Pubblicazioni recenti - cardio-oncology
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Atherosclerotic Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Retrospective Cohort Study.
Heart Lung Circ2023 Dec;():. doi: S1443-9506(23)04375-5.
Tan Sean, Spear Ella, Sane Nikhita, Chan Jasmine, Nelson Adam J, Alamgeer Muhammad, Nerlekar Nitesh, Segelov Eva, Nicholls Stephen J,
Abstract
BACKGROUND:
Immune checkpoint inhibitors (ICIs) are effective therapies for numerous cancers, but have been associated with atherosclerotic cardiovascular disease (ASCVD). This study aimed to identify predictors for ASCVD events among cancer patients treated with ICIs and the cardiovascular risk factor (CVRF) control of those who developed ASCVD.
METHOD:
A single-centre retrospective study of 366 cancer patients who received ICIs from 2018 to 2020 was performed. Demographic, baseline CVRF, cancer history, and ICI regimen data were obtained from medical records. The primary end point of ASCVD events was defined as myocardial infarction, coronary revascularisation, ischaemic stroke, or acute limb ischaemia. Cox proportional multivariable modelling and competing risks analysis were performed to assess ASCVD predictors. Descriptive analysis was performed to describe CVRF management among those who developed ASCVD events.
RESULTS:
Over a median follow-up of 3.4 years (2.8-4.3), 26 patients (7.1%) experienced 27 ASCVD events (seven myocardial infarction, one coronary revascularisation, 13 ischaemic stroke, and six acute limb ischaemia events). There were 226 (61.8%) cancer-related deaths and no cardiac deaths. History of ASCVD before ICI initiation was independently associated with ASCVD events on traditional Cox modelling (hazard ratio [HR] 4.00; 95% confidence interval [CI] 1.79-8.91; p
CONCLUSIONS:
History of ASCVD was associated with subsequent ASCVD events among patients treated with ICIs, which could occur even after active treatment was stopped. Identification and aggressive management of modifiable CVRFs should be considered throughout cancer survivorship in patients who received ICI treatment.
Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.
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Preventing broken hearts in women with breast cancer: A concise review on chemotherapy-mediated cardiotoxicity.
Can J Physiol Pharmacol2023 Dec;():. doi: 10.1139/cjpp-2023-0358.
Bews Hilary, Mackic Lana, Jassal Davinder S,
Abstract
Cancer and cardiovascular disease are the leading causes of death for Canadian women. 1 in 8 Canadian women will receive the life-changing diagnosis of breast cancer (BC) in their lifetime, with 1 in 34 dying from the disease. Although doxorubicin (DOX) and trastuzumab (TRZ) have significantly improved survival in women diagnosed with human epidermal growth factor receptor 2 (HER2)-positive BC, approximately 1 in 4 women who receive this treatment are at risk of developing chemotherapy-induced cardiotoxicity. Cardiotoxicity is defined as a decline in left ventricular ejection fraction (LVEF) of >10% to an absolute value of
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Cardiovascular Health Metrics Differ Between Individuals With and Without Cancer.
J Am Heart Assoc2023 Dec;():e030942. doi: 10.1161/JAHA.123.030942.
Kobo Ofer, Abramov Dmitry, Fiuza Manuela, Chew Nicholas W S, Ng Cheng Han, Parwani Purvi, Menezes Miguel Nobre, Thavendiranathan Paaladinesh, Mamas Mamas A,
Abstract
BACKGROUND:
Although individuals with cancer experience high rates of cardiovascular morbidity, there are limited data on the potential differences in cardiovascular health (CVH) metrics between individuals with and without cancer.
