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Lessons learnt in the first year of an Australian pediatric cardio oncology clinic 澳大利亚儿科心脏肿瘤诊所第一年的经验教训
IF 3.3 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1186/s40959-023-00194-x
Claudia Toro, Ben Felmingham, Mangesh Jhadav, David S. Celermajer, Andre La Gerche, John O’Sullivan, Sanjeev Kumar, Marion K. Mateos, Joy Fulbright, Dinisha Govender, Lane Collier, Michael Cheung, David D. Eisenstat, Peter W. Lange, Julian Ayer, David A. Elliott, Rachel Conyers
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引用次数: 0
Correction: Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report. 更正:奥西替尼诱发的双室心肌病伴心脏MRI异常:1例报告。
IF 3.3 Q2 Medicine Pub Date : 2023-11-29 DOI: 10.1186/s40959-023-00195-w
Karishma Patel, Kristie Y Hsu, Kevin Lou, Krishan Soni, Yoo Jin Lee, Claire K Mulvey, Alan H Baik
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引用次数: 0
Surveillance cardiopulmonary exercise testing can risk-stratify childhood cancer survivors: underlying pathophysiology of poor exercise performance and possible room for improvement. 监测心肺运动测试可以对儿童癌症幸存者进行风险分层:不良运动表现的潜在病理生理学和可能的改进空间。
IF 3.3 Q2 Medicine Pub Date : 2023-11-17 DOI: 10.1186/s40959-023-00193-y
Takeshi Tsuda, Kimberly Davidow, Gina D'Aloisio, Joanne Quillen

Background: Asymptomatic childhood cancer survivors (CCS) frequently show decreased exercise performance. Poor exercise performance may indicate impaired future cardiovascular health.

Methods: Cardiopulmonary exercise testing (CPET) was performed in asymptomatic off-treatment CCS (age ≥ 10 years). Patients were divided into Normal and Poor performance groups by %predicted maximum VO2 at 80%. Both peak and submaximal CPET values were analyzed.

Results: Thirty-eight males (19 Normal, 19 Poor) and 40 females (18 Normal, 22 Poor) were studied. Total anthracycline dosage was comparable among 4 groups. The body mass index (BMI), although normal, and weight were significantly higher in Poor groups. Peak heart rate (HR) and peak respiratory exchange ratio (RER) were comparable in all four groups. Peak work rate (pWR)/kg, peak oxygen consumption (pVO2)/kg, peak oxygen pulse (pOP)/kg, and ventilatory anaerobic threshold (VAT)/kg were significantly lower, whereas heart rate (HR) increase by WR/kg (ΔHR/Δ[WR/kg] was significantly higher in Poor groups. Simultaneously plotting of weight & pVO2 and ΔHR/ΔWR & ΔVO2/ΔHR revealed a distinct difference between the Normal and Poor groups in both sexes, suggesting decreased skeletal muscle mass and decreased stroke volume reserve, respectively, in Poor CCS. The relationship between VAT and pVO2 was almost identical between the two groups in both sexes. Ventilatory efficiency was mildly diminished in the Poor groups.

Conclusions: Decreased skeletal muscle mass, decreased stroke volume reserve, and slightly decreased ventilatory efficiency characterize Poor CCS in both sexes. This unique combined CPET analysis provides useful clinical biomarkers to screen subclinical cardiovascular abnormality in CCS and identifies an area for improvement.

