 阳性乳腺癌并接受曲妥珠单抗辅助治疗的患者。我们使用多变量逻辑回归模型分析了社会人口学因素、肿瘤特征、治疗方案和心血管疾病风险因素与TIC和LVEF恢复这两项主要结果之间的关系。TIC的定义是LVEF下降>10%,总体LVEF为50%:在 496 名可评估的患者中,中位年龄为 53 岁(IQR:45.0-62.0),36.6% 为白种人,15.8% 为非西班牙裔黑人(NHB),27.8% 为西班牙裔,19.8% 为其他族裔。53名患者(10.6%)出现了TIC,其中半数患者的LVEF得到了恢复。与 NHW 相比,NHB 的 TIC 发生率更高(分别为 9.3% 对 17.7%),LVEF 恢复率更低(分别为 70.6% 对 21.4%),然而,在调整了混杂因素后,种族/民族并不是 TIC 的重要预测因素。在多变量分析中,年龄增加、基线LVEF降低、使用蒽环类药物、患有高血压或冠状动脉疾病与TIC显著相关:结论:与NHW相比,TIC在NHB中更为常见,但在调整心血管疾病风险因素后,黑人种族与TIC的关系并不一致。这表明,心血管疾病并发症(如高血压)对少数种族和族裔的影响更大,而且是可以改变的,这可能解释了TIC发病率和恢复情况的差异。
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引用次数: 0
Comparison of heart failure risk assessment tools among cancer survivors. 癌症幸存者心力衰竭风险评估工具的比较。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-11 DOI: 10.1186/s40959-024-00267-5
Cheng Hwee Soh, Thomas H Marwick

Background: Cancer survivors have an increased risk of incident heart failure (HF) attributable to shared risk factors and cancer treatment-induced cardiac dysfunction. Selection for HF screening depends on risk assessment, but the optimal means of assessing risk is undefined. We undertook a comparison of HF risk calculators among survivors.

Methods: In this study from the UK Biobank, cancer and HF diagnoses were determined based on the International Classification of Diseases (ICD)-10 code and non-cancer participants were included as controls. Participants' risk of incident HF was determined using the Heart Failure Association-International Cardio-oncology Society (HFA-ICOS), the Atherosclerosis Risk in Communities (ARIC-HF) and the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF). The predictive performances of each were compared using the area under the curve (AUC).

Results: After propensity matching with age and sex, 9,232 survivors from breast cancer or lymphoma (mean age 59.9 years, 87.8% female), and 23,800 survivors from other cancer types (mean age 59.1 years, 85.8% female) were included in the analysis. The discriminative value for HFA-ICOS (AUC 0.753 [95%CI: 0.739-0.766]) and ARIC-HF (0.757 [95%CI: 0.744-0.770]) were similar, and superior to PCP-HF (0.717 [95%CI: 0.702-0.732]). The overall performance for each risk score was better among participants in other cancer types than those with breast cancer and lymphoma.

Conclusions: HFA-ICOS and ARIC-HF outperformed the PCP-HF among cancer- and non-cancer cohort, although all showed modest discrimination for incident HF to be applied to clinical practice. A cancer-specific HF prediction tool could facilitate HF prevention among survivors.