METHODS AND RESULTS:
The National Health and Nutrition Examination Survey between 2015 and 2020 was queried to evaluate the prevalence of health metrics that comprise the American Heart Association Life's Essential 8 construct of cardiovascular health among adult individuals with and without cancer in the United States. Health metric scores were also evaluated according to important patient demographics including age, sex, race and ethnicity, and socioeconomic status. Among 4370 participants representing >180?million US adults, 9.4% had a history of cancer. Individuals with cancer had lower overall cardiovascular health scores (67.1 versus 69.1,
CONCLUSIONS:
We highlight important variations in simple cardiovascular health metrics among individuals with cancer compared with individuals without cancer and demonstrate differences among health metrics based on age, race and ethnicity, and socioeconomic status. These findings may explain ongoing racial, ethnic, and socioeconomic status disparities in the cancer population and provide a framework for optimizing cardiovascular health among individuals with cancer.
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Qili Qiangxin (QLQX) capsule as a multi-functional traditional Chinese medicine in treating chronic heart failure (CHF): A review of ingredients, molecular, cellular, and pharmacological mechanisms.
Heliyon2023 Nov;9(11):e21950. doi: e21950.
Wang Tongxing, Hou Bin, Qin Haoran, Liang Junqing, Shi Min, Song Yanfei, Ma Kun, Chen Meng, Li Huixin, Ding Guoyuan, Yao Bing, Wang Zhixin, Wei Cong, Jia Zhenhua,
Abstract
Chronic heart failure (CHF) is a key part of cardiovascular continuum. Under the guidance of the theory of vessel-collateral doctrine, the present study proposes therapeutic benefits of Qili Qiangxin (QLQX) capsules, an innovative Chinese medicine, on chronic heart failure. The studies show that multiple targets of the drug on CHF, including enhancing myocardial systole, promoting urine excretion, inhibiting excessive activation of the neuroendocrine system, preventing ventricular remodeling by inhibiting inflammatory response, myocardial fibrosis, apoptosis and autophagy, enhancing myocardial energy metabolism, promoting angiogenesis, and improving endothelial function. Investigation on the effects and mechanism of the drug is beneficial to the treatment of chronic heart failure (CHF) through multiple targets and/or signaling pathways. Meanwhile, it provides new insights to further understand other refractory diseases in the cardiovascular continuum, and it also has an important theoretical and practical significance in enhancing prevention and therapeutic effect of traditional Chinese medicine for these diseases.
© 2023 Published by Elsevier Ltd.
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Recent Advances in Serum Biomarkers for Cardiological Risk Stratification and Insight into the Cardiac Management of the Patients With Hematological Malignancies Treated With Targeted Therapy.
Cureus2023 Nov;15(11):e49696. doi: e49696.
Andreescu Mihaela,
Abstract
Cardiovascular diseases (CVD) have emerged as a common and serious complication of cancer treatment, particularly in patients undergoing cardiotoxic therapies. Over the last few years, the medical community has become increasingly aware of the potential for cardiotoxicity resulting from cancer treatments involving chemotherapy, targeted therapies, and radiation therapy. This recognition is due to the significant risk of morbidity and mortality in cancer patients and survivors resulting from such treatment-induced cardiovascular damage. While the cardiotoxic effects of chemotherapy and targeted therapy have been discussed in medical literature, only a limited number of studies have explored the role of serum biomarkers in cardiological risk stratification. In recent years, serum biomarkers have emerged as a valuable tool for assessing and managing cardiotoxicity in patients with hematological malignancies. This review article provides a summary of the current state of knowledge on the usefulness of biomarkers in managing cardiotoxicity resulting from different targeted therapies throughout the cancer care continuum. Although cardiac biomarkers have demonstrated potential in identifying subclinical cardiotoxicity and tracking the response to cardioprotective treatments, further research is necessary to determine optimal biomarkers and surveillance strategies. The incorporation of cardiac biomarkers into clinical practice in patients undergoing targeted therapies could potentially lead to improved long-term cardiovascular outcomes in cancer patients and survivors.
Copyright © 2023, Andreescu et al.
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A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors.
J Cardiopulm Rehabil Prev2023 Nov;():. doi: 10.1097/HCR.0000000000000834.
Foulkes Stephen J, Howden Erin J, Pituskin Edith, Thompson Richard B, La Gerche André, Haykowsky Mark J,
Abstract
PURPOSE:
Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy.
REVIEW METHODS:
A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy.