背景:无症状儿童癌症幸存者(CCS)经常表现为运动表现下降。运动表现不佳可能表明未来心血管健康受损。方法:对无症状停药期CCS患者(年龄≥10岁)进行心肺运动试验(CPET)。患者按预测最大VO2在80%时的百分比分为正常组和表现不佳组。分析峰值和次峰值CPET值。结果:男性38例(正常19例,不良19例),女性40例(正常18例,不良22例)。4组间蒽环类药物总剂量具有可比性。虽然身体质量指数(BMI)正常,但贫困人群的体重明显更高。四组的峰值心率(HR)和峰值呼吸交换率(RER)具有可比性。峰值工作速率(pWR)/kg、峰值耗氧量(pVO2)/kg、峰值氧脉冲(pOP)/kg和通气无氧阈(VAT)/kg显著降低,而心率(HR)增加WR/kg (ΔHR/Δ[WR/kg]显著升高。同时,对体重和pVO2以及ΔHR/ΔWR和ΔVO2/ΔHR的绘制显示了正常组和贫穷组在两性之间的明显差异,表明贫穷的CCS分别减少了骨骼肌质量和减少了卒中容量储备。在两性两组中,VAT和pVO2之间的关系几乎相同。贫困组的通气效率轻度降低。结论:骨骼肌质量下降,卒中容量储备减少,通气效率轻微下降是男女CCS不良的特征。这种独特的联合CPET分析为筛查CCS的亚临床心血管异常提供了有用的临床生物标志物,并确定了需要改进的领域。
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引用次数: 0
Cardiovascular disease incidence rates: a study using routinely collected health data. 心血管疾病发病率:一项使用常规收集的健康数据的研究。
IF 3.3 Q2 Medicine Pub Date : 2023-11-15 DOI: 10.1186/s40959-023-00189-8
Johanna Ramroth, Rebecca Shakir, Sarah C Darby, David J Cutter, Valerie Kuan

Background: There is substantial evidence that systemic anticancer therapies and radiotherapy can increase the long-term risk of cardiovascular disease (CVD). Optimal management decisions for cancer patients therefore need to take into account the likely risks from a proposed treatment option, as well as its likely benefits. For CVD, the magnitude of the risk depends on the incidence of the disease in the general population to which the patient belongs, including variation with age and sex, as well as on the treatment option under consideration. The aim of this paper is to provide estimates of CVD incidence rates in the general population of England for use in cardio-oncology and in other relevant clinical, research and health policy contexts.

Methods: We studied a population-based representative cohort, consisting of 2,633,472 individuals, derived by electronic linkage of records from primary care with those of admitted-patient care in England during April 1, 2010, to April 1, 2015. From 38 individual CVDs available via the linked dataset we identified five relevant categories of CVD whose risk may be increased by cancer treatments: four of heart disease and one of stroke.

Results: We calculated incidence rates by age-group and sex for all relevant CVD categories combined, for the four relevant categories of heart disease combined, and for the five relevant CVD categories separately. We present separate incidence rates for all 38 individual CVDs available via the linked dataset. We also illustrate how our data can be used to estimate absolute CVD risks in a range of people with Hodgkin lymphoma treated with chemotherapy and radiotherapy.

Conclusions: Our results provide population-based CVD incidence rates for a variety of uses, including the estimation of absolute risks of CVD from cancer treatments, thus helping patients and clinicians to make appropriate individualized cancer treatment decisions. Graphical Abstract: Cardiovascular incidence rates for use in cardio-oncology and elsewhere: A presentation of age- and sex-specific cardiovascular disease (CVD) incidence rates for use in calculation of absolute cardiovascular risks of cancer treatments, and in other clinical, research and health policy contexts. Abbreviations - CVD: cardiovascular disease; y: years.

背景:有大量证据表明,全身抗癌治疗和放疗可增加心血管疾病(CVD)的长期风险。因此,对癌症患者的最佳管理决策需要考虑到拟议的治疗方案可能带来的风险,以及可能带来的益处。对于心血管疾病,风险的大小取决于该疾病在患者所属的一般人群中的发病率,包括年龄和性别的差异,以及正在考虑的治疗方案。本文的目的是提供英国普通人群心血管疾病发病率的估计,用于心脏肿瘤学和其他相关的临床、研究和卫生政策背景。方法:我们研究了一个以人群为基础的代表性队列,由2,633,472人组成,通过2010年4月1日至2015年4月1日期间英国初级保健和住院患者护理的电子链接记录得出。从通过关联数据集获得的38个个体心血管疾病中,我们确定了五种相关的心血管疾病,其风险可能因癌症治疗而增加:四种心脏病和一种中风。结果:我们按年龄组和性别计算了所有相关心血管疾病类别的发病率,四种相关心脏病类别的发病率,以及五种相关心血管疾病类别的发病率。我们通过关联数据集提供了所有38种个体心血管疾病的单独发病率。我们还说明了我们的数据如何用于估计一系列接受化疗和放疗的霍奇金淋巴瘤患者的绝对心血管疾病风险。结论:我们的研究结果为多种用途提供了基于人群的心血管疾病发病率,包括估计癌症治疗引起的心血管疾病的绝对风险,从而帮助患者和临床医生做出适当的个体化癌症治疗决策。图表摘要:心血管肿瘤学和其他领域的心血管发病率:年龄和性别特异性心血管疾病(CVD)发病率的介绍,用于计算癌症治疗的绝对心血管风险,以及其他临床、研究和卫生政策背景。缩写- CVD:心血管疾病;y:年。
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引用次数: 0
Cardiac electrical abnormalities in childhood acute lymphoblastic leukemia survivors: a systematic review. 儿童急性淋巴细胞白血病幸存者的心电异常:一项系统综述。
IF 3.3 Q2 Medicine Pub Date : 2023-11-11 DOI: 10.1186/s40959-023-00188-9
Émilie Bertrand, Maxime Caru, Audrey Harvey, Philippe Dodin, Vincent Jacquemet, Daniel Curnier

