Pubblicazioni recenti - cardio-oncology
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Evaluation of all-cause mortality and cardiovascular safety in patients receiving chimeric antigen receptor T cell therapy: a prospective cohort study.
EClinicalMedicine2024 Mar;69():102504. doi: 10.1016/j.eclinm.2024.102504.
Korell Felix, Entenmann Lukas, Romann Sebastian, Giannitsis Evangelos, Schmitt Anita, Müller-Tidow Carsten, Frey Norbert, Dreger Peter, Schmitt Michael, Lehmann Lorenz H,
Abstract
BACKGROUND:
Assessment of cardiovascular risk is critical for patients with cancer. Previous retrospective studies suggest potential cardiotoxicity of CAR T cell therapies. We aimed to prospectively assess cardiotoxicity and the predictive value of cardiac biomarkers and classical risk factors (age, cardiac function, diabetes, arterial hypertension, smoking) for cardiac events and all-cause mortality (ACM).
METHODS:
In this prospective cohort study, all patients treated with CAR T cell constructs (axi-cel, tisa-cel, brexu-cel, ide-cel, or the 3rd generation CAR HD-CAR-1) from Oct 1, 2018, to Sept 30, 2022 at the University Hospital Heidelberg were included. Surveillance included cardiac assessment with biomarkers (high-sensitive Troponin T (hs-cTnT), N-terminal brain natriuretic peptide (NT-proBNP)), 12-lead-ECG, and 2D echocardiography. ACM was defined as the primary study endpoint, while cardiotoxicity, defined by clinical syndromes of heart failure or decline in ejection fraction, served as a secondary endpoint.
FINDINGS:
Overall, 137 patients (median age 60, range 20-83, IQR 16), were included in the study. 46 patients died during the follow up period (median 0.75 years, range 0.02-4.33, IQR 0.89) 57 month, with a median survival of 0.57 years (range 0.03-2.38 years, IQR 0.79). A septal wall thickness above 11 mm (HR 2.48, 95%-CI = 1.10-5.67, = ) was associated with an increased risk of ACM, with a trend seen for reduced left ventricular ejection fraction prior to therapy (LVEF
INTERPRETATION:
Reduced pre-lymphodepletion ejection fraction and early post-infusion biomarker kinetics may be associated with increased ACM and cardiotoxicity events. These findings may help to identify patients who could benefit from intensified cardio-oncological surveillance.
FUNDING:
The German Center for Cardiovascular Research, German Research Foundation, and the Federal Ministry of Education and Research.
© 2024 The Author(s).
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Onco-Hypertension: A Continuously Developing Field between Cancer and Hypertension.
Int J Mol Sci2024 Mar;25(6):. doi: 3442.
Totolici Stefan, Vrabie Ana-Maria, Badila Elisabeta, Weiss Emma,
Abstract
The prognosis of cancer patients has greatly improved in the last years, owing to the development of novel chemotherapeutic agents. However, this progress comes with an increasing occurrence of cardiovascular adverse reactions. A serious side effect is arterial hypertension (HT), which is the most frequent comorbidity encountered in cancer patients, influencing the outcomes in cancer survivors. Even though secondary HT related to specific chemotherapeutic agents, such as vascular endothelial growth factor inhibitors, is usually mild and reversible, in rare instances it can be severe, leading to discontinuation of chemotherapy. In addition, HT per se has been studied as a potential risk factor for cancer development. The relationship is even more complex than previously thought, as concerning evidence recently highlighted the potential oncogenic effects of antihypertensive drugs, particularly thiazide diuretics, which may increase the risk of skin cancer. As a result, in light of the similar risk factors and overlapping pathophysiological mechanisms between HT and cancer, a promising concept of onco-hypertension has emerged, aiming to improve the understanding of the complicated interplay between these two pathologies and maintain a balance between the efficacy and risks of both antihypertensive drugs and chemotherapy agents.
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Cardio-Oncoimmunology: Cardiac Toxicity, Cardiovascular Hypersensitivity, and Kounis Syndrome.
Life (Basel)2024 Mar;14(3):. doi: 400.