背景:癌症幸存者发生心力衰竭(HF)的风险增加,这归因于共同的风险因素和癌症治疗引起的心功能障碍。高血压筛查的选择取决于风险评估,但风险评估的最佳方法尚未确定。我们对幸存者中的高血压风险计算器进行了比较:在这项来自英国生物库的研究中,癌症和高血压诊断是根据国际疾病分类(ICD)-10 编码确定的,非癌症参与者被列为对照组。采用心力衰竭协会-国际心脏病-肿瘤协会(HFA-ICOS)、社区动脉粥样硬化风险(ARIC-HF)和预防心力衰竭队列汇总方程(PCP-HF)确定参与者发生心力衰竭的风险。结果:根据年龄和性别进行倾向匹配后,9232 名乳腺癌或淋巴瘤幸存者(平均年龄 59.9 岁,87.8% 为女性)和 23800 名其他类型癌症幸存者(平均年龄 59.1 岁,85.8% 为女性)被纳入分析。HFA-ICOS(AUC 0.753 [95%CI:0.739-0.766])和 ARIC-HF(0.757 [95%CI:0.744-0.770])的判别值相似,优于 PCP-HF(0.717 [95%CI:0.702-0.732])。与乳腺癌和淋巴瘤患者相比,其他癌症类型参与者的各风险评分的总体表现更好:结论:HFA-ICOS和ARIC-HF在癌症和非癌症队列中的表现优于PCP-HF,但它们对HF事件的区分度都不高,无法应用于临床实践。癌症特异性高血压预测工具有助于幸存者预防高血压。
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引用次数: 0
Building a machine learning-assisted echocardiography prediction tool for children at risk for cancer therapy-related cardiomyopathy. 为有癌症治疗相关心肌病风险的儿童建立机器学习辅助超声心动图预测工具。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-09 DOI: 10.1186/s40959-024-00268-4
Lindsay A Edwards, Christina Yang, Surbhi Sharma, Zih-Hua Chen, Lahari Gorantla, Sanika A Joshi, Nicolas J Longhi, Nahom Worku, Jamie S Yang, Brandy Martinez Di Pietro, Saro Armenian, Aarti Bhat, William Border, Sujatha Buddhe, Nancy Blythe, Kayla Stratton, Kasey J Leger, Wendy M Leisenring, Lillian R Meacham, Paul C Nathan, Shanti Narasimhan, Ritu Sachdeva, Karim Sadak, Eric J Chow, Patrick M Boyle

Background: Despite routine echocardiographic surveillance for childhood cancer survivors, the ability to predict cardiomyopathy risk in individual patients is limited. We explored the feasibility and optimal processes for machine learning-enhanced cardiomyopathy prediction in survivors using serial echocardiograms from five centers.

Methods: We designed a series of deep convolutional neural networks (DCNNs) for prediction of cardiomyopathy (shortening fraction ≤ 28% or ejection fraction ≤ 50% on two occasions) for at-risk survivors ≥ 1-year post initial cancer therapy. We built DCNNs with four subsets of echocardiographic data differing in timing relative to case (survivor who developed cardiomyopathy) index diagnosis and two input formats (montages) with differing image selections. We used holdout subsets in a 10-fold cross-validation framework and standard metrics to assess model performance (e.g., F1-score, area under the precision-recall curve [AUPRC]). Performance of the input formats was compared using a combined 5 × 2 cross-validation F-test.

Results: The dataset included 542 pairs of montages: 171 montage pairs from 45 cases at time of cardiomyopathy diagnosis or pre-diagnosis and 371 pairs from 70 at-risk survivors who didn't develop cardiomyopathy during follow-up (non-case). The DCNN trained to distinguish between non-case and time of cardiomyopathy diagnosis or pre-diagnosis case montages achieved an AUROC of 0.89 ± 0.02, AUPRC 0.83 ± 0.03, and F1-score: 0.76 ± 0.04. When limited to smaller subsets of case data (e.g., ≥ 1 or 2 years pre-diagnosis), performance worsened. Model input format did not impact performance accuracy across models.

Conclusions: This methodology is a promising first step toward development of a DCNN capable of accurately differentiating pre-diagnosis versus non-case echocardiograms to predict survivors more likely to develop cardiomyopathy.