Purpose: The aim was to provide evidence about the prevalence, incidence, and risk factors of cardiac electrical abnormalities in childhood acute lymphoblastic leukemia (ALL) survivors.

Methods: We included all original studies reporting the incidence and/or prevalence of cardiac electrical abnormalities and/or risk factors associated with cardiac electrical abnormalities in childhood ALL survivors (< 21 years old at the time of their initial cancer diagnosis) who were post-treatment. Searches of the databases PubMed, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R), Ovid All EBM Reviews, Ovid Embase, and ISI Web of Science were completed in May 2023. The risk of bias was assessed using the standard JBI critical appraisal checklists.

Results: The 11 studies included in this review (N = 1,264 participants) evaluated various parameters, including different cardiac electrical abnormalities. Five studies reported heart rate abnormalities (0-68%), six reported repolarization disorders (0-30%), two reported depolarization disorders (0-1%), seven reported rhythm disturbances or abnormalities (0-100%), four reported conduction disorders (0-10%), and three reported unclassified abnormalities (1-38%). No risk factors were reported.

Conclusions: Electrical heart problems have been observed in childhood ALL survivors after completion of treatment. Large prospective studies in childhood ALL survivors, clear definitions of cardiac electrical abnormalities, and comparison with a control group are warranted.

Implications for cancer survivors: Cardiac electrical abnormalities induced by chemotherapy-related cardiotoxicity in the growing population of childhood ALL survivors need to be better characterized to ensure better long-term follow-up and improve overall survival rate.

目的:为儿童急性淋巴细胞白血病(ALL)存活者的心电异常的发生率、发病率和危险因素提供证据。方法:我们纳入了所有报告儿童all幸存者心电异常的发生率和/或患病率和(或)与心电异常相关的危险因素的原始研究(结果:本综述中包括的11项研究(N = 1264名参与者)评估了包括不同的心电异常在内的各种参数。5项研究报告了心率异常(0-68%),6项报告了复极障碍(0-30%),2项报告了去极化障碍(0-1%),7项报告了节律紊乱或异常(0-100%),4项报告了传导障碍(0-10%),3项报告了未分类异常(1-38%)。未报告任何危险因素。结论:儿童ALL幸存者在完成治疗后出现了电性心脏问题。有必要对儿童ALL幸存者进行大规模前瞻性研究,明确定义心电异常,并与对照组进行比较。对癌症幸存者的影响:在不断增长的儿童ALL幸存者群体中,需要更好地描述化疗相关心脏毒性引起的心电异常,以确保更好的长期随访并提高总体存活率。
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引用次数: 0
Utilization and short-term outcomes of percutaneous left atrial appendage occlusion in patients with cancer. 癌症患者经皮左心耳封堵术的应用及近期疗效。
IF 3.3 Q2 Medicine Pub Date : 2023-11-04 DOI: 10.1186/s40959-023-00192-z
Yaqi Zhang, Zhuoran Yang, Muhammad U Almani, Raquel Soon-Shiong, Bolun Liu

Background: Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA's approval in 2015 and has become more of a same-day-discharge procedure. Cancer patient with atrial fibrillation/flutter (AF) population can benefit from the procedure but the in-hospital outcomes and readmission data were rarely studied.

Objectives: We investigated the utilization, in-hospital and readmission outcomes in cancer patients with AF who underwent LAAO.

Methods: Data were derived from the National Inpatient Sample and National Readmissions Database from 2016 to 2019. Patients with primary diagnosis of AF admitted for LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed in-hospital mortality, length of stay, total hospital charges, and complications. Thirty-day readmission rates were compared.