Kounis Nicholas G, Hung Ming-Yow, de Gregorio Cesare, Mplani Virginia, Gogos Christos, Assimakopoulos Stelios F, Plotas Panagiotis, Dousdampanis Periklis, Kouni Sophia N, Maria Anastasopoulou, Tsigkas Grigorios, Koniari Ioanna,
Abstract
Cancer therapy can result in acute cardiac events, such as coronary artery spasm, acute myocardial infarction, thromboembolism, myocarditis, bradycardia, tachyarrhythmias, atrio-ventricular blocks, QT prolongation, torsades de pointes, pericardial effusion, and hypotension, as well as chronic conditions, such as hypertension, and systolic and diastolic left ventricular dysfunction presenting clinically as heart failure or cardiomyopathy. In cardio-oncology, when referring to cardiac toxicity and cardiovascular hypersensitivity, there is a great deal of misunderstanding. When a dose-related cardiovascular side effect continues even after the causative medication is stopped, it is referred to as a cardiotoxicity. A fibrotic response is the ultimate outcome of cardiac toxicity, which is defined as a dose-related cardiovascular adverse impact that lasts even after the causative treatment is stopped. Cardiotoxicity can occur after a single or brief exposure. On the other hand, the term cardiac or cardiovascular hypersensitivity describes an inflammatory reaction that is not dose-dependent, can occur at any point during therapy, even at very low medication dosages, and can present as Kounis syndrome. It may also be accompanied by anti-drug antibodies and tryptase levels. In this comprehensive review, we present the current views on cardiac toxicity and cardiovascular hypersensitivity, together with the reviewed cardiac literature on the chemotherapeutic agents inducing hypersensitivity reactions. Cardiac hypersensitivity seems to be the pathophysiologic basis of coronary artery spasm, acute coronary syndromes such as Kounis syndrome, and myocarditis caused by cancer therapy.
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Left Ventricular Longitudinal Strain Abnormalities in Childhood Exposure to Anthracycline Chemotherapy.
Children (Basel)2024 Mar;11(3):. doi: 378.
Rique Arnaud, Cautela Jennifer, Thuny Franck, Michel Gérard, Ovaert Caroline, El Louali Fedoua,
Abstract
Current mortality is low in cases of childhood acute leukemia. Dilated cardiomyopathy induced by anthracyclines remains the main cause of morbidity and mortality during mid-term and long-term follow-up. The aim of our study was to analyze the profile of left ventricular alterations in children treated with anthracyclines and to analyze risks and protective factors, including physical activity. Children and young adults with acute leukemia treated with anthracyclines between 2000 and 2018 during childhood were included. The physical activity performed by the patients before and after treatment was quantified in metabolic equivalent tasks, MET.h, per week. An echocardiographic assessment was performed, including strain analysis. Thirty-eight patients with a median age of 5 [3-8] years were included. Dilated cardiomyopathy was diagnosed in 3 patients and longitudinal strain abnormalities were observed in 11 patients (28.9%). Radiotherapy, cumulative anthracycline doses > 240 mg/m, and the practice of physical activity > 14 MET.h per week (after leukemia treatment) were independently associated with strain abnormalities. In multivariate analysis, radiotherapy was significantly associated with an increased risk of LV GLS abnormalities (OR = 1.26 [1.01-1.57], = 0.036), and physical activity > 14 MET.h/week after oncological treatment was significantly associated with a reduction in the risk of LV GLS abnormalities (OR of 0.03 [0.002-0.411], = 0.009). The strain assessment of left ventricular function is an interesting tool for patient follow-up after leukemia treatment. Moderate and steady physical activity seems to be associated with fewer longitudinal strain abnormalities in patients treated with anthracyclines during childhood.
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Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers.
J Adv Res2024 Mar;():. doi: S2090-1232(24)00117-6.
Guan Tianwang, Monteiro Olivia, Chen Dongting, Luo Zehao, Chi Kaiyi, Li Zhihao, Liang Yinglan, Lu Zhenxing, Jiang Yanting, Yang Jinming, Lin Wenrui, Yi Min, Zhang Kang, Ou Caiwen,
Abstract
INTRODUCTION:
Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers.
