Cardio-oncology最新文献

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.

Advances in cancer therapeutics have significantly improved patient survival; however, cardiotoxic effects-including arrhythmias-have emerged as a growing clinical concern. This expert opinion, developed by the Working Groups on Cardio-Oncology and Electrophysiology of the Hellenic Cardiological Society, aims to raise awareness of the increasing burden of arrhythmias in cancer patients and survivors. This document explores the multifactorial etiology of arrhythmias in this population, including patient-related factors, the direct effects of malignancy, and the arrhythmogenic potential of therapies such as classical chemotherapy, targeted agents, immunotherapy, hormonal treatments, and radiotherapy. Additionally, the often-overlooked contributors-such as autonomic dysfunction and drug-drug interactions- are discussed and emphasis is put on specific diagnostic and management challenges. It provides practical insights into the spectrum of arrhythmias and conduction disorders, including atrial fibrillation, QTc prolongation, and sudden cardiac death, while underscoring the importance of comprehensive cardiologic assessment throughout the cancer care continuum.

A cardio-oncology multidisciplinary team is essential for the successful delivery of patient-centred care. The roles of oncologists, haematologists, and cardiologists have been clearly articulated in literature pertaining to the creation of cardio-oncology clinics. However, the involvement of other key team members, such as pharmacists, nurses and nurse practitioners, social workers, psychologists and other allied health professionals has been less well-defined. In this review we aim to define the role of pharmacists and nurses as part of a multidisciplinary cardio-oncology team. We also discuss models of care and opportunities to expand the delivery of cardio-oncology services to further enhance outcomes for individuals with cancer, and highlight the challenges experienced by those living in regional, rural, and remote communities.

Background: Neoplasms are a major cause of mortality globally, where early diagnosis is essential for improving outcomes. Current diagnostic methods are often invasive, expensive, and inaccessible in resource-limited settings. This study explores the potential of electrocardiogram (ECG) data, a widely available and non-invasive tool for diagnosing neoplasms through cardiovascular changes linked to neoplastic presence.

Methods: A diagnostic pipeline combining tree-based machine learning models with Shapley value analysis for explainability was developed. The model was trained and internally validated on a large dataset and externally validated on an independent cohort to ensure robustness and generalizability. Key ECG features contributing to predictions were identified and analyzed.

Results: The model achieved high diagnostic accuracy in both internal testing and external validation cohorts. Shapley value analysis highlighted significant ECG features, including novel predictors. The approach is cost-effective, scalable, and suitable for resource-limited settings, offering insights into cardiovascular changes associated with neoplasms and their therapies.

Conclusions: This study demonstrates the feasibility of using ECG signals and machine learning for non-invasive neoplasm diagnosis. By providing interpretable insights into cardio-neoplasm interactions, this method addresses gaps in diagnostics and supports integration into broader diagnostic and therapeutic frameworks.

Background: Tyrosine kinase inhibitor (TKI) therapy improves the overall survival of patients with chronic myeloid leukemia (CML). However, the risk of vascular adverse events (VAEs) in these patients is reported to be higher than that in healthy individuals, because of both CML itself and the effects of TKIs. Appropriate and effective VAE risk assessment tools for TKI treatment have long been anticipated.

Methods: Here, we investigated the usefulness of a newly developed VAE risk assessment tool, the Hisayama score, and presented data on the clinical characteristics of VAEs in Japanese patients with CML based on an analysis of a real-world, large-cohort database.

Results: Patients with CML who developed VAEs were evaluated using three VAE risk assessment tools. Forty-four VAEs were reported in 41 out of 626 patients with CML, with three patients developing multiple VAEs during the observation period. There were 16 cases of cerebral infarction, 19 of ischemic heart disease, and nine of peripheral artery occlusive disease, with rates per 1,000 person-years of 3.23, 3.84, and 2.02, respectively. The Framingham and Hisayama scores stratified high-risk patients with VAEs more effectively than the SCORE chart. Smoking and hypertension are prominent risk factors for VAEs.

Conclusions: Our results clearly demonstrate that the Hisayama score can be used to evaluate VAE risk in high-risk patients. Selecting appropriate TKIs based on each patient risk, smoking cessation, and blood pressure control may contribute to selecting appropriate TKIs and managing VAE risk.

Aims: Cancer patients and survivors are at increased risk of developing heart failure (HF) and heart failure hospitalization (HFH). Yet, the utilization of wireless pulmonary artery pressure sensing devices (PAPSD), like CardioMEMS, in this group is limited.

Objectives: We aimed to explore the utilization of CardioMEMS in managing HF among oncology patients.

Methods: We conducted a single-center retrospective study reviewing consecutive patients implanted with the CardioMEMS device between November 11, 2015, and February 21, 2023. We analyzed the device's impact on pulmonary artery pressures and HFH using statistical methods including Cox regression models and correlation studies between NT-proBNP levels and hemodynamic parameters.

Results: The study included 28 patients, with hypertension (78%) and hyperlipidemia (78%) as prevalent comorbidities. Most patients had heart failure with preserved ejection fraction (64%). Post-implantation, we observed a reduction in HFH and improvements in pulmonary artery pressures. Cox regression identified prior HFH and elevated pulmonary artery systolic (PAS) and diastolic pressures (PAD) as risk factors for repeat HFH (HR: 1.24, 1.04, 1.07, respectively). Biomarker analysis showed a moderate positive correlation between NT-proBNP and PAD, indicating that higher levels are associated with increased hospital admissions. The device was safe with no sensor failures reported.

Conclusions: CardioMEMS shows potential in improving HF management in cancer patients, reducing HFH and enhancing pulmonary artery pressure profiles. These preliminary results advocate for further, larger-scale prospective studies to confirm the benefits and integrate CardioMEMS into cardio-oncology care.

Background: Anthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use.

Objective: This study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC).

Methods: We conducted an extensive search across seven databases to identify randomized controlled trials (RCTs) pertinent to the prevention and treatment of AIC with medications. Subsequently, a Bayesian Model-based network meta-analysis was performed in the R 4.4.0.

Results: A total of 128 RCTs involving 10,431 cancer patients treated with anthracyclines and 78 drug regimens were included in this study. The network meta-analysis results showed that, compared with patients who did not receive cardioprotective drugs, those treated with Calcium Dibutyryladenosine Cyclophosphate (Mean Difference [95% Credible Interval], 8.760 [0.5917, 16.92]), Carvedilol (4.024 [0.5372, 7.656]), Carvedilol + Candesartan (7.934 [3.159, 12.91]), Compound Salvia Miltiorrhiza + Levocarnitine (9.087 [0.9160, 17.25]), Dexrazoxane (5.066 [2.589, 7.540]), Dexrazoxane + Cinobufacini (11.61 [4.590, 18.70]), Dexrazoxane + Shenqi Fuzheng (13.05 [4.640, 21.40]), Nicorandil (14.24 [5.122, 23.31]), Qiliqiangxin (11.38 [2.826, 19.91]), and Xinmai Long (6.371 [1.735, 11.02]) experienced less decrease in LVEF after chemotherapy. The SUCRA ranking results indicated that the most effective treatment option for preserving LVEF was Nicorandil (SUCRA 91.76%).

Conclusion: Apart from Dexrazoxane, Carvedilol, a β-blocker, also appears to show significant potential in preventing AIC. Furthermore, our results indicate that there is insufficient evidence to support the beneficial effects of statins, Sildenafil, Ivabradine, Levocarnitine, N-acetylcysteine, Glutathione, Coenzyme Q10, Vitamin E, and Vitamin C in preventing LVEF decline and exerting a positive effect on the prevention of AIC.

Introduction: Anthracycline-induced cardiotoxicity is a significant concern for breast cancer patients undergoing treatment, often leading to chronic cardiovascular complications and reduced long-term survival. The study aimed to systematically evaluate the efficacy of nine classes of pharmacological agents in protecting against cardiotoxicity in breast cancer patients treated with anthracyclines.

Methods: A comprehensive search of databases was performed from January 2000 to October 2024 to identify randomized controlled trials (RCTs) investigating cardioprotective agents. The risk of bias in the studies was evaluated using the Cochrane risk-of-bias tool. Bayesian network meta-analysis was conducted in Stata 15.1.

Results: Of 3718 studies identified, 29 RCTs involving 2599 patients were included in the network systematic review. The study found that trimetazidine significantly improved left ventricular ejection fraction (LVEF), with a Surface Under the Cumulative Ranking (SUCRA) of 94.0%. The combination of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with beta-blocker (AA-BB) significantly improved global longitudinal strain (GLS), with a SUCRA of 72.8%. Dexrazoxane was highly effective, significantly reducing B-type natriuretic peptide (BNP) levels, cardiac troponin (cTn) levels, and the E/e' ratio (ratio of the mitral early filling velocity to the mean early relaxation tissue velocity), with SUCRA values of 98.9%, 98.2%, and 99.9%, respectively. Additionally, mineralocorticoid receptor antagonist (MRA) showed the highest SUCRA of 88.4% for improving the E/A ratio (ratio of the mitral early diastolic velocity to the late diastolic velocity).

Discussion: Trimetazidine, ACEI/ARB, beta-blocker, dexrazoxane, and MRA demonstrate potential as cardioprotective agents in breast cancer patients undergoing anthracycline chemotherapy. Further research is needed to elucidate the specific cardioprotective mechanisms against anthracycline-induced cardiotoxicity.