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Pubblicazioni recenti - cardio-oncology
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Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic.
Trends Cardiovasc Med2020 May;():. doi: S1050-1738(20)30069-4.
Ganatra Sarju, Dani Sourbha S, Shah Sachin, Asnani Aarti, Neilan Tomas G, Lenihan Daniel, Ky Bonnie, Barac Ana, Hayek Salim S, Leja Monika, Herrmann Joerg, Thavendiranathan Paaladinesh, Fradley Michael, Bang Vigyan, Shreyder Katherine, Parikh Rohan, Patel Rushin, Singh Amitoj, Brar Simarjeet, Guha Avirup, Gupta Dipti, Mascari Paolo, Patten Richard, Venesy David, Nohria Anju, Resnic Frederic S,
Abstract
Patients with pre-existing cardiovascular disease and risk factors are more likely to experience adverse outcomes associated with the novel coronavirus disease-2019 (COVID-19). Additionally, consistent reports of cardiac injury and de novo cardiac complications, including possible myocarditis, arrhythmia, and heart failure in patients without prior cardiovascular disease or significant risk factors, are emerging, possibly due to an accentuated host immune response and cytokine release syndrome. As the spread of the virus increases exponentially, many patients will require medical care either for COVID-19 related or traditional cardiovascular issues. While the COVID-19 pandemic is dominating the attention of the healthcare system, there is an unmet need for a standardized approach to deal with COVID-19 associated and other traditional cardiovascular issues during this period. We provide consensus guidance for the management of various cardiovascular conditions during the ongoing COVID-19 pandemic with the goal of providing the best care to all patients and minimizing the risk of exposure to frontline healthcare workers.
Copyright © 2020. Published by Elsevier Inc.
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Clinical and Research Tools for the Study of Cardiovascular Effects of Cancer Therapy.
J Cardiovasc Transl Res2020 May;():. doi: 10.1007/s12265-020-10030-7.
Feroze Rafey A, Leya Jeff, Herron Todd, Hayek Salim S,
Abstract
The expansion of cancer therapeutics has paved the way for improved cancer-related outcomes. Cardiotoxicity from cancer therapy occurs in a small but significant subset of patients, is often poorly understood, and contributes to adverse outcomes at all stages of cancer treatment. Given the often-idiopathic occurrence of cardiotoxicity, novel strategies are needed for risk-stratification and early identification of cancer patients experiencing cardiotoxicity. Clinical and research tools extending from imaging to blood-based biomarkers and pluripotent stem cells are being explored as methods to study the cardiovascular impact of various cancer treatments. Here we provide an overview of tools currently available for evaluation of cardiotoxicity and highlight novel techniques in development aimed at understanding underlying pathophysiologic mechanisms.
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Cardiotoxicity of the BCR-ABL1 tyrosine kinase inhibitors: Emphasis on ponatinib.
Int J Cardiol2020 May;():. doi: S0167-5273(20)30723-3.
Singh Anand Prakash, Umbarkar Prachi, Tousif Sultan, Lal Hind,
Abstract
The advent of tyrosine kinase inhibitors (TKIs) targeted therapy revolutionized the treatment of chronic myeloid leukemia (CML) patients. However, cardiotoxicity associated with these targeted therapies puts the cancer survivors at higher risk. Ponatinib is a third-generation TKI for the treatment of CML patients having gatekeeper mutation T315I, which is resistant to the first and second generation of TKIs, namely, imatinib, nilotinib, dasatinib, and bosutinib. Multiple unbiased screening from our lab and others have identified ponatinib as most cardiotoxic FDA approved TKI among the entire FDA approved TKI family (total 50+). Indeed, ponatinib is the only treatment option for CML patients with T315I mutation. This review focusses on the cardiovascular risks and mechanism/s associated with CML TKIs with a particular focus on ponatinib cardiotoxicity. We have summarized our recent findings with transgenic zebrafish line harboring BNP luciferase activity to demonstrate the cardiotoxic potential of ponatinib. Additionally, we will review the recent discoveries reported by our and other laboratories that ponatinib primarily exerts its cardiotoxicity via an off-target effect on cardiomyocyte prosurvival signaling pathways, AKT and ERK. Finally, we will shed light on future directions for minimizing the adverse sequelae associated with CML-TKIs.
Copyright © 2020. Published by Elsevier B.V.
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Doxorubicin contributes to thrombus formation and vascular injury via enhancing platelet functions in vivo.
Am J Physiol Heart Circ Physiol2020 May;():. doi: 10.1152/ajpheart.00456.2019.
Lv Haichen, Tan Ruopeng, Liao Jiawei, Hao Zhujing, Yang Xiaolei, Liu Yang, Xia Yunlong,
Abstract
In clinical studies, platelet aggregation and risk of thrombosis are increased in patients after doxorubicin treatment. However, the exact role of doxorubicin in platelet functions and thrombus formation in vivo remain unclear. The present study is to investigate the role of doxorubicin in platelet function in relation to thrombus formation and vascular toxicity, as well as the efficacy of antiplatelet therapy. Mice were treated with doxorubicin or vehicle (5 mg/kg i.v., 4 weeks) and the following parameters were determined: platelet count and size, platelet surface adhesive receptors by flow cytometry, density of granules by electron microscopy, platelet aggregation and degranulation at resting or agonist-stimulated state, platelet adhesion on fibrinogen or endothelial cells, and thrombus formation on collagen matrix. The efficacy of clopidogrel (15 mg/kg/day, followed by 5 mg/kg/day) on doxorubicin-induced changes in the aforementioned parameters as well as vascular injury were also determined. Whilst platelet count and size were similar between doxorubicin treated and vehicle treated mice, doxorubicin promoted thrombus formation evidenced by greater platelet aggregation, degranulation and adhesion to endothelial cells evoked by agonists. Clopidogrel treatment attenuated the enhanced platelet activity and thrombus formation by doxorubicin, as well as vascular platelet infiltration and ROS generation. Collectively, this study demonstrates that platelet functions are enhanced after long-term doxorubicin administration, which leads to thrombus formation and vascular toxicity, and that doxorubicin-induced changes in the functionality of platelets can be effectively inhibited by anti-platelet drugs.
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Mechanistic Biomarkers Informative of Both Cancer and Cardiovascular Disease: JACC State-of-the-Art Review.
J Am Coll Cardiol2020 Jun;75(21):2726-2737. doi: S0735-1097(20)34862-2.
Narayan Vivek, Thompson Elizabeth W, Demissei Biniyam, Ho Jennifer E, Januzzi James L, Ky Bonnie,
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality worldwide. Although conventionally managed as separate disease processes, recent research has lent insight into compelling commonalities between CVD and cancer, including shared mechanisms for disease development and progression. In this review, the authors discuss several pathophysiological processes common to both CVD and cancer, such as inflammation, resistance to cell death, cellular proliferation, neurohormonal stress, angiogenesis, and genomic instability, in an effort to understand common mechanisms of both disease states. In particular, the authors highlight key circulating and genomic biomarkers associated with each of these processes, as well as their associations with risk and prognosis in both cancer and CVD. The purpose of this state-of-the-art review is to further our understanding of the potential mechanisms underlying cancer and CVD by contextualizing pathways and biomarkers common to both diseases.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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The EACVI survey on cardiac imaging in cardio-oncology.
Eur Heart J Cardiovasc Imaging2020 May;():. doi: jeaa111.
Stankovic Ivan, Dweck Marc R, Marsan Nina Ajmone, Bergler-Klein Jutta, Holte Espen, Manka Robert, Schulz-Menger Jeanette, Sitges Marta, Haugaa Kristina H,
Abstract
Early and late cardiovascular (CV) toxicities related to many cancer treatments may complicate the clinical course of patients, offsetting therapeutic benefits, and altering prognosis. The early detection, monitoring, and treatment of cardiotoxicity have therefore become essential parts of cancer patient care. CV imaging is a cornerstone of every cardio-oncology unit, but its use may vary across Europe because of the non-uniform availability of advanced imaging techniques and differences in the organization and logistics of cardio-oncology services. The purpose of this EACVI survey in cardio-oncology is to obtain real-world data on the current usage of cardiac imaging in cancer patients. Data from 104 centres and 35 different countries confirmed that cardiac imaging plays a pivotal role in the detection and monitoring of cardiac toxicity in oncology patients in Europe and beyond. However, it also revealed gaps between guidelines recommendations and everyday clinical practice, highlighting some of the challenges that need to be overcome in this rapidly advancing field.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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The role of metabolic diseases in cardiotoxicity associated with cancer therapy: What we know, what we would know.
Life Sci2020 May;():117843. doi: S0024-3205(20)30593-2.
L'Abbate Serena, Russo Ilaria, Kusmic Claudia,
Abstract
Metabolic diseases, such as obesity and type 2 diabetes, is known risk factor for cardiovascular (CV) diseases. Thus, patients with those comorbidities could be at increased risk of experiencing cardiotoxicity related to treatment with Anthracyclines and the other new generation targeted anticancer drugs. However, investigations addressing the mechanisms underlying the development of CV complications and poor outcome in such cohort of patients are still few and controversial. Given the importance of a personalized approach against chemotherapy-induced cardiomyopathy, this review summarizes our current knowledge on the pathophysiology of chemotherapy-induced cardiomyopathy and its association with obesity and type 2 diabetes. Along with clinical evidences, future perspectives of preclinical research around this field and its role in addressing important open questions, including the development of more proactive strategies for prevention, and treatment of cardiotoxicity during and after chemotherapy in the presence of metabolic diseases, is also presented.
Copyright © 2020. Published by Elsevier Inc.
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Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a Position Statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society.
Eur J Heart Fail2020 May;():. doi: 10.1002/ejhf.1920.
Lyon Alexander R, Dent Susan, Stanway Susanna, Earl Helena, Brezden-Masley Christine, Cohen-Solal Alain, Tocchetti Carlo G, Moslehi Javid, Groarke John D, Bergler-Klein Jutta, Khoo Vincent, Tan Li Ling, Anker Markus S, von Haehling Stephan, Maack Christoph, Pudil Radek, Barac Ana, Thavendirnathan Paaladinesh, Ky Bonnie, Neilan Tomas G, Belenkov Yury, Rosen Stuart D, Iakobishvili Zaza, Sverdlov Aaron L, Hajjar Ludhmila A, Macedo Ariane V S, Manisty Charlotte, Ciardiello Fortunato, Farmakis Dimitrios, De Boer Rudolf A, Skouri Hadi, Suter Thomas M, Cardinale Daniela, Witteles Ronald M, Fradley Michael G, Herrmann Joerg, Cornell Robert F, Wechelaker Ashutosh, Mauro Michael J, Milojkovic Dragana, de Lavallade Hugues, Ruschitzka Frank, Coats Andrew J S, Seferovic Petar M, Chioncel Ovidiu, Thum Thomas, Bauersachs Johann, Andres M Sol, Wright David J, López-Fernández Teresa, Plummer Chris, Lenihan Daniel,
Abstract
This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi-targeted kinase inhibitors for CML targeting BCR-ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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The COVID-19 Pandemic and its Impact on the Cardio-Oncology Population.
Curr Oncol Rep2020 05;22(6):60. doi: 10.1007/s11912-020-00945-4.
Asokan Ishan, Rabadia Soniya V, Yang Eric H,
Abstract
PURPOSE OF REVIEW:
The novel Coronavirus (2019-nCoV, COVID-19) is historically one of the most severe acute respiratory syndromes and pandemics to affect the globe in the twenty-first century. Originating in Wuhan, the virus rapidly spread and impacted subsets of populations with initial unclear risk factors contributing to worsening morbidity and mortality. Patients with diagnosis of cancer and undergoing treatment further represent a population at risk for worsening cardiopulmonary outcomes. This review explores specific risk factors, diagnoses, and treatment options that impact cardio-oncologic patients with COVID-19.
RECENT FINDINGS:
Multiple studies globally, including Italy, China, and the USA, have documented severe outcomes. Cancer patients are at increased risk of cardiac injury which itself is a risk factor for mortality. Additionally, elderly cancer patients undergoing recent anti-cancer treatment may be at greater risk for sustaining worse outcomes, although data remains suboptimal in this population. Major gaps remain regarding risk associated with type of cancer and type of anti-cancer treatment, as well as the layered risk of cardiovascular disease and cancer. Immunomodulatory therapies used to treat cytokine release syndrome secondary to anti-cancer therapies, as well as other agents being traditionally used to treat cardiovascular and cancer disease states, are being investigated for treatment of COVID-19. Hypertension, cardiovascular disease, diabetes, and cancer have been associated with more severe COVID-19 infection and worse outcomes. Patients undergoing anti-cancer therapy or those who have suffered from coronavirus infection may develop long-standing changes, not limited to pulmonary fibrosis, hyperlipidemia, and worsening atherosclerosis. Those undergoing anti-cancer therapy are at theoretically increased susceptibility for infection, with type of cancer not necessarily dictating outcome. A review of the literature of patients with cardiovascular and/or cancer disease is presented, as well as proposed strategies to attenuate risk regarding treatment, management, and surveillance in this vulnerable population.
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Exercise Training for Cancer Survivors.
Curr Treat Options Oncol2020 May;21(7):53. doi: 10.1007/s11864-020-00752-w.
Tong Calvin K W, Lau Benny, Davis Margot K,
Abstract
OPINION STATEMENT:
Cardiovascular diseases are a common cause of morbidity and mortality in cancer survivors. Furthermore, some cancer therapies are now being increasingly recognized to have negative cardiovascular effects, or cardiotoxicity. Exercise therapy has been found to improve cardiorespiratory fitness in patients with cancer as well as attenuate the cardiotoxic effects of cancer therapy. It is the centerpiece for cardiac and pulmonary rehabilitation programs. It is also an important component in cardio-oncology rehabilitation. Exercise is generally safe, and its benefit is observed when started as soon as the diagnosis of cancer and throughout cancer survivorship.
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Presence and prognostic value of ventricular diastolic function in arrhythmogenic right ventricular cardiomyopathy.
Echocardiography2020 May;():. doi: 10.1111/echo.14716.
Sadeghpour Anita, Hosseini Leila, Rezaeian Nahid, Alizadehasl Azin, Maleki Majid, Emkanjoo Zahra, Bakhshandeh Hooman, Zadehbagheri Fatemeh,
Abstract
INTRODUCTION:
Limited data exist regarding the presence and importance of diastolic parameters in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We sought to evaluate RV diastolic parameters and echo-based diastolic predictors of major adverse cardiovascular events (MACE).
METHOD:
48 patients with a definitive diagnosis of ARVC were included and followed for 6-18 months. A comprehensive standard two-dimensional (2D) transthoracic echocardiography (TTE) with precise evaluation of systolic and diastolic indices of both ventricles was done. RV isovolumetric relaxation time (IVRT), RV myocardial performance index (MPI), and right atrial (RA) volume were evaluated.
RESULTS:
48 patients (mean age = 38.5 ± 14 years; 79.2% male) were enrolled. 27.3% had grade I, 68.2% had grade II, and 4.5% had grade III RV diastolic dysfunction. In 12-month follow-up, 12 patients (25%, with mean RV3DEF = 24.8 ± 9%) experienced MACE and required hospitalization: ventricular tachyarrhythmia in 7 patients (14.6%), RV clot in 2 subjects (4.2%), and right-sided failure in 3 cases (6.3%). In logistic regression analysis, tissue Doppler velocity of tricuspid annulus (e' TV) (P = .02, OR = 0.581, CI = 0.368-0.917), peak E mitral valve (P = .043, OR = 0.95, CI = 0.913-0.999), tissue Doppler velocity of septal e' (P = .052, OR = 0.733, CI = 0.536-1.003), and MPI (P = .009, OR = 95, CI = 3.083-2942) were powerful predictors of MACE.
CONCLUSION:
In our study, RV diastolic function parameters including e' TV and e' MV, RA volume and area, and RV MPI were powerful predictors of MACE and may be considered during the baseline and follow-up of the ARVC patients.
© 2020 Wiley Periodicals LLC.
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Vascular Endothelial Cells and Innate Immunity.
Arterioscler Thromb Vasc Biol2020 Jun;40(6):e138-e152. doi: 10.1161/ATVBAHA.120.314330.
Shao Ying, Saredy Jason, Yang William Y, Sun Yu, Lu Yifan, Saaoud Fatma, Drummer Charles, Johnson Candice, Xu Keman, Jiang Xiaohua, Wang Hong, Yang Xiaofeng,
Abstract
In addition to the roles of endothelial cells (ECs) in physiological processes, ECs actively participate in both innate and adaptive immune responses. We previously reported that, in comparison to macrophages, a prototypic innate immune cell type, ECs have many innate immune functions that macrophages carry out, including cytokine secretion, phagocytic function, antigen presentation, pathogen-associated molecular patterns-, and danger-associated molecular patterns-sensing, proinflammatory, immune-enhancing, anti-inflammatory, immunosuppression, migration, heterogeneity, and plasticity. In this highlight, we introduce recent advances published in both and many other journals: (1) several significant characters classify ECs as novel immune cells not only in infections and allograft transplantation but also in metabolic diseases; (2) several new receptor systems including conditional danger-associated molecular pattern receptors, nonpattern receptors, and homeostasis associated molecular patterns receptors contribute to innate immune functions of ECs; (3) immunometabolism and innate immune memory determine the innate immune functions of ECs; (4) a great induction of the immune checkpoint receptors in ECs during inflammations suggests the immune tolerogenic functions of ECs; and (5) association of immune checkpoint inhibitors with cardiovascular adverse events and cardio-oncology indicates the potential contributions of ECs as innate immune cells.
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Pediatric Primary Dilated Cardiomyopathy Gene Testing and Variant Reclassification: Does It Matter?
J Am Heart Assoc -
Trends in the Use of Cardiac Imaging for Women with Newly Diagnosed Breast Cancer.
J Cardiovasc Transl Res2020 May;():. doi: 10.1007/s12265-020-10023-6.
Barac Ana, Isaacs Claudine, M Shara Nawar, Lynce Filipa, Desale Sameer, Haynes Kevin, Potosky Arnold L,