背景:尽管对儿童癌症幸存者进行了常规超声心动图监测,但预测个别患者心肌病风险的能力仍然有限。我们利用五个中心的连续超声心动图,探索了机器学习增强型心肌病预测的可行性和最佳流程:我们设计了一系列深度卷积神经网络(DCNN),用于预测首次癌症治疗后≥1年的高危幸存者的心肌病(两次缩短率≤28%或射血分数≤50%)。我们使用四个超声心动图数据子集构建了 DCNN,这些数据子集的时间相对于病例(发生心肌病的幸存者)指数诊断和两种输入格式(蒙太奇)具有不同的图像选择。我们在 10 倍交叉验证框架中使用了保留子集和标准指标来评估模型性能(如 F1 分数、精度-召回曲线下面积 [AUPRC])。使用 5 × 2 交叉验证 F 测试对输入格式的性能进行了比较:数据集包括 542 对蒙太奇:数据集包括 542 对蒙太奇:171 对蒙太奇来自 45 个心肌病诊断时或诊断前的病例,371 对蒙太奇来自 70 个在随访期间未患心肌病的高危幸存者(非病例)。为区分非病例与心肌病诊断或诊断前病例蒙太奇而训练的 DCNN 的 AUROC 为 0.89 ± 0.02,AUPRC 为 0.83 ± 0.03,F1-score 为 0.76 ± 0.04。当局限于较小的病例数据子集时(如诊断前≥ 1 年或 2 年),性能有所下降。模型输入格式对不同模型的性能准确性没有影响:该方法是开发 DCNN 的有希望的第一步,DCNN 能够准确区分诊断前与非病例超声心动图,从而预测更有可能患心肌病的幸存者。
{"title":"Building a machine learning-assisted echocardiography prediction tool for children at risk for cancer therapy-related cardiomyopathy.","authors":"Lindsay A Edwards, Christina Yang, Surbhi Sharma, Zih-Hua Chen, Lahari Gorantla, Sanika A Joshi, Nicolas J Longhi, Nahom Worku, Jamie S Yang, Brandy Martinez Di Pietro, Saro Armenian, Aarti Bhat, William Border, Sujatha Buddhe, Nancy Blythe, Kayla Stratton, Kasey J Leger, Wendy M Leisenring, Lillian R Meacham, Paul C Nathan, Shanti Narasimhan, Ritu Sachdeva, Karim Sadak, Eric J Chow, Patrick M Boyle","doi":"10.1186/s40959-024-00268-4","DOIUrl":"10.1186/s40959-024-00268-4","url":null,"abstract":"<p><strong>Background: </strong>Despite routine echocardiographic surveillance for childhood cancer survivors, the ability to predict cardiomyopathy risk in individual patients is limited. We explored the feasibility and optimal processes for machine learning-enhanced cardiomyopathy prediction in survivors using serial echocardiograms from five centers.</p><p><strong>Methods: </strong>We designed a series of deep convolutional neural networks (DCNNs) for prediction of cardiomyopathy (shortening fraction ≤ 28% or ejection fraction ≤ 50% on two occasions) for at-risk survivors ≥ 1-year post initial cancer therapy. We built DCNNs with four subsets of echocardiographic data differing in timing relative to case (survivor who developed cardiomyopathy) index diagnosis and two input formats (montages) with differing image selections. We used holdout subsets in a 10-fold cross-validation framework and standard metrics to assess model performance (e.g., F1-score, area under the precision-recall curve [AUPRC]). Performance of the input formats was compared using a combined 5 × 2 cross-validation F-test.</p><p><strong>Results: </strong>The dataset included 542 pairs of montages: 171 montage pairs from 45 cases at time of cardiomyopathy diagnosis or pre-diagnosis and 371 pairs from 70 at-risk survivors who didn't develop cardiomyopathy during follow-up (non-case). The DCNN trained to distinguish between non-case and time of cardiomyopathy diagnosis or pre-diagnosis case montages achieved an AUROC of 0.89 ± 0.02, AUPRC 0.83 ± 0.03, and F1-score: 0.76 ± 0.04. When limited to smaller subsets of case data (e.g., ≥ 1 or 2 years pre-diagnosis), performance worsened. Model input format did not impact performance accuracy across models.</p><p><strong>Conclusions: </strong>This methodology is a promising first step toward development of a DCNN capable of accurately differentiating pre-diagnosis versus non-case echocardiograms to predict survivors more likely to develop cardiomyopathy.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"10 1","pages":"66"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388385","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
Dexrazoxane prevents vascular toxicity in doxorubicin-treated mice. 右雷佐生可预防多柔比星治疗小鼠的血管毒性。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-04 DOI: 10.1186/s40959-024-00270-w
Dustin N Krüger, Matthias Bosman, Emeline M Van Craenenbroeck, Guido R Y De Meyer, Constantijn Franssen, Pieter-Jan Guns

Background: Doxorubicin (DOX) is used for breast cancer and lymphoma, but can cause cardiotoxicity, arterial stiffness, and endothelial dysfunction. We recently reported SERPINA3N as biomarker of cardiovascular toxicity in patients and mice. Dexrazoxane (DEXRA) is an FDA-approved drug that prevents DOX-induced cardiac toxicity in high-risk patients. However, the effect of DEXRA on vascular dysfunction during DOX treatment has not been documented. Therefore, here we investigated whether DEXRA protects against DOX-induced arterial stiffness, endothelial dysfunction, and SERPINA3N upregulation in tissue and plasma from mice.