SUMMARY:
Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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Correction: Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report.
Cardiooncology2023 Nov;9(1):43. doi: 43.
Patel Karishma, Hsu Kristie Y, Lou Kevin, Soni Krishan, Lee Yoo Jin, Mulvey Claire K, Baik Alan H,
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Secondary Prevention and Extreme Cardiovascular Risk Evaluation (SEVERE-1), Focus on Prevalence and Associated Risk Factors: The Study Protocol.
High Blood Press Cardiovasc Prev2023 Nov;():. doi: 10.1007/s40292-023-00607-z.
Maloberti Alessandro, Intravaia Rita Cristina Myriam, Mancusi Costantino, Cesaro Arturo, Golia Enrica, Ilaria Fucile, Coletta Silvio, Merlini Piera, De Chiara Benedetta, Bernasconi Davide, Algeri Michela, Ossola Paolo, Ciampi Claudio, Riccio Alfonso, Tognola Chiara, Ardissino Maddalena, Inglese Elvira, Scaglione Francesco, Calabrò Paolo, De Luca Nicola, Giannattasio Cristina,
Abstract
INTRODUCTION:
Despite significant improvement in secondary CardioVascular (CV) preventive strategies, some acute and chronic coronary syndrome (ACS and CCS) patients will suffer recurrent events (also called "extreme CV risk"). Recently new biochemical markers, such as uric acid (UA), lipoprotein A [Lp(a)] and several markers of inflammation, have been described to be associated with CV events recurrence. The SEcondary preVention and Extreme cardiovascular Risk Evaluation (SEVERE-1) study will accurately characterize extreme CV risk patients enrolled in cardiac rehabilitation (CR) programs.
AIM:
Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.
AIM:
Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.
METHODS:
We will prospectively enrol 730 ACS/CCS patients at the beginning of a CR program. Extreme CV risk will be retrospectively defined as the presence of a previous (within 2 years) CV events in the patients' clinical history. UA, Lp(a) and inflammatory markers (interleukin-6 and -18, tumor necrosis factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with those without extreme CV risk but also with two control groups: 1180 hypertensives and 765 healthy subjects. The association between these biomarkers and extreme CV risk will be assessed with a multivariable model and two scoring systems will be created for an accurate identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce the biochemical markers. Finally, by exome sequencing we will both evaluate polygenic risk score ability to predict recurrent events and perform mendellian randomization analysis on CV biomarkers.
CONCLUSIONS:
Our study proposal was granted by the European Union PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence rising attention on this condition and leading cardiologist to do a better diagnosis and to carry out a more intensive treatment optimization that will finally leads to a reduction of future ACS recurrence. This will be even more important for cardiologists working in CR that is a very important place for CV risk definition and therapies refinement.
© 2023. The Author(s).
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Cyclooxygenase-2 inhibition prevents renal toxicity but not hypertension during sunitinib treatment.
Eur J Pharmacol2023 Nov;():176199. doi: 10.1016/j.ejphar.2023.176199.
van Dorst Daan C H, Mirabito Colafella Katrina M, van Veghel Richard, Garrelds Ingrid M, de Vries René, Mathijssen Ron H J, Danser A H Jan, Versmissen Jorie,
Abstract
BACKGROUND:
Anticancer angiogenesis inhibitors cause hypertension and renal injury. Previously we observed in rats that high-dose aspirin (capable of blocking cyclooxygenase (COX)-1 and-2) was superior to low-dose aspirin (blocking COX-1 only) to prevent these side-effects during treatment with the angiogenesis inhibitor sunitinib, suggesting a role for COX-2. High-dose aspirin additionally prevented the rise in COX-derived prostacyclin (PGI). Therefore, we studied the preventive effects of selective COX-2 inhibition and the hypothesized contributing role of PGI during angiogenesis inhibition.