OBJECTIVES:
To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites.
METHODS:
A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER)(1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs).
RESULTS:
In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95?%CI, 1·95-1·97]-19·85[95?%CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95?%CI, 1·93-1·95]-19·25[95?%CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95?%CI, 2·02-2·08]-24·71[95?%CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group.
CONCLUSION:
The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancer (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.
Copyright © 2024. Production and hosting by Elsevier B.V.
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Socioeconomic and ethnic disparities in the process of care and outcomes among cancer patients with acute coronary syndrome.
Can J Cardiol2024 Mar;():. doi: S0828-282X(24)00273-3.
Mohamed Mohamed, Ghosh Arjun K, Banerjee Amitava, Mamas Mamas,
Abstract
Cancer and acute coronary syndrome (ACS) are the leading causes of morbidity and mortality globally, with many shared risk factors between both conditions. There are several challenges to the management of patients with cancer presenting with ACS due to their higher baseline risk profile, the complexities of their cancer-related therapies and prognosis, and their higher risk of adverse outcomes after ACS. Although previous studies have demonstrated disparities in the care of both cancer and ACS among patients from ethnic minorities and socioeconomic deprivation, there is limited evidence around the magnitude of such disparities specifically in cancer patients presenting with ACS. This review summarises the current literature on differences in prevalence and management of ACS among patients with cancer from ethnic minorities and socioeconomically deprived backgrounds, as well as the gaps in evidence around the care of this high-risk population and their potential solutions.
Copyright © 2024. Published by Elsevier Inc.
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Comparison of Echocardiography and Myocardial Scintigraphy to Detect Cancer Therapy-Related Cardiovascular Toxicity in Breast Cancer Patients.
J Imaging2024 Feb;10(3):. doi: 54.
Harada Yuko, Shimada Kyosuke, Harada Satoshi John, Sato Tomomi, Kubota Yukino, Yamashita Miyoko,
Abstract
The mortality rate of cancer patients has been decreasing; however, patients often suffer from cardiac disorders due to chemotherapy or other cancer therapies (e.g., cancer-therapy-related cardiovascular toxicity (CVR-CVT)). Therefore, the field of cardio-oncology has drawn more attention in recent years. The first European Society of Cardiology (ESC) guidelines on cardio-oncology was established last year. Echocardiography is the gold standard for the diagnosis of CVR-CVT, but many breast cancer patients are unable to undergo echocardiography due to their surgery wounds or anatomical reasons. We performed a study to evaluate the usefulness of myocardial scintigraphy using Iodine-123 ?-methyl-P-iodophenyl-pentadecanoic acid (I-BMIPP) in comparison with echocardiography and published the results in the Journal of Imaging last year. This is the secondary analysis following our previous study. A total of 114 breast cancer patients who received chemotherapy within 3 years underwent echocardiography, as well as Thallium (Tl) and I-BMIPP myocardial perfusion and metabolism scintigraphy. The ratio of isotope uptake reduction was scored by Heart Risk View-S software (Nihon Medi-Physics). The scores were then compared with the echocardiography parameters. All the patients' charts and data from January 2022 to November 2023 were reviewed for the secondary analysis. Echocardiogram parameters were obtained from 99 patients (87% of total patients). No correlations were found between the echocardiography parameters and Heart Risk View-S scores of Tl myocardial perfusion scintigraphy, nor those of the BMIPP myocardial metabolism scintigraphy. In total, 8 patients out of 114 (7.0%) died within 22 months, while 3 patients out of 26 CVR-CVT patients (11.5%) died within 22 months. Evaluation by echocardiography was sometimes difficult to perform on breast cancer patients. However, other imaging modalities, including myocardial scintigraphy, cannot serve as alternatives to echocardiography. Cardiac scintigraphy detects circulation disorder or metabolism disorder in the myocardium; therefore, it should be able to reveal myocardial damage to some extent. The mortality rate of breast cancer patients was higher with CVR-CVT. A new modality to detect CVR-CVT besides echocardiography can possibly be anticipated for patients who cannot undergo echocardiography.