Results: LAAO was performed in 60,380 patients with AF and 3% were cancer patients. There were no differences in in-hospital mortality and total hospital charges; however, cancer patients tended to have longer hospital stay (1.59 ± 0.11 vs. 1.32 ± 0.02, p = 0.013). Among complications, cancer patients had higher rates in open or percutaneous pericardial drainage (adjusted odds ratio [aOR] 2.38; 95% confidence interval [CI] 1.19-4.76) and major bleeding events (aOR 7.07; 95% CI 1.82-27.38). There was no statistical significance of 30-day readmission rates between patients with and without cancer (10.0% vs. 9.1%, p = 0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding.

Conclusions: LAAO is a promising procedure in cancer patients complicated by AF with contraindication to anticoagulation. Readmission rate is comparable between patients with and without cancer.

背景:自2015年美国食品药品监督管理局批准以来,经皮左心耳封堵术(LAAO)一直在快速发展,并已成为更多的当天出院程序。患有心房颤动/扑动(AF)人群的癌症患者可以从该手术中受益,但住院结果和再入院数据很少研究。目的:我们调查了接受LAAO的癌症房颤患者的利用率、住院和再入院结果。方法:数据来源于2016年至2019年全国住院患者样本和全国自述数据库。原发诊断为房颤的LAAO患者(ICD-10代码02L73DK)按癌症分组作为二级诊断。我们评估了住院死亡率、住院时间、总住院费用和并发症。比较了30天的再入院率。结果:60380例房颤患者行LAAO,3%为癌症患者。住院死亡率和总住院费用没有差异;然而,癌症患者的住院时间往往更长(1.59 ± 0.11对1.32 ± 0.02,p = 在并发症中,癌症患者有较高的开放或经皮心包引流率(调整比值比[aOR]2.38;95%置信区间[CI]1.19-4.76)和主要出血事件(aOR7.07;95%CI1.82-27.38) = 癌症患者最常见的再入院原因是消化道出血。结论:对于有抗凝禁忌证的癌症合并房颤患者,LAAO是一种很有前途的治疗方法。癌症和非癌症患者的再移植率相当。
{"title":"Utilization and short-term outcomes of percutaneous left atrial appendage occlusion in patients with cancer.","authors":"Yaqi Zhang,&nbsp;Zhuoran Yang,&nbsp;Muhammad U Almani,&nbsp;Raquel Soon-Shiong,&nbsp;Bolun Liu","doi":"10.1186/s40959-023-00192-z","DOIUrl":"https://doi.org/10.1186/s40959-023-00192-z","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA's approval in 2015 and has become more of a same-day-discharge procedure. Cancer patient with atrial fibrillation/flutter (AF) population can benefit from the procedure but the in-hospital outcomes and readmission data were rarely studied.</p><p><strong>Objectives: </strong>We investigated the utilization, in-hospital and readmission outcomes in cancer patients with AF who underwent LAAO.</p><p><strong>Methods: </strong>Data were derived from the National Inpatient Sample and National Readmissions Database from 2016 to 2019. Patients with primary diagnosis of AF admitted for LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed in-hospital mortality, length of stay, total hospital charges, and complications. Thirty-day readmission rates were compared.</p><p><strong>Results: </strong>LAAO was performed in 60,380 patients with AF and 3% were cancer patients. There were no differences in in-hospital mortality and total hospital charges; however, cancer patients tended to have longer hospital stay (1.59 ± 0.11 vs. 1.32 ± 0.02, p = 0.013). Among complications, cancer patients had higher rates in open or percutaneous pericardial drainage (adjusted odds ratio [aOR] 2.38; 95% confidence interval [CI] 1.19-4.76) and major bleeding events (aOR 7.07; 95% CI 1.82-27.38). There was no statistical significance of 30-day readmission rates between patients with and without cancer (10.0% vs. 9.1%, p = 0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding.</p><p><strong>Conclusions: </strong>LAAO is a promising procedure in cancer patients complicated by AF with contraindication to anticoagulation. Readmission rate is comparable between patients with and without cancer.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71478477","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
Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report. 奥西美替尼诱导的双心室心肌病伴心脏MRI异常:一例报告。
IF 3.3 Q2 Medicine Pub Date : 2023-10-31 DOI: 10.1186/s40959-023-00190-1
Karishma Patel, Kristie Y Hsu, Kevin Lou, Krishan Soni, Yoo Jin Lee, Claire K Mulvey, Alan H Baik

Background: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects.