Methods: Male C57BL6/J mice were treated with DOX (4 mg/kg), DEXRA (40 mg/kg), a combination (DEXRA + DOX), or VEHICLE (0.9% NaCl) weekly i.p. for 6 weeks (n = 8 per group). Cardiovascular function was measured in vivo by ultrasound imaging at baseline, weeks 2 and 6. Vascular reactivity was analyzed ex vivo in the thoracic aorta at week 6 and molecular analysis was performed.

Results: DEXRA prevented left ventricular ejection fraction decline by DOX (DEXRA + DOX: 62 ± 2% vs DOX: 51 ± 2%). Moreover, DEXRA prevented the increase in pulse wave velocity by DOX (DEXRA + DOX: 2.1 ± 0.2 m/s vs DOX: 4.5 ± 0.3 m/s) and preserved endothelium-dependent relaxation (DEXRA + DOX: 82 ± 3% vs DOX: 62 ± 3%). In contrast to DOX-treated mice, SERPINA3N did not increase in the DEXRA + DOX group.

Conclusion: Our results not only confirm the cardioprotective effects of DEXRA against DOX-induced cardiotoxicity but also add preservation of vascular endothelial cell function as an important mechanism. Moreover, the study demonstrates the potential of SERPINA3N as a biomarker for monitoring cardiovascular complications of DOX in high-risk patients.

背景:多柔比星(DOX)用于治疗乳腺癌和淋巴瘤,但可引起心脏毒性、动脉僵化和内皮功能障碍。我们最近报道了 SERPINA3N 作为心血管毒性的生物标志物在患者和小鼠中的应用。右雷佐生(DEXRA)是美国食品及药物管理局批准的一种药物,可预防高危患者因 DOX 引起的心脏毒性。然而,DEXRA对DOX治疗期间血管功能障碍的影响尚未被记录。因此,我们在此研究 DEXRA 是否能防止 DOX 诱导的动脉僵化、内皮功能障碍以及小鼠组织和血浆中 SERPINA3N 的上调:雄性 C57BL6/J 小鼠接受 DOX(4 毫克/千克)、DEXRA(40 毫克/千克)、联合用药(DEXRA + DOX)或 VEHICLE(0.9% NaCl)治疗,每周一次静脉注射,连续 6 周(每组 8 只)。在基线、第 2 周和第 6 周,通过超声波成像测量体内心血管功能。在第6周时对胸主动脉的血管反应性进行体外分析,并进行分子分析:结果:DEXRA阻止了DOX导致的左心室射血分数下降(DEXRA + DOX:62 ± 2% vs DOX:51 ± 2%)。此外,DEXRA 还能防止 DOX 导致的脉搏波速度增加(DEXRA + DOX:2.1 ± 0.2 m/s vs DOX:4.5 ± 0.3 m/s),并保持内皮依赖性松弛(DEXRA + DOX:82 ± 3% vs DOX:62 ± 3%)。与 DOX 处理的小鼠相比,DEXRA + DOX 组的 SERPINA3N 没有增加:我们的研究结果不仅证实了 DEXRA 对 DOX 引起的心脏毒性有保护作用,而且还将保护血管内皮细胞功能作为一个重要机制。此外,该研究还证明了 SERPINA3N 作为生物标记物监测 DOX 高危患者心血管并发症的潜力。
{"title":"Dexrazoxane prevents vascular toxicity in doxorubicin-treated mice.","authors":"Dustin N Krüger, Matthias Bosman, Emeline M Van Craenenbroeck, Guido R Y De Meyer, Constantijn Franssen, Pieter-Jan Guns","doi":"10.1186/s40959-024-00270-w","DOIUrl":"10.1186/s40959-024-00270-w","url":null,"abstract":"<p><strong>Background: </strong>Doxorubicin (DOX) is used for breast cancer and lymphoma, but can cause cardiotoxicity, arterial stiffness, and endothelial dysfunction. We recently reported SERPINA3N as biomarker of cardiovascular toxicity in patients and mice. Dexrazoxane (DEXRA) is an FDA-approved drug that prevents DOX-induced cardiac toxicity in high-risk patients. However, the effect of DEXRA on vascular dysfunction during DOX treatment has not been documented. Therefore, here we investigated whether DEXRA protects against DOX-induced arterial stiffness, endothelial dysfunction, and SERPINA3N upregulation in tissue and plasma from mice.</p><p><strong>Methods: </strong>Male C57BL6/J mice were treated with DOX (4 mg/kg), DEXRA (40 mg/kg), a combination (DEXRA + DOX), or VEHICLE (0.9% NaCl) weekly i.p. for 6 weeks (n = 8 per group). Cardiovascular function was measured in vivo by ultrasound imaging at baseline, weeks 2 and 6. Vascular reactivity was analyzed ex vivo in the thoracic aorta at week 6 and molecular analysis was performed.</p><p><strong>Results: </strong>DEXRA prevented left ventricular ejection fraction decline by DOX (DEXRA + DOX: 62 ± 2% vs DOX: 51 ± 2%). Moreover, DEXRA prevented the increase in pulse wave velocity by DOX (DEXRA + DOX: 2.1 ± 0.2 m/s vs DOX: 4.5 ± 0.3 m/s) and preserved endothelium-dependent relaxation (DEXRA + DOX: 82 ± 3% vs DOX: 62 ± 3%). In contrast to DOX-treated mice, SERPINA3N did not increase in the DEXRA + DOX group.</p><p><strong>Conclusion: </strong>Our results not only confirm the cardioprotective effects of DEXRA against DOX-induced cardiotoxicity but also add preservation of vascular endothelial cell function as an important mechanism. Moreover, the study demonstrates the potential of SERPINA3N as a biomarker for monitoring cardiovascular complications of DOX in high-risk patients.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"10 1","pages":"65"},"PeriodicalIF":3.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375207","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
Coronary artery calcium score and other risk factors in patients at moderate and high risk of cancer therapy-related cardiovascular toxicity. 癌症治疗相关心血管毒性中度和高度风险患者的冠状动脉钙化评分及其他风险因素。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-28 DOI: 10.1186/s40959-024-00266-6
Anna Borowiec, Patrycja Ozdowska, Magdalena Rosinska, Agnieszka Maria Zebrowska, Agnieszka Jagiello-Gruszfeld, Sławomir Jasek, Joanna Waniewska, Beata Kotowicz, Hanna Kosela-Paterczyk, Elzbieta Lampka, Katarzyna Pogoda, Andrzej Cieszanowski, Zbigniew Nowecki, Jan Walewski