METHODS:
Male WKY rats received vehicle, sunitinib ((SU), 14?mg/kg/day) alone or combined with COX-2 inhibition (celecoxib, 10?mg/kg/day) or a PGI analogue (iloprost, 100??g/kg/day) for 8 days (n?=?8-9 per group). Mean arterial pressure (MAP) was measured via radiotelemetry, biochemical measurements were performed via ELISA and vascular function was assessed via wire myography.
RESULTS:
SU increased MAP (17±1mmHg versus 3±1mmHg after vehicle on day 4, P
CONCLUSION:
Selective COX-2 inhibition ameliorates albuminuria during angiogenesis inhibition, which most likely acts independently of PGI. To combat angiogenesis inhibitor-induced hypertension, dual rather than selective COX-1/2 blockade seems preferential.
Copyright © 2023. Published by Elsevier B.V.
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Rising global burden of cancer attributable to high BMI from 2010 to 2019.
Metabolism2023 Nov;():155744. doi: 10.1016/j.metabol.2023.155744.
Tan Darren Jun Hao, Ng Cheng Han, Muthiah Mark, Yong Jie Ning, Chee Douglas, Teng Margaret, Wong Zhen Yu, Zeng Rebecca Wenling, Chin Yip Han, Wang Jiong-Wei, Danpanichkul Pojsakorn, Rajaram Ruveena Bhavani, DasGupta Ramanuj, Suzuki Hiroyuki, Takahashi Hirokazu, Tamaki Nobuharu, Dan Yock Young, Lui Rashid, Duseja Ajay, Siddiqui Mohammad Shadab, Yeoh Khay Guan, Sanyal Arun, Wijarnpreecha Karn, Loomba Rohit, Mantzoros Christos Socrates, Huang Daniel Q,
Abstract
BACKGROUND:
High body mass index (BMI) is a major risk factor for cancer development, but its impact on the global burden of cancer remains unclear.
METHODS:
We estimated global and regional temporal trends in the burden of cancer attributable to high BMI, and the contributions of various cancer types using the framework of the Global Burden of Disease Study.
RESULTS:
From 2010 to 2019, there was a 35?% increase in deaths and a 34?% increase in disability-adjusted life-years from cancers attributable to high BMI. The age-standardized death rates for cancer attributable to high BMI increased over the study period (annual percentage change [APC] +0.48?%, 95?% CI 0.22 to 0.74?%). The greatest number of deaths from cancer attributable to high BMI occurred in Europe, but the fastest-growing age-standardized death rates and disability-adjusted life-years occurred in Southeast Asia. Liver cancer was the fastest-growing cause of cancer mortality (APC: 1.37?%, 95?% CI 1.25 to 1.49?%) attributable to high BMI.
CONCLUSION:
The global burden of cancer-related deaths attributable to high BMI has increased substantially from 2010 to 2019. The greatest increase in age-standardized death rates occurred in Southeast Asia, and liver cancer is the fastest-growing cause of cancer mortality attributable to high BMI. Urgent and sustained measures are required at a global and regional level to reverse these trends and slow the growing burden of cancer attributed to high BMI.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Long-term cardiovascular mortality risk in patients with bladder cancer: a real-world retrospective study of 129,765 cases based on the SEER database.
Front Cardiovasc Med2023 ;10():1142417. doi: 1142417.
Liao Jia, Zhou Zihua,
Abstract
INTRODUCTION:
Among 28 cancer types, bladder cancer (BC) patients have the highest risk of dying from cardiovascular disease (CVD). We aimed to identify the independent risk factors and develop a novel nomogram for predicting long-term cardiovascular mortality in patients with BC.
METHODS:
We extracted data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with bladder cancer (BC) between 2000 and 2017. The cumulative incidence function (CIF) was computed for both CVD-related death and other causes of death. Then we performed univariate and multivariate analyses to explore the independent risk factors and further develop a novel nomogram to predict cardiovascular mortality at 5- and 10-year for patients with BC by using the Fine-Gray competing risk model. The efficacy of the developed nomogram was assessed by the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).