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The Conundrum of Cancer-Associated Thrombosis: Lesson Learned from Two Intriguing Cases and Literature Review.
Diseases2024 Feb;12(3):. doi: 47.
Laurino Simona, Russi Sabino, Omer Ludmila Carmen, D'Angelo Alberto, Bozza Giovanni, Gallucci Giuseppina, Falco Geppino, Roviello Giandomenico, Bochicchio Anna Maria,
Abstract
The correlation between cancer and venous thromboembolism (VTE) is solid, whereas the knowledge about cancer-related arterial thromboembolism (ATE) still needs a deeper investigation to clarify its pathogenesis. We describe two cases that represent useful hints for a comprehensive review of the thrombotic issue. A 75-year-old man with advanced rectal cancer treated with fluoropyrimidines suffered two catheter-related VTE events managed according to current guidelines. There was no indication for "extended" anticoagulant therapy for him, but during antithrombotic wash-out and fluoropyrimidines plus panitumumab regimen, he suffered a massive right coronary artery (RCA) thrombosis. Another patient with no cardiovascular (CV) risk factors and affected by advanced bladder cancer was treated with a platinum-containing regimen and suffered an acute inferior myocardial infarction 2 days after chemotherapy administration. He was successfully treated with primary Percutaneous Transluminal Coronary Angioplasty of RCA, discontinuing platinum-based therapy. Our observations raise the issue of cancer-associated thrombosis (CAT) complexity and the potential correlation between arterial and venous thrombotic events. Moreover, physicians should be aware of the thrombotic risk associated with anticancer therapies, suggesting that an appropriate prophylaxis should be considered.
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Inflammation and acute cardiotoxicity in adult hematological patients treated with CAR-T cells: results from a pilot proof-of-concept study.
Cardiooncology2024 Mar;10(1):18. doi: 18.
Camilli Massimiliano, Viscovo Marcello, Felici Tamara, Maggio Luca, Ballacci Federico, Carella Giacomo, Bonanni Alice, Lamendola Priscilla, Tinti Lorenzo, Di Renzo Antonio, Coarelli Giulia, Galli Eugenio, Liuzzo Giovanna, Burzotta Francesco, Montone Rocco Antonio, Sorà Federica, Sica Simona, Hohaus Stefan, Lanza Gaetano Antonio, Crea Filippo, Lombardo Antonella, Minotti Giorgio,
Abstract
AIMS:
Chimeric Antigen Receptor-T (CAR-T) cell infusion is a rapidly evolving antitumor therapy; however, cardiovascular (CV) complications, likely associated with cytokine release syndrome (CRS) and systemic inflammation, have been reported to occur. The CARdio-Tox study aimed at elucidating incidence and determinants of cardiotoxicity related to CAR-T cell therapy.
METHODS:
Patients with blood malignancies candidate to CAR-T cells were prospectively evaluated by echocardiography at baseline and 7 and 30 days after infusion. The study endpoints were i) incidence of cancer therapy-related cardiac dysfunction (CTRCD), CTRCD were also balanced for any grade CRS, but CTRCD occurred of Cardiology Guidelines on Cardio-Oncology (decrements of left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) and/or elevations of cardiac biomarkers (high sensitivity troponin I, natriuretic peptides) and ii), correlations of echocardiographic metrics with inflammatory biomarkers.
RESULTS:
Incidence of CTRCD was high at 7 days (59,3%), particularly in subjects with CRS. The integrated definition of CTRCD allowed the identification of the majority of cases (50%). Moreover, early LVEF and GLS decrements were inversely correlated with fibrinogen and interleukin-2 receptor levels (p always???0.01).
CONCLUSIONS:
There is a high incidence of early CTRCD in patients treated with CAR-T cells, and a link between CTRCD and inflammation can be demonstrated. Dedicated patient monitoring protocols are advised.
© 2024. The Author(s).
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Heart failure related to contemporary breast cancer treatment.