Background: The presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity.

Methods: The study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed.

Results: A total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups.

Conclusions: In patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.

背景:冠状动脉钙化(CAC)的存在和负担是心血管事件的有力预测指标。欧洲心脏病学会(ESC)目前的心脏病肿瘤学指南不建议使用 CAC 评分来确定癌症患者的风险状况。本研究旨在评估心脏断层扫描中CAC的存在和负担,以及癌症治疗相关心血管毒性中度和高度基线风险患者的心血管毒性风险因素分布情况:该研究前瞻性地纳入了确诊并符合蒽环类化疗全身治疗条件的癌症患者。收集了所有患者的临床数据和血液样本。此外,还进行了超声心动图和冠状动脉计算机断层扫描(CCTA),并计算了冠状动脉钙化(CAC)评分:共有 80 名患者(平均年龄 60.5 岁,75 名女性)参与了研究。大多数患者(62 人,77.5%)患有乳腺癌,11 人(13.8%)被诊断为肉瘤,7 人(8.8%)患有淋巴瘤。根据目前的ESC指南,42名(52.5%)患者被归类为癌症治疗相关心血管毒性的中度风险(MR),38名(47.5%)患者被归类为癌症治疗相关心血管毒性的高风险(HR)。与中度风险相比,高风险患者年龄更大,更有可能患有高血压、高脂血症和慢性肾病。高风险组的平均冠状动脉钙化评分明显更高(150.4 vs. 24.8; p = 0.000)。此外,高危患者的心脏生物标志物也更高(P = 0.000)。在超声心动图参数中,HR 组的整体纵向应变(GLS)更低(p = 0.012),舒张功能障碍更常见。然而,MR 组和 HR 组的左心室射血分数(LVEF)相似:结论:在癌症治疗相关心血管毒性的高风险和中度风险患者中,心血管毒性风险因素很常见,在高风险组中更为普遍。高风险组的冠状动脉钙化评分也明显较高。评估冠状动脉钙的存在和负担是评估癌症患者额外心血管风险的一个有吸引力的选择。
{"title":"Coronary artery calcium score and other risk factors in patients at moderate and high risk of cancer therapy-related cardiovascular toxicity.","authors":"Anna Borowiec, Patrycja Ozdowska, Magdalena Rosinska, Agnieszka Maria Zebrowska, Agnieszka Jagiello-Gruszfeld, Sławomir Jasek, Joanna Waniewska, Beata Kotowicz, Hanna Kosela-Paterczyk, Elzbieta Lampka, Katarzyna Pogoda, Andrzej Cieszanowski, Zbigniew Nowecki, Jan Walewski","doi":"10.1186/s40959-024-00266-6","DOIUrl":"https://doi.org/10.1186/s40959-024-00266-6","url":null,"abstract":"<p><strong>Background: </strong>The presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity.</p><p><strong>Methods: </strong>The study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed.</p><p><strong>Results: </strong>A total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups.</p><p><strong>Conclusions: </strong>In patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"10 1","pages":"64"},"PeriodicalIF":3.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342488","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
How to utilize current guidelines to manage patients with cancer at high risk for heart failure. 如何利用现行指南管理心力衰竭高风险癌症患者。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-28 DOI: 10.1186/s40959-024-00259-5
Michelle Bloom, Jose A Alvarez-Cardona, Sarju Ganatra, Ana Barac, Iskra Pusic, Daniel Lenihan, Susan Dent