Case presentation: We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient's biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy.

Conclusions: This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.

背景:Osimertinib是一种第三代表皮生长因子受体(EGFR)抑制剂,由于其与前几代EGFR抑制剂相比具有良好的疗效和耐受性,目前是转移性EGFR突变的非小细胞肺癌(NSCLC)的一线治疗药物。然而,它可能会导致罕见但严重的心血管不良反应。病例介绍:我们报告了一例63岁的EGFR突变非小细胞肺癌患者,他接受奥西替尼治疗,在心包积液扩大的情况下发展为新发非缺血性心肌病,伴有双心室功能障碍和心力衰竭。我们首次证明了与奥西替尼相关心肌病相关的心脏MR成像结果,包括局灶性晚期钆增强和心肌水肿。患者的双心室功能在开始以目标为导向的心力衰竭药物治疗并服用奥西替尼后恢复正常。患者随后开始服用第二代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)阿法替尼,没有心肌病复发。结论:该病例强调需要更好地了解奥西替尼诱导的心脏毒性,以及在癌症治疗中出现严重心脏毒性的患者中优化肿瘤治疗的策略。它进一步强调了对出现心脏毒性的癌症患者进行专业多学科护理以优化其肿瘤结果的重要性。
{"title":"Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report.","authors":"Karishma Patel, Kristie Y Hsu, Kevin Lou, Krishan Soni, Yoo Jin Lee, Claire K Mulvey, Alan H Baik","doi":"10.1186/s40959-023-00190-1","DOIUrl":"10.1186/s40959-023-00190-1","url":null,"abstract":"<p><strong>Background: </strong>Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects.</p><p><strong>Case presentation: </strong>We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient's biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy.</p><p><strong>Conclusions: </strong>This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71421089","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: 1
Simplified rules-based tool to facilitate the application of up-to-date management recommendations in cardio-oncology. 简化的基于规则的工具,便于在心脏肿瘤学中应用最新的管理建议。
IF 3.3 Q2 Medicine Pub Date : 2023-10-27 DOI: 10.1186/s40959-023-00179-w
Sherry-Ann Brown, Abdulaziz Hamid, Erin Pederson, Allen Hanna Bs, Ragasnehith Maddula, Rachel Goodman, Morgan Lamberg, Pedro Caraballo, Peter Noseworthy, Opeoluwa Lukan, Gift Echefu, Generika Berman, Indrajit Choudhuri

Background: Millions of cancer survivors are at risk of cardiovascular diseases, a leading cause of morbidity and mortality. Tools to potentially facilitate implementation of cardiology guidelines, consensus recommendations, and scientific statements to prevent atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular diseases are limited. Thus, inadequate utilization of cardiovascular medications and imaging is widespread, including significantly lower rates of statin use among cancer survivors for whom statin therapy is indicated.

Methods: In this methodological study, we leveraged published guidelines documents to create a rules-based tool to include guidelines, expert consensus, and medical society scientific statements relevant to point of care cardiovascular disease prevention in the cardiovascular care of cancer survivors. Any overlap, redundancy, or ambiguous recommendations were identified and eliminated across all converted sources of knowledge. The integrity of the tool was assessed with use case examples and review of subsequent care suggestions.

Results: An initial selection of 10 guidelines, expert consensus, and medical society scientific statements was made for this study. Then 7 were kept owing to overlap and revisions in society recommendations over recent years. Extensive formulae were employed to translate the recommendations of 7 selected guidelines into rules and proposed action measures. Patient suitability and care suggestions were assessed for several use case examples.

Conclusion: A simple rules-based application was designed to provide a potential format to deliver critical cardiovascular disease best-practice prevention recommendations at the point of care for cancer survivors. A version of this tool may potentially facilitate implementing these guidelines across clinics, payers, and health systems for preventing cardiovascular diseases in cancer survivors.

Trial registration: ClinicalTrials.Gov Identifier: NCT05377320.