JAAPA2024 Apr;37(4):29-33. doi: 10.1097/01.JAA.0001005640.41824.fe.
Durkin Megan, DeJesus Neisha,
Abstract
This article addresses cardiotoxicity in patients with breast cancer who are treated with anthracyclines and/or anti-human epidermal growth factor 2 (HER2) therapy, namely doxorubicin and trastuzumab. Development of concise clinical guidelines for chemotherapy-induced heart failure is ongoing. Through identification of specific risk factors and clinical predictors of cardiotoxicity, clinicians are able to better understand and define effective monitoring strategies and optimize patient care. Close cardiac monitoring is recommended for patients throughout treatment with anthracyclines and anti-HER2 therapy. Pretreatment risk assessment with echocardiography and evaluation of cardiovascular risk factors aid in predicting the development of left ventricular (LV) dysfunction. Further clinical trials are needed to increase understanding and optimize treatment guidelines for LV dysfunction in patients taking anthracyclines or anti-HER2 therapy.
Copyright © 2024 American Academy of Physician Associates.
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Assessment of left and right ventricular systolic function in dogs with multicentric lymphoma.
Top Companion Anim Med2024 Mar;():100858. doi: 10.1016/j.tcam.2024.100858.
Wolf Marcela, Lucina Stephany B, Silva Vinícius B C, Silveira Matheus F, Silva Victoria G, Sarraff Ana P, Custódio Claudia C, Sousa Marlos G,
Abstract
OBJECTIVE:
Myocardial dysfunction in cardio-oncology is generally thought to be related to the cardiotoxicity of chemotherapy treatment. However, it is known that some tumors have direct effects on myocardial function. These effects have already been studied in man, but there are no publications of these of the effects in dogs. Novel advanced echocardiographic techniques may allow early detection of myocardial dysfunction when compared to conventional echocardiographic techniques. This study aims to assess myocardial systolic function in dogs with multicentric lymphoma prior to initiation of chemotherapy.
ANIMALS:
Fifteen dogs with multicentric lymphoma and nineteen healthy dogs.
METHODS:
Case-control study. Dogs with multicentric lymphoma and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, standard and speckle tracking echocardiography to assess biventricular systolic function.
RESULTS:
There were no differences between groups in terms of ejection fraction, fractional shortening, left ventricular systolic and diastolic diameter, tricuspid annular plane systolic excursion, mitral annular plane systolic excursion and fractional area change of the right ventricle (RV). However, there was a reduction in the values of global circumferential strain (p=0.0003), RV strain (p=0.01) and RV tissue motion annular displacement (p
CONCLUSIONS:
Speckle tracking techniques appear to demonstrate early systolic dysfunction, primarily affecting the RV, in dogs with lymphoma prior to chemotherapy treatment.
Copyright © 2024. Published by Elsevier Inc.
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[ANMCO Position paper in collaboration with ITACARE-P: Cardio-oncology rehabilitation. Are we ready?].
G Ital Cardiol (Rome)2024 Apr;25(4):281-293. doi: 10.1714/4244.42210.
Bisceglia Irma, Venturini Elio, Canale Maria Laura, Ambrosetti Marco, Riccio Carmine, Giallauria Francesco, Gallucci Giuseppina, Abrignani Maurizio Giuseppe, Russo Giulia, Lestuzzi Chiara, Mistrulli Raffaella, De Luca Giovanni, Turazza Fabio, Mureddu Gian Francesco, Di Fusco Stefania Angela, Lucà Fabiana, De Luca Leonardo, Camerini Andrea, Halasz Geza, Camilli Massimiliano, Quagliariello Vincenzo, Maurea Nicola, Fattirolli Francesco, Gulizia Michele Massimo, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio,
Abstract
Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation, but also a pillar of preventive cardio-oncology. CORE is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared to an "exercise only" program, comprehensive CORE demonstrates a better outcome. It involves nutritional counseling, psychological support and cardiovascular risk assessment, and it is directed to a very demanding population with a heavy burden of cardiovascular diseases driven by physical inactivity, cancer therapy-induced metabolic derangements and cancer therapy-related cardiovascular toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (telerehabilitation). Not all cardio-oncology rehabilitation is created equal: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey.The aim of this position paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar patient population, but also for oncologists, primary care providers, patients and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during and after cancer treatment, in order to improve quality of life and to fight health inequities.