Heart failure (HF) in patients with cancer is associated with high morbidity and mortality. The success of cancer therapy has resulted in an exponential rise in the population of cancer survivors, however cardiovascular disease (CVD) is now a major life limiting condition more than 5 years after cancer diagnosis [Sturgeon, Deng, Bluethmann, et al 40(48):3889-3897, 2019]. Prevention and early detection of CVD, including cardiomyopathy (CM) and HF is of paramount importance. The European Society of Cardiology (ESC) published guidelines on Cardio-Oncology (CO) [Lyon, López-Fernández, Couch, et al 43(41):4229-4361, 2022] detailing cardiovascular (CV) risk stratification, prevention, monitoring, diagnosis, and treatment throughout the course and following completion of cancer therapy. Here we utilize a case to summarize aspects of the ESC guideline relevant to HF clinicians, with a focus on risk stratification, early detection, prevention of CM and HF, and the role for guideline directed medical therapy in patients with cancer.

癌症患者的心力衰竭(HF)与高发病率和高死亡率有关。癌症治疗的成功使癌症幸存者人数呈指数级增长,然而,心血管疾病(CVD)目前已成为癌症确诊 5 年后限制生命的主要疾病 [Sturgeon, Deng, Bluethmann, et al 40(48):3889-3897,2019]。预防和早期发现心血管疾病,包括心肌病(CM)和高血压至关重要。欧洲心脏病学会(ESC)发布了心脏病肿瘤学(CO)指南[Lyon, López-Fernández, Couch, et al 43(41):4229-4361, 2022],详细介绍了癌症治疗过程中和治疗结束后的心血管(CV)风险分层、预防、监测、诊断和治疗。在此,我们利用一个病例来总结ESC指南中与高血压临床医生相关的内容,重点是癌症患者的风险分层、早期检测、CM和高血压的预防以及指南指导的药物治疗的作用。
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引用次数: 0
Enhancing nurse competence in early recognition of cardiotoxicity. 提高护士早期识别心脏毒性的能力。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-14 DOI: 10.1186/s40959-024-00261-x
Jeff Kolbus, Mopelola T Adeola, Janelle M Tipton, Caitlin E D Luebcke

Background: Preliminary research reveals that many nurses feel inadequate and possess limited knowledge when it comes to managing cardiotoxicity, underscoring the necessity for educational programs to enhance nursing skills in this area.

Methods: The aim of the study was to assess the impact of an educational intervention on nurses perceived self-efficacy in recognizing patients exhibiting symptoms of cancer treatment-related cardiotoxicity. The study was set in a 16-bed cardiac critical care unit (CCU) within a 462-bed hospital. The sample group was comprised of registered nurses (RNs) working on or floating to the CCU. The study used a within-subjects design. Participants completed a pre-education survey, attended one of six 30-minute education interventions, and completed a post-education survey. The outcome variables were 7 self-confidence questions from the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Related Cardiotoxicity (NSS-CTC) on a 5-point Likert scale and one yes or no self-efficacy question. Descriptive statistics and paired T-tests were applied to analyze pre- and post-education surveys.