背景:数以百万计的癌症幸存者有患心血管疾病的风险,心血管疾病是发病率和死亡率的主要原因。潜在促进实施心脏病学指南、共识建议和科学声明以预防动脉粥样硬化性心血管疾病(ASCVD)和其他心血管疾病的工具是有限的。因此,心血管药物和成像的不充分利用是普遍存在的,包括癌症幸存者中他汀类药物的使用率明显较低,他汀类药物治疗是指他汀类药物。方法:在这项方法学研究中,我们利用已发表的指南文件创建了一个基于规则的工具,其中包括与癌症幸存者心血管护理中的护理点心血管疾病预防相关的指南、专家共识和医学会科学声明。在所有转换的知识来源中,发现并消除了任何重叠、冗余或模棱两可的建议。该工具的完整性通过用例示例和后续护理建议的审查进行了评估。结果:本研究初步选择了10项指南、专家共识和医学会科学声明。然后,由于近年来社会建议的重叠和修订,保留了7项。采用了广泛的公式,将7项选定准则的建议转化为规则和拟议的行动措施。对几个使用案例的患者适用性和护理建议进行了评估。结论:设计了一个简单的基于规则的应用程序,以提供一种潜在的形式,在癌症幸存者的护理点提供关键的心血管疾病最佳实践预防建议。该工具的一个版本可能有助于在诊所、付款人和卫生系统中实施这些指南,以预防癌症幸存者的心血管疾病。试验注册:临床试验。Gov标识符:NCT05377320。
{"title":"Simplified rules-based tool to facilitate the application of up-to-date management recommendations in cardio-oncology.","authors":"Sherry-Ann Brown,&nbsp;Abdulaziz Hamid,&nbsp;Erin Pederson,&nbsp;Allen Hanna Bs,&nbsp;Ragasnehith Maddula,&nbsp;Rachel Goodman,&nbsp;Morgan Lamberg,&nbsp;Pedro Caraballo,&nbsp;Peter Noseworthy,&nbsp;Opeoluwa Lukan,&nbsp;Gift Echefu,&nbsp;Generika Berman,&nbsp;Indrajit Choudhuri","doi":"10.1186/s40959-023-00179-w","DOIUrl":"10.1186/s40959-023-00179-w","url":null,"abstract":"<p><strong>Background: </strong>Millions of cancer survivors are at risk of cardiovascular diseases, a leading cause of morbidity and mortality. Tools to potentially facilitate implementation of cardiology guidelines, consensus recommendations, and scientific statements to prevent atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular diseases are limited. Thus, inadequate utilization of cardiovascular medications and imaging is widespread, including significantly lower rates of statin use among cancer survivors for whom statin therapy is indicated.</p><p><strong>Methods: </strong>In this methodological study, we leveraged published guidelines documents to create a rules-based tool to include guidelines, expert consensus, and medical society scientific statements relevant to point of care cardiovascular disease prevention in the cardiovascular care of cancer survivors. Any overlap, redundancy, or ambiguous recommendations were identified and eliminated across all converted sources of knowledge. The integrity of the tool was assessed with use case examples and review of subsequent care suggestions.</p><p><strong>Results: </strong>An initial selection of 10 guidelines, expert consensus, and medical society scientific statements was made for this study. Then 7 were kept owing to overlap and revisions in society recommendations over recent years. Extensive formulae were employed to translate the recommendations of 7 selected guidelines into rules and proposed action measures. Patient suitability and care suggestions were assessed for several use case examples.</p><p><strong>Conclusion: </strong>A simple rules-based application was designed to provide a potential format to deliver critical cardiovascular disease best-practice prevention recommendations at the point of care for cancer survivors. A version of this tool may potentially facilitate implementing these guidelines across clinics, payers, and health systems for preventing cardiovascular diseases in cancer survivors.</p><p><strong>Trial registration: </strong>ClinicalTrials.Gov Identifier: NCT05377320.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61561351","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
Outcomes of patients with active cancers and pre-existing cardiovascular diseases infected with SARS-CoV-2. 患有严重急性呼吸系统综合征冠状病毒2型活动性癌症和已有心血管疾病的患者的结果。
IF 3.3 Q2 Medicine Pub Date : 2023-10-06 DOI: 10.1186/s40959-023-00187-w
Brijesh Patel, Scott A Chapman, Jake T Neumann, Aayush Visaria, Oluwabunmi Ogungbe, Sijin Wen, Maryam Khodaverdi, Priyal Makwana, Jasvinder A Singh, George Sokos

Objective: To determine the impact of acute SARS-CoV-2 infection on patient with concomitant active cancer and CVD.