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Suction thrombectomy of a uterine carcinosarcoma tumor thrombus extending into the IVC and right atrium.
Int Cancer Conf J2024 Apr;13(2):177-181. doi: 10.1007/s13691-024-00662-w.
Talati Jay, Khazem Maher, Vogel Jeffrey, Davis Hugh, Heithaus Robert,
Abstract
Uterine carcinosarcoma is a rare, aggressive tumor with several cases in the literature reporting cardiac tumor thrombus involvement. In this case report, we describe a 72-year-old female with a history of uterine carcinosarcoma, who presented with extensive thrombus in the Inferior Vena Cava (IVC) and right atrium. The patient underwent an aspiration thrombectomy which aided in intravascular debulking of the thrombus. Histopathological analysis of the thrombus revealed tumor thrombus. In cryptic cases of tumor thrombus, thrombectomy with histopathological analysis can help confirm the diagnosis of metastatic disease and help guide oncologic staging and further therapy.
© The Author(s) under exclusive licence to The Japan Society of Clinical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
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Early microvascular coronary endothelial dysfunction precedes pembrolizumab-induced cardiotoxicity. Preventive role of high dose of atorvastatin.
Basic Res Cardiol2024 Mar;():. doi: 10.1007/s00395-024-01046-0.
Efentakis Panagiotis, Choustoulaki Angeliki, Kwiatkowski Grzegorz, Varela Aimilia, Kostopoulos Ioannis V, Tsekenis George, Ntanasis-Stathopoulos Ioannis, Georgoulis Anastasios, Vorgias Constantinos E, Gakiopoulou Harikleia, Briasoulis Alexandros, Davos Constantinos H, Kostomitsopoulos Nikolaos, Tsitsilonis Ourania, Dimopoulos Meletios Athanasios, Terpos Evangelos, Ch?opicki Stefan, Gavriatopoulou Maria, Andreadou Ioanna,
Abstract
Immune checkpoint inhibitors (ICIs) exhibit remarkable antitumor activity and immune-related cardiotoxicity of unknown pathomechanism. The aim of the study was to investigate the ICI class-dependent cardiotoxicity in vitro and pembrolizumab's (Pem's) cardiotoxicity in vivo, seeking for translational prevention means. Cytotoxicity was investigated in primary cardiomyocytes and splenocytes, incubated with ipilimumab, Pem and avelumab. Pem's cross-reactivity was assessed by circular dichroism (CD) on biotechnologically produced human and murine PD-1 and in silico. C57BL6/J male mice received IgG4 or Pem for 2 and 5 weeks. Echocardiography, histology, and molecular analyses were performed. Coronary blood flow velocity mapping and cardiac magnetic resonance imaging were conducted at 2 weeks. Human EA.hy926 endothelial cells were incubated with Pem-conditioned media from human mononuclear cells, in presence and absence of statins and viability and molecular signaling were assessed. Atorvastatin (20 mg/kg, daily) was administered in vivo, as prophylaxis. Only Pem exerted immune-related cytotoxicity in vitro. Pem's cross-reactivity with the murine PD-1 was confirmed by CD and docking. In vivo, Pem initiated coronary endothelial and diastolic dysfunction at 2 weeks and systolic dysfunction at 5 weeks. At 2 weeks, Pem induced ICAM-1 and iNOS expression and intracardiac leukocyte infiltration. At 5 weeks, Pem exacerbated endothelial activation and triggered cardiac inflammation. Pem led to immune-related cytotoxicity in EA.hy926 cells, which was prevented by atorvastatin. Atorvastatin mitigated functional deficits, by inhibiting endothelial dysfunction in vivo. We established for the first time an in vivo model of Pem-induced cardiotoxicity. Coronary endothelial dysfunction precedes Pem-induced cardiotoxicity, whereas atorvastatin emerges as a novel prophylactic therapy.