Results: The pre-and post-education comparative analysis for each of the 7 NSS-CTC self-confidence questions was statistically significant with test statistics ranging from t = 3.43 to t = 8.69 and p-values ranging from 0.0021 to less than 0.0001. All 26 RNs answered "yes" in their ability to detect symptoms of cancer therapy-related cardiotoxicity after the education.

Conclusions: The lack of education for cardiac nurses against the backdrop of increasing cardiotoxicity in cancer patients showcases the essential need for cardiac nurse early symptom recognition education.

背景:初步研究显示,许多护士在处理心脏毒性时感到力不从心,掌握的知识也很有限,这突出表明有必要开展教育项目以提高这方面的护理技能:研究旨在评估教育干预对护士识别癌症治疗相关心脏毒性症状患者的自我效能感的影响。研究地点设在一家拥有 462 张病床的医院内的一个拥有 16 张病床的心脏重症监护病房(CCU)。样本组由在重症监护室工作或流动的注册护士(RN)组成。研究采用了受试者内部设计。参与者完成教育前调查,参加六次 30 分钟教育干预中的一次,并完成教育后调查。结果变量包括 7 个自信心问题,这些问题来自管理癌症治疗相关心脏毒性的护理自我效能量表(NSS-CTC),采用 5 点李克特量表,还有一个 "是 "或 "否 "的自我效能问题。采用描述性统计和配对 T 检验对教育前后的调查进行分析:在 7 个 NSS-CTC 自信心问题中,每个问题的教育前后比较分析都具有显著的统计学意义,检验统计量从 t = 3.43 到 t = 8.69 不等,P 值从 0.0021 到小于 0.0001 不等。所有 26 名护士在接受教育后,对癌症治疗相关心脏毒性症状的检测能力均回答 "是":结论:在癌症患者心脏毒性不断增加的背景下,心脏科护士缺乏相关教育,这表明心脏科护士亟需早期症状识别教育。
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引用次数: 0
Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: an updated systematic review and meta-analysis. 曾接受过胸部放射治疗的癌症幸存者经导管主动脉瓣置换术后的疗效:最新系统综述和荟萃分析。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-12 DOI: 10.1186/s40959-024-00265-7
Farah Yasmin, Abdul Moeed, Muhammad Tanveer Alam, Vikash Virwani, Yumna Khabir, Asim Shaikh, Apurva V Vyas, M Chadi Alraies

Clinical outcomes for TAVR in cancer survivors with prior chest radiation therapy (C-XRT) who develop symptomatic aortic-valve stenosis are not adequately assessed in major clinical trials leading to conflicting results. Hence, we conducted this meta-analysis to evaluate the, safety, efficacy, and mortality outcomes of cancer survivors with prior C-XRT undergoing TAVR. MEDLINE and Scopus were searched up to March 2024. Observational studies and randomized controlled trials comparing severe aortic stenosis patients with and without prior C-XRT undergoing TAVR with at least one outcome of interest were shortlisted. Data were analyzed using random-effects model to derive weighted mean differences, and risk ratios with 95% confidence intervals. Six studies with 6,191 patients (278 C-XRT and 5,913 no-C-XRT) were included. All-cause mortality at 30-day (RR 1.63, p = 0.12) and 1-year interval (RR 1.59, p = 0.08) showed no significant differences with prior C-XRT versus no-C-XRT. Worsening CHF was the only post-procedural safety outcome significantly higher in patients with prior C-XRT (RR 1.98, p = 0.0004) versus no- C-XRT. The efficacy end-points i.e., improvement in LVEF (MD 1.24; -0.50, 2.98), and aortic valve gradient (MD -0.63; -1.32, 0.05) were not significantly different. TAVR has similar all-cause mortality, efficacy and safety (except CHF worsening) among cancer survivors with and without a prior history of C-XRT.