RESULTS:
A total of 12,9765 patients were randomly divided into training (?=?90,835, 70%), and validation (?=?38,930, 30%) cohorts. During the follow-up period, 31,862 (46.4%) patients died from BC, and 36793 (53.6%) patients died from non-BC, of which CVD-related death accounted for 17,165 (46.7%), being the major cause of non-cancer deaths. The multivariate analysis showed that age, sex, race, marital status, histologic type, tumor grade, summary stage, and chemotherapy were independent risk factors of CVD-related death in BC patients. The nomogram based on the above eight factors showed good discrimination power, excellent consistency, and clinical practicability: (1) the areas under the curve of the ROC for 5- and 10-year CVD-related death of 0.725 and 0.732 in the training cohort and 0.726 and 0.734 in the validation cohort; (2) the calibration curves showed that the prediction probabilities were basically consistent with the observed probabilities; (3) the DCA curves revealed that the nomogram had high positive net benefits.
DISCUSSION:
To our knowledge, this was the first study to identify the independent risk factors and develop a novel nomogram for predicting long-term cardiovascular mortality in patients with BC based on the competing risk model. Our results could help clinicians comprehensively and effectively manage the co-patient of BC and CVD, thereby reducing the risk of cardiovascular mortality in BC survivors.
© 2023 Liao and Zhou.
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Primary Cardiac Lymphoma Patients Presenting With Heart Failure.
CASE (Phila)2023 Nov;7(11):449-455. doi: 10.1016/j.case.2023.08.008.
Ghantous Eihab, Hochstadt Aviram, Aviram Galit, Perry Chava, Ingbir Merav, Havakuk Ofer, Banai Shmuel, Topilsky Yan, Laufer-Perl Michal,
Abstract
? DLBCL is the most common type of lymphoma with cardiac involvement. ? Obtaining tissue for diagnosis may be challenging in PCLs. ? A safe diagnostic procedure may diagnose DLBCL patients with cardiac masses. ? R-CHOP chemotherapy protocol is the standard treatment for PCL.
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Causes of death in women with breast cancer: a risks and rates study on a population-based cohort.
Front Oncol2023 ;13():1270877. doi: 1270877.
Contiero Paolo, Boffi Roberto, Borgini Alessandro, Fabiano Sabrina, Tittarelli Andrea, Mian Michael, Vittadello Fabio, Epifani Susi, Ardizzone Antonino, Cirilli Claudia, Boschetti Lorenza, Marguati Stefano, Cascone Giuseppe, Tumino Rosario, Fanetti Anna Clara, Giumelli Paola, Candela Giuseppa, Scuderi Tiziana, Castelli Maurizio, Bongiorno Salvatore, Barigelletti Giulio, Perotti Viviana, Veronese Chiara, Turazza Fabio, Crivaro Marina, Tagliabue Giovanna, ,
Abstract
INTRODUCTION:
The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors.
MATERIALS AND METHODS:
Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area.
RESULTS:
The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age
CONCLUSION:
The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.
Copyright © 2023 Contiero, Boffi, Borgini, Fabiano, Tittarelli, Mian, Vittadello, Epifani, Ardizzone, Cirilli, Boschetti, Marguati, Cascone, Tumino, Fanetti, Giumelli, Candela, Scuderi, Castelli, Bongiorno, Barigelletti, Perotti, Veronese, Turazza, Crivaro, Tagliabue and the MAPACA Working Group.
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Lipid-lowering drugs and cancer: an updated perspective.
Pharmacol Rep2023 Nov;():. doi: 10.1007/s43440-023-00553-6.
Alizadehasl Azin, Alavi Maryam Sadat, Boudagh Shabnam, Alavi Mohaddeseh Sadat, Mohebi Somaye, Aliabadi Leila, Akbarian Mahsa, Ahmadi Parisa, Mannarino Massimo R, Sahebkar Amirhossein,
Abstract
Statins and non-statin medications used for the management of dyslipidemia have been shown to possess antitumor properties. Since the use of these drugs has steadily increased over the past decades, more knowledge is required about their relationship with cancer. Lipid-lowering agents are heterogeneous compounds; therefore, it remains to be revealed whether anticancer potential is a class effect or related to them all. Here, we reviewed the literature on the influence of lipid-lowering medications on various types of cancer during development or metastasis. We also elaborated on the underlying mechanisms associated with the anticancer effects of antihyperlipidemic agents by linking the reported in vivo and in vitro studies.