Methods: The researchers extracted and analyzed data from the National COVID Cohort Collaborative (N3C) database between January 1, 2020, and July 22, 2022. They included only patients with acute SARS-CoV-2 infection, defined as a positive test by PCR 21 days before and 5 days after the day of index hospitalization. Active cancers were defined as last cancer drug administered within 30 days of index admission. The "Cardioonc" group consisted of patients with CVD and active cancers. The cohort was divided into four groups: (1) CVD (-), (2) CVD ( +), (3) Cardioonc (-), and (4) Cardioonc ( +), where (-) or ( +) denotes acute SARS-CoV-2 infection status. The primary outcome of the study was major adverse cardiovascular events (MACE), including acute stroke, acute heart failure, myocardial infarction, or all-cause mortality. The researchers analyzed the outcomes by different phases of the pandemic and performed competing-risk analysis for other MACE components and death as a competing event.

Results: The study analyzed 418,306 patients, of which 74%, 10%, 15.7%, and 0.3% had CVD (-), CVD ( +), Cardioonc (-), and Cardioonc ( +), respectively. The Cardioonc ( +) group had the highest MACE events in all four phases of the pandemic. Compared to CVD (-), the Cardioonc ( +) group had an odds ratio of 1.66 for MACE. However, during the Omicron era, there was a statistically significant increased risk for MACE in the Cardioonc ( +) group compared to CVD (-). Competing risk analysis showed that all-cause mortality was significantly higher in the Cardioonc ( +) group and limited other MACE events from occurring. When the researchers identified specific cancer types, patients with colon cancer had higher MACE.

Conclusion: In conclusion, the study found that patients with both CVD and active cancer suffered relatively worse outcomes when they had acute SARS-CoV-2 infection during early and alpha surges in the United States. These findings highlight the need for improved management strategies and further research to better understand the impact of the virus on vulnerable populations during the COVID-19 pandemic.

目的:确定急性SARS-CoV-2感染对伴有活动性癌症和心血管疾病患者的影响。方法:研究人员从2020年1月1日至2022年7月22日期间的国家COVID队列协作(N3C)数据库中提取并分析数据。他们只包括急性严重急性呼吸系统综合征冠状病毒2型感染的患者,定义为指数住院前21天和住院后5天通过PCR检测呈阳性。活动性癌症被定义为指数入院后30天内最后一次服用癌症药物。“Cardioonc”组由心血管疾病和活动性癌症患者组成。该队列被分为四组:(1)CVD(-),(2)CVD( +), (3) Cardioonc(-)和(4)( +), 其中(-)或( +) 表示急性严重急性呼吸系统综合征冠状病毒2型感染状态。该研究的主要结果是主要心血管不良事件(MACE),包括急性中风、急性心力衰竭、心肌梗死或全因死亡率。研究人员分析了疫情不同阶段的结果,并对其他MACE成分和作为竞争事件的死亡进行了竞争风险分析。结果:该研究分析了418306名患者,其中74%、10%、15.7%和0.3%患有CVD(-)( +), Cardioonc(-)( +), 分别地The Cardioonc( +) 在疫情的所有四个阶段中,该组的MACE事件最高。与CVD(-)相比,Cardioonc( +) 组MACE的比值比为1.66。然而,在奥密克戎时代,心脏病患者发生MACE的风险在统计学上显著增加( +) 与CVD(-)相比。竞争风险分析显示,心血管疾病患者的全因死亡率明显较高( +) 分组并限制其他MACE事件的发生。当研究人员确定特定的癌症类型时,癌症结肠癌患者的MACE较高。这些发现强调了改进管理策略和进一步研究的必要性,以更好地了解新冠肺炎大流行期间病毒对弱势人群的影响。
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引用次数: 0
Cardiovascular adverse events of antineoplastic monoclonal antibodies among cancer patients: real-world evidence from a tertiary healthcare system. 癌症患者中抗肿瘤单克隆抗体的心血管不良事件:来自三级医疗系统的现实证据。
IF 3.3 Q2 Medicine Pub Date : 2023-09-25 DOI: 10.1186/s40959-023-00184-z
Abdulrazaq S Al-Jazairi, Nahlah Bahammam, Dhai Aljuaid, Lama Almutairi, Shroog Alshahrani, Norah Albuhairan, Peter M B Cahusac, Ghazwa B Korayem