曾接受过胸部放射治疗(C-XRT)的癌症幸存者在出现无症状主动脉瓣狭窄时接受 TAVR 的临床结果在主要临床试验中未得到充分评估,导致结果相互矛盾。因此,我们进行了这项荟萃分析,以评估曾接受过 C-XRT 的癌症幸存者接受 TAVR 的安全性、有效性和死亡率。我们检索了截至 2024 年 3 月的 MEDLINE 和 Scopus。筛选出了观察性研究和随机对照试验,这些研究比较了接受 TAVR 的重度主动脉瓣狭窄患者接受 C-XRT 和未接受 C-XRT 的情况,并得出了至少一项相关结果。采用随机效应模型对数据进行分析,得出加权平均差、风险比和 95% 置信区间。共纳入六项研究,6,191 名患者(278 名 C-XRT 患者和 5,913 名非 C-XRT 患者)。30天(RR 1.63,p = 0.12)和1年(RR 1.59,p = 0.08)的全因死亡率显示,先行C-XRT与未行C-XRT无显著差异。CHF恶化是既往接受过C-XRT(RR 1.98,p = 0.0004)与未接受过C-XRT的患者术后安全性显著较高的唯一结果。疗效终点,即 LVEF 改善(MD 1.24;-0.50,2.98)和主动脉瓣坡度(MD -0.63;-1.32,0.05)没有明显差异。在既往接受过C-XRT治疗和未接受过C-XRT治疗的癌症幸存者中,TAVR具有相似的全因死亡率、疗效和安全性(除CHF恶化外)。
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引用次数: 0
Routine Ankle-Brachial Index (ABI) measurement: a window into atherosclerosis and early left ventricular dysfunction in patients diagnosed with cancer. 常规踝肱指数(ABI)测量:确诊癌症患者动脉粥样硬化和早期左心室功能障碍的窗口。
IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-12 DOI: 10.1186/s40959-024-00262-w
Netanel Golan, Rafael Y Brzezinski, Moaad Slieman, Shafik Khoury, Ofer Havakuk, Yan Topilsky, Shmuel Banai, Michal Laufer-Perl

Background: Cancer therapy is considered to cause accelerated ischemia. Ankle-Brachial Index (ABI) measurement is an inexpensive, simple, available test for the early diagnosis of peripheral artery disease (PAD); however, it is not performed routinely. We aimed to evaluate the role of routine ABI measurement for the diagnosis of PAD among patients diagnosed with cancer and whether it correlates with left ventricular (LV) dysfunction.

Methods: A retrospective, single-center study including patients diagnosed with cancer at Tel Aviv Sourasky Medical Center. The cohort included patients performing routine ABI and LV global longitudinal strain (GLS) echocardiography. The primary endpoint was the prevalence of PAD and whether it correlates with LV dysfunction, defined by LV GLS absolute value < 19%. The secondary composite endpoint evaluated the association between reduced ABI to LV dysfunction and all-cause mortality.

Results: Among 226 patients, PAD was diagnosed in 14 patients (6%). We revealed a positive correlation between ABI and LV GLS (r = 0.22, p < 0.01) with a reduced mean ABI score among patients with reduced LV GLS. A reduced mean ABI was observed among the positive composite endpoint group; however, it was not statistically significant (p = 0.35).

Conclusions: We report, for the first time to our knowledge, the routine use of ABI testing among patients diagnosed with cancer. ABI showed a significant correlation to LV GLS, implying a potential tool in the early diagnosis of atherosclerosis and cardiotoxicity. Considering its low cost and availability, future prospective trials are needed to integrate its role in routine assessment.

背景:癌症治疗被认为会加速缺血。踝肱指数(ABI)测量是一种廉价、简单、可用于早期诊断外周动脉疾病(PAD)的检测方法;然而,它并不是常规检测方法。我们旨在评估常规 ABI 测量在诊断癌症患者 PAD 中的作用,以及它是否与左心室(LV)功能障碍相关:这是一项回顾性单中心研究,研究对象包括特拉维夫苏拉斯基医疗中心的癌症患者。研究对象包括进行常规 ABI 和左心室整体纵向应变 (GLS) 超声心动图检查的患者。主要终点是PAD的患病率以及它是否与左心室功能障碍(以左心室GLS绝对值定义)相关:在 226 名患者中,14 名患者(6%)被确诊为 PAD。我们发现 ABI 与 LV GLS 之间存在正相关(r = 0.22,p 结论:ABI 与 LV GLS 之间存在正相关:据我们所知,我们首次报告了在癌症患者中常规使用 ABI 检测的情况。ABI 与左心室 GLS 呈明显相关性,这意味着它是早期诊断动脉粥样硬化和心脏毒性的潜在工具。考虑到 ABI 的低成本和可用性,未来需要进行前瞻性试验,将其纳入常规评估中。
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引用次数: 0
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Cardio-oncology
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