© 2023. The Author(s) under exclusive licence to Maj Institute of Pharmacology Polish Academy of Sciences.
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Temporal trends in guideline-recommended cardiometabolic testing completeness before initiating immune checkpoint inhibitors: A cohort study.
J Intern Med2023 Nov;():. doi: 10.1111/joim.13754.
Chan Jeffrey Shi Kai, Chou Oscar Hou In, Lee Teddy Tai Loy, Lee Yan Hiu Athena, Chan Raymond Ngai Chiu, Dee Edward Christopher, Ng Kenrick, Liu Tong, Tse Gary,
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Author Correction: Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis.
Nat Med2023 Nov;():. doi: 10.1038/s41591-023-02690-0.
Fenioux Charlotte, Abbar Baptiste, Boussouar Samia, Bretagne Marie, Power John R, Moslehi Javid J, Gougis Paul, Amelin Damien, Dechartres Agnès, Lehmann Lorenz H, Courand Pierre-Yves, Cautela Jennifer, Alexandre Joachim, Procureur Adrien, Rozes Antoine, Leonard-Louis Sarah, Qin Juan, , Cheynier Rémi, Charmeteau-De Muylder Benedicte, Redheuil Alban, Tubach Florence, Cadranel Jacques, Milon Audrey, Ederhy Stéphane, Similowski Thomas, Johnson Douglas B, Pizzo Ian, Catalan Toniemarie, Benveniste Olivier, Hayek Salim S, Allenbach Yves, Rosenzwajg Michelle, Dolladille Charles, Salem Joe-Elie,
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Cardiological parameters predict mortality and cardiotoxicity in oncological patients.
ESC Heart Fail2023 Nov;():. doi: 10.1002/ehf2.14587.
Romann Sebastian W, Finke Daniel, Heckmann Markus B, Hund Hauke, Giannitsis Evangelos, Katus Hugo A, Frey Norbert, Lehmann Lorenz H,
Abstract
AIMS:
Oncological patients suspected at risk for cardiotoxicity are recommended to undergo intensified cardiological surveillance. We investigated the value of cardiac biomarkers and patient-related risk factors [age, cardiovascular risk factors (CVRFs), and cardiac function] for the prediction of all-cause mortality (ACM) and the development of cardiotoxicity.
METHODS AND RESULTS:
Between January 2016 and December 2020, patients with oncological diseases admitted to the Cardio-Oncology Unit at the Heidelberg University Hospital were included. They were evaluated by medical history, physical examination, 12-lead electrocardiogram, 2D echocardiography, and cardiac biomarkers [high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP)]. The primary endpoint was defined as ACM and the secondary endpoint was defined as cardiotoxicity, as defined by the European Society of Cardiology. Of the 1971 patients enrolled, the primary endpoint was reached by 490 patients (25.7%) with a median of 363.5 [interquartile range (IQR) 121.8, 522.5] days after presentation. Hs-cTnT of ? 7 ng/L [odds ratio (OR) 1.82, P
CONCLUSIONS:
In cancer patients, CVRF accumulation predicts cardiotoxicity whereas elevated hs-cTnT or NT-proBNP levels are associated with ACM. Accordingly, less intensive surveillance protocols may be warranted in patients with low cardiac biomarker levels and absence of CVRFs.
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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The Metabolic Fingerprint of Doxorubicin-Induced Cardiotoxicity in Male CD-1 Mice Fades Away with Time While Autophagy Increases.
Pharmaceuticals (Basel)2023 Nov;16(11):. doi: 1613.
Brandão Sofia Reis, Reis-Mendes Ana, Neuparth Maria João, Carvalho Félix, Ferreira Rita, Costa Vera Marisa,
Abstract
The cardiotoxicity of doxorubicin (DOX) may manifest at the beginning/during treatment or years after, compromising patients' quality of life. We intended to study the cardiac pathways one week (short-term, control 1 [CTRL1] and DOX1 groups) or five months (long-term, CTRL2 and DOX2 groups) after DOX administration in adult male CD-1 mice. Control groups were given saline, and DOX groups received a 9.0 mg/Kg cumulative dose. In the short-term, DOX decreased the content of AMP-activated protein kinase (AMPK) while the electron transfer flavoprotein-ubiquinone oxidoreductase (ETF-QO) increased compared to CTRL1, suggesting the upregulation of fatty acids oxidation. Moreover, mitofusin1 (Mfn1) content was decreased in DOX1, highlighting decreased mitochondrial fusion. In addition, increased B-cell lymphoma-2 associated X-protein (BAX) content in DOX1 pointed to the upregulation of apoptosis. Conversely, in the long-term, DOX decreased the citrate synthase (CS) activity and the content of Beclin1 and autophagy protein 5 (ATG5) compared to CTRL2, suggesting decreased mitochondrial density and autophagy. Our study demonstrates that molecular mechanisms elicited by DOX are modulated at different extents over time, supporting the differences on clinic cardiotoxic manifestations with time. Moreover, even five months after DOX administration, meaningful heart molecular changes occurred, reinforcing the need for the continuous cardiac monitoring of patients and determination of earlier biomarkers before clinical cardiotoxicity is set.
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The Essential Strategies to Mitigate Cardiotoxicity Caused by Doxorubicin.
Life (Basel)2023 Oct;13(11):. doi: 2148.
Chaulin Aleksey Michailovich,
Abstract
The study of mechanisms underlying cardiotoxicity of doxorubicin and the development of strategies to mitigate doxorubicin-induced cardiotoxicity are the most relevant issues of modern cardio-oncology. This is due to the high prevalence of cancer in the population and the need for frequent use of highly effective chemotherapeutic agents, in particular anthracyclines, for optimal management of cancer patients. However, while being a potent agent to counteract cancer, doxorubicin also affects the cardiovascular systems of patients undergoing chemotherapy in a significant and unfavorable fashion. Consecutively reviewed in this article are risk factors and mechanisms of doxorubicin cardiotoxicity, and the essential strategies to mitigate cardiotoxic effects of doxorubicin treatment in cancer patients are discussed.
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Reverse Onco-Cardiology: What Is the Evidence for Breast Cancer? A Systematic Review of the Literature.
Int J Mol Sci2023 Nov;24(22):. doi: 16500.
Boutas Ioannis, Kontogeorgi Adamantia, Kalantaridou Sophia N, Dimitrakakis Constantine, Patsios Panagiotis, Kalantzi Maria, Xanthos Theodoros,
Abstract
Breast cancer and cardiovascular diseases (CVD) represent significant global health challenges, with CVD being the leading cause of mortality and breast cancer, showing a complex pattern of incidence and mortality. We explore the intricate interplay between these two seemingly distinct medical conditions, shedding light on their shared risk factors and potential pathophysiological connections. A specific connection between hypertension (HTN), atrial fibrillation (AF), myocardial infarction (MI), and breast cancer was evaluated. HTN is explored in detail, emphasizing the role of aging, menopause, insulin resistance, and obesity as common factors linking HTN and breast cancer. Moreover, an attempt is made to identify the potential impact of antihypertensive medications and highlight the increased risk of breast cancer among those women, with a focus on potential mechanisms. A summary of key findings underscores the need for a multisystem approach to understanding the relationship between CVD and breast cancer is also explored with a highlight for all the gaps in current research, such as the lack of clinical observational data on MI and breast cancer in humans and the need for studies specifically designed for breast cancer. This paper concludes that there should be a focus on potential clinical applications of further investigation in this field, including personalized prevention and screening strategies for women at risk. Overall, the authors attempt to provide a comprehensive overview of the intricate connections between breast cancer and cardiovascular diseases, emphasizing the importance of further research in this evolving field of cardio-oncology.
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