Abstract
Cancer therapeutics induced cardiotoxicity has emerged as an important factor of long-term adverse cardiovascular outcomes in survivors of various malignant diseases. Early detection of myocardial injury in the setting of cancer treatment is important for the initiation of targeted cardioprotective therapy, in order to prevent irreversible cardiac dysfunction and heart failure, while not withholding a potentially life-saving cancer therapy. Cardiac imaging techniques including echocardiography, cardiac magnetic resonance, and nuclear cardiac imaging are the main tools for the identification of cardiotoxicity. There is also growing evidence for the detection of subclinical cardiac dysfunction in cancer patients by speckle tracking echocardiography. In this review article, we focus on current and emerging data regarding the role of cardiac imaging for the detection of changes in myocardial function related with cancer treatment in clinical practice.
PMID: 32306221 [PubMed - as supplied by publisher]
21 April 2020
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Cardiotoxicity News
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Modified Routine Cardiac Imaging Surveillance of Adult Cancer Patients and Survivors during the COVID-19 Pandemic.
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Modified Routine Cardiac Imaging Surveillance of Adult Cancer Patients and Survivors during the COVID-19 Pandemic.
JACC CardioOncol. 2020 Apr 16;:
Authors: Calvillo-Argüelles O, Abdel-Qadir H, Ky B, Liu JE, Lopez-Mattei JC, Amir E, Thavendiranathan P
PMID: 32309816 [PubMed - as supplied by publisher]
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Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular function in patients with cancer therapy-related left ventricular dysfunction.
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Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular function in patients with cancer therapy-related left ventricular dysfunction.
Discoveries (Craiova). 2019 Jun 27;7(2):e94
Authors: Cherata DA, Donoiu I, Diaconu R, Glodeanu A, Cârstea D, Militaru C, Istrătoaie O
Abstract
BACKGROUND: This study was designed to assess right ventricular systolic function in cancer patients.
METHODS AND RESULTS: 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%.<0.0001)<0.0001)<0.0001).<0.0001).17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations.
CONCLUSIONS: Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.
PMID: 32309612 [PubMed]
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Therapy-induced cardiotoxicity in breast cancer patients: a well-known yet unresolved problem.
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Therapy-induced cardiotoxicity in breast cancer patients: a well-known yet unresolved problem.
Discoveries (Craiova). 2019 Mar 31;7(1):e89
Authors: Florescu DR, Nistor DE
Abstract
Breast cancer is the second most commonly diagnosed cancer, being one of the main health issues that needs to be addressed worldwide. New therapies have led to a remarkable increase in survival rates, which is unfortunately overshadowed by their negative impact on cardiac structure and function in disease-free patients. Since anthracyclines and trastuzumab cause the most undesired outcome in breast cancer patients - cardiac-related mortality, they have been widely studied. However, other therapies (such as hormonal therapy, tyrosine kinase inhibitors, anti-VEGF drugs etc.) can also affect the cardiovascular system and lead to ischemia, hypertension or vascular thromboembolism. Even though excessive research has been conducted in thepast decades, there are still no guidelines regarding the most adequate methods neither to detect and prevent severe cardiotoxicity that can finally lead to heart failure and ultimately death nor for the further management of patients after cardiotoxicity is detected. Biomarkers of ischemia (troponins T and I) and of overload (BNP and NT-proBNP) in association with periodic echocardiographies (assessment of the global longitudinal strain) are two of the most important means used by physicians in the evaluation of cardiac disease in this group of patients. Given that no internationally accepted guidelines for screening and surveillance of different populations exist, the cardio-oncology team is crucial in the management of these patients, their collaboration resulting in individualized treatment regimens. After careful evaluation of different variables (treatment effects, malignancy status, and the patient's pre-existing conditions), a decision is made to either reduce the dosage or rate of administration, change the medication or interrupt the treatment and initiate the cardioprotective therapeutic associations. Consequently, it is an absolute necessity the development of customized treatment guidelines and the conduction of multiple clinical studies in order to demonstrate their effect on long-term survival.
PMID: 32309607 [PubMed]
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Identifying Cancer Patients at Risk for Heart Failure Using Machine Learning Methods.
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Identifying Cancer Patients at Risk for Heart Failure Using Machine Learning Methods.
AMIA Annu Symp Proc. 2019;2019:933-941
Authors: Yang X, Gong Y, Waheed N, March K, Bian J, Hogan WR, Wu Y
Abstract
Cardiotoxicity related to cancer therapies has become a serious issue, diminishing cancer treatment outcomes and quality of life. Early detection of cancer patients at risk for cardiotoxicity before cardiotoxic treatments and providing preventive measures are potential solutions to improve cancer patients' quality of life. This study focuses on predicting the development of heart failure in cancer patients after cancer diagnoses using historical electronic health record (EHR) data. We examined four machine learning algorithms using 143,199 cancer patients from the University of Florida Health (UF Health) Integrated Data Repository (IDR). We identified a total number of 1,958 qualified cases and matched them to 15,488 controls by gender, age, race, and major cancer type. Two feature encoding strategies were compared to encode variables as machine learning features. The gradient boosting (GB) based model achieved the best AUC score of 0.9077 (with a sensitivity of 0.8520 and a specificity of 0.8138), outperforming other machine learning methods. We also looked into the subgroup of cancer patients with exposure to chemotherapy drugs and observed a lower specificity score (0.7089). The experimental results show that machine learning methods are able to capture clinical factors that are known to be associated with heart failure and that it is feasible to use machine learning methods to identify cancer patients at risk for cancer therapy-related heart failure.
PMID: 32308890 [PubMed - in process]
22 April 2020
13:08
Cardiotoxicity News
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Antitumour anthracyclines: progress and perspectives.
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Antitumour anthracyclines: progress and perspectives.
ChemMedChem. 2020 Apr 20;:
Authors: Martins-Teixeira MB, Carvalho I
Abstract
Anthracyclines are ranked among the most effective chemotherapeutics against cancer. They are glycoside drugs comprised by the aminosugar daunosamine linked to a hydroxy anthraquinone aglycone, and act by DNA-intercalation, oxidative stress generation and topoisomerase II poisoning. Regardless of their therapeutic value, multidrug resistance and severe cardiotoxicity are important limitations of anthracycline treatment, prompting the discovery of novel analogues. This review covers the most clinically relevant anthracyclines and their development over decades, since the first discovered natural prototypes to recent semi-synthetic and synthetic derivatives. These include registered drugs, drug candidates undergoing clinical trials, and compounds under pre-clinical investigation. The impact of the structural modifications on antitumour activity, toxicity and resistance profile are addressed.
PMID: 32314528 [PubMed - as supplied by publisher]
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Design and synthesis of 3,5-substituted 1,2,4-oxadiazoles as catalytic inhibitors of human DNA topoisomerase IIα.
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Design and synthesis of 3,5-substituted 1,2,4-oxadiazoles as catalytic inhibitors of human DNA topoisomerase IIα.
Bioorg Chem. 2020 Apr 08;99:103828
Authors: Loboda KB, Valjavec K, Štampar M, Wolber G, Žegura B, Filipič M, Dolenc MS, Perdih A
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