© 2024. The Author(s).
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Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients.
Eur J Clin Invest2024 Mar;():e14197. doi: 10.1111/eci.14197.
Cinza-Sanjurjo Sergio, Mazón-Ramos Pilar, Rey-Aldana Daniel, Garcia-Vega David, Portela-Romero Manuel, Rodríguez-Mañero Moisés, Sestayo-Fernández Manuela, Lage-Fernández Ricardo, López-López Rafael, González-Juanatey José R,
Abstract
BACKGROUND:
The prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long-term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e-consultation.
METHODS:
We analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n?=?6889) and compared two care models: traditional in-person consultations and e-consultations. In e-consultation model, cardiologists reviewed electronic health records (e-consultation) to determine whether the demand could be addressed remotely or necessitated an in-person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all-cause and CV related hospital admissions and (3) rates of all-cause and CV-related mortality within the first year after the initial consultation or e-consultation at the CD.
RESULTS:
Introduction of e-consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%-51.9%) in waiting times. Furthermore, we observed decreased 1-year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73-.77] for CV-related hospitalizations, .43 [.42-.44] for all-cause hospitalizations, and .87 [.86-.88] for all-cause mortality.
CONCLUSIONS:
Compared to traditional in-person consultations, an outpatient care program incorporating e-consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.
© 2024 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.
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Landscape fire smoke airway exposure impairs respiratory and cardiac function and worsens experimental asthma.
J Allergy Clin Immunol2024 Mar;():. doi: S0091-6749(24)00272-0.
Gomez Henry M, Haw Tatt J, Ilic Dusan, Robinson Peter, Donovan Chantal, Croft Amanda J, Vanka Kanth S, Small Ellen, Carroll Olivia R, Kim Richard Y, Mayall Jemma R, Beyene Tesfalidet, Palanisami Thava, Ngo Doan Tm, Zosky Graeme R, Holliday Elizabeth G, Jensen Megan E, McDonald Vanessa M, Murphy Vanessa E, Gibson Peter, Horvat Jay C,
Abstract
BACKGROUND:
Millions of people are exposed to landscape fire smoke (LFS) globally and inhalation of LFS particulate matter is associated with poor respiratory and cardiovascular outcomes. However, how LFS affects respiratory and cardiovascular function is less well understood.
OBJECTIVE:
To characterize the pathophysiological effects of representative LFS airway exposure on respiratory and cardiac function and on asthma outcomes.
METHODS:
LFS was generated using a customized combustion chamber. 8-week old female Balb/C mice were administered low (25?g/m, 24 hour equivalent) or moderate (100?g/m, 24 hour equivalent) concentrations of LFS particulate matter (10?m and below; PM) daily for 3 (short-term) and 14 (long-term) days in the presence and absence of experimental asthma. Lung inflammation, gene expression, structural changes and lung function were assessed. 8-week old male C57Bl/6 mice were administered low concentration LFS PM for 3 days. Cardiac function and gene expression were assessed.
RESULTS:
Short- and long-term LFS PM airways exposure increased airways hyperresponsiveness and induced steroid-insensitivity in experimental asthma, independent of significant changes in airway inflammation. Long-term LFS PM airways exposure also decreased gas diffusion. Short-term LFS PM airways exposure decreased cardiac function and the expression of gene changes relating to oxidative stress and cardiovascular pathologies.
CONCLUSION:
We have characterised significant detrimental effects of physiologically relevant concentrations and durations of LFS PM airways exposure on lung and heart function. Our study provides a platform for assessment of mechanisms that underpin LFS PM airways exposure on respiratory and cardiovascular disease outcomes.
Copyright © 2024. Published by Elsevier Inc.
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Cardio-oncology disparities: Interplay of psychosocial stress, inflammation, and cardiometabolic health among Black breast cancer survivors.
Am Heart J Plus2024 Feb;38():100366. doi: 100366.