Background: Antineoplastic monoclonal antibodies (mAbs), such as trastuzumab, bevacizumab, and pertuzumab have been the mainstay of therapy in cancer patients. Despite proven efficacy of the monoclonal antibodies, cardiovascular-induced adverse events such as heart failure, hypertension, ischemic heart disease, arrhythmias, thromboembolic events, and hemorrhage remain a major complication. The European society of cardiology address that concern with antineoplastic monoclonal antibodies issuing a guideline to manage and monitor chemotherapy-induced cardiotoxicity. There is limited evidence of the real-world prevalence of cardiovascular (CV) events induced by monoclonal antibodies among patients with cancer in Saudi Arabia.

Objective: To evaluate the prevalence of cardiovascular adverse events among patients with cancer treated with monoclonal antibodies in Saudi Arabia.

Methods: This is a retrospective study conducted in a tertiary care hospital, Riyadh, Saudi Arabia. Data were obtained from an electronic medical record of patients with cancer treated with one of the selected monoclonal antibodies, who met the inclusion criteria between January 2005 until June 2015 and have been followed up for at least one year. Patients were stratified into groups according to monoclonal antibodies treatment: trastuzumab, bevacizumab, pertuzumab, and combined mAbs.

Results: A total of 1067 patient were included in the study, within the pre-determined study period. The prevalence of cardiovascular disease among patients with cancer treated with monoclonal antibodies was 16.3%. The prevalence of heart failure was relatively higher in the trastuzumab group (46/626 patients, 7.3%). Among 418 patients treated with bevacizumab, hypertension was the most frequent adverse event, reported in 38 patients (9.1%), followed by thromboembolism reported in 27 patients (6.5%). Treatment discontinuation owing to cardiovascular adverse events was reported in 42/1,067 patients (3.9%).

Conclusion and relevance: Prevalence of antineoplastic monoclonal antibody induced cardiovascular adverse events among patients with cancer is substantially high in Saudi Arabia. There is an urgent need to streamline the practice for identifying high risk patients and flexible referral system for cardio-oncology care.

背景:抗肿瘤单克隆抗体(mAbs),如曲妥珠单抗、贝伐单抗和帕妥珠单抗已成为癌症患者治疗的主要药物。尽管单克隆抗体已被证明有效,但心血管诱发的不良事件,如心力衰竭、高血压、缺血性心脏病、心律失常、血栓栓塞事件和出血,仍然是一个主要并发症。欧洲心脏病学会发布了一份管理和监测化疗引起的心脏毒性的指南,以解决抗肿瘤单克隆抗体的问题。沙特阿拉伯癌症患者中单克隆抗体诱导的心血管(CV)事件的真实患病率证据有限。目的:评估沙特阿拉伯接受单克隆抗体治疗的癌症患者心血管不良事件的患病率。方法:这是一项在利雅得一家三级护理医院进行的回顾性研究,沙特阿拉伯。数据来自癌症患者的电子医疗记录,这些患者在2005年1月至2015年6月期间接受了一种选定的单克隆抗体治疗,符合入选标准,并已随访至少一年。根据单克隆抗体治疗将患者分组:曲妥珠单抗、贝伐单抗、帕妥珠单抗和联合单克隆抗体。结果:在预先确定的研究期内,共有1067名患者被纳入研究。在接受单克隆抗体治疗的癌症患者中,心血管疾病的患病率为16.3%。曲妥珠单抗组的心力衰竭患病率相对较高(46/626名患者,7.3%)。在接受贝伐珠单抗治疗的418名患者中,高血压是最常见的不良事件,38名患者报告了高血压(9.1%),27名患者(6.5%)报告了血栓栓塞。42/1067名患者(3.9%)报告了因心血管不良事件而停止治疗。结论和相关性:沙特阿拉伯癌症患者中抗肿瘤单克隆抗体诱导的心血管不良事件的患病率相当高。迫切需要简化识别高危患者的做法,并为心血管肿瘤护理提供灵活的转诊系统。
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Cardio-oncology
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