Cousin Lakeshia,
Abstract
Black breast cancer (BC) survivors have a lower survival rate at every stage of the disease, largely due to a higher BC mortality rate of 41 %, more aggressive forms of BC, cardiovascular comorbidities, and stress related to structural inequities. An underexplored factor is Black women's increased risk for cardiometabolic syndrome (CM), exacerbating cardio-oncology disparities. Many factors associated with increased risk for CM are modifiable through lifestyle behavior interventions and generally fail to improve outcomes among Black women. This lack of efficacy is likely due to the interventions' failure to address the cumulative effects of long-term exposure to psychosocial stressors unique to Black women using cultural frameworks. The protocol design of an 8-week pilot study was presented at the inaugural UF Health Cardio-Oncology Symposium, "Emerging Topics in Cardio-Oncology." Twenty-six selfreported Black BC survivors will be randomized using a two-group parallel random assignment experimental design, and study details are reported on ClinicalTrials.gov (#NCT05473026). Our primary aim is to assess the feasibility and acceptability of a culturally relevant gratitude journaling intervention to manage stress and promote goalsetting techniques. The second aim is to test the preliminary efficacy of the intervention on stress, inflammatory biomarkers (TNF-?, IL-6, GDF15, CRP), dispositional gratitude, spiritual well-being, and a culturally relevant framework (Superwoman Schema) to examine stressors unique to Black women. If found to be effective, this clinical trial will provide evidence of a viable non-pharmacological intervention for managing psychosocial stressors, improving CM risk, and reducing cardio-oncology disparities.
© 2024 The Author(s).
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Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021.
Am Heart J Plus2024 Feb;38():100354. doi: 100354.
Brown Sherry-Ann, Beavers Craig, Bauer Brenton, Cheng Richard K, Berman Generika, Marshall Catherine H, Guha Avirup, Jain Prantesh, Steward Austin, DeCara Jeanne M, Olaye Iredia M, Hansen Kathryn, Logan Jim, Bergom Carmen, Glide-Hurst Carri, Loh Irving, Gambril John Alan, MacLeod James, Maddula Ragasnehith, McGranaghan Peter J, Batra Akshee, Campbell Courtney, Hamid Abdulaziz, Gunturkun Fatma, Davis Robert, Jefferies John, Fradley Michael, Albert Katherine, Blaes Anne, Choudhuri Indrajit, Ghosh Arjun K, Ryan Thomas D, Ezeoke Ogochukwu, Leedy Douglas J, Williams Wadsworth, Roman Sebastian, Lehmann Lorenz, Sarkar Abdullah, Sadler Diego, Polter Elizabeth, Ruddy Kathryn J, Bansal Neha, Yang Eric, Patel Brijesh, Cho David, Bailey Alison, Addison Daniel, Rao Vijay, Levenson Joshua E, Itchhaporia Dipti, Watson Karol, Gulati Martha, Williams Kim, Lloyd-Jones Donald, Michos Erin, Gralow Julie, Martinez Hugo,
Abstract
As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and technology companies. In this report, we summarize proceedings from the first two annual COIN summits (inaugural in 2020 and subsequent in 2021) including educational sessions on technological innovations for establishing best practices and aligning resources. Herein, we highlight emerging areas for innovation and defining unmet needs to further improve the outcome for cancer patients and survivors of all ages. Additionally, we provide actionable suggestions for advancing innovation, collaboration, and education in cardio-oncology in the digital era.
© 2023 Published by Elsevier Inc.
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Rate of adverse cardiovascular events in breast cancer patients receiving chemotherapy and targeted therapy: Impact of frailty.
Am Heart J Plus -
Research summary of poster presentations at the 2023 Florida cardio-oncology symposium.
Am Heart J Plus2024 Jan;37():100348. doi: 100348.
Bruno Katelyn A, O'Dell Walter G, Tantawy Marwa, Casson Camara L, Ferrall-Fairbanks Meghan C, DeRemer David L, Dungan Jennifer R, Nguyen Branden L, Roumi Nathalie H, Shabnaz Samia, Smuder Ashley J, Vilaro Melissa J, Norton Nadine, Fairweather DeLisa, Gong Yan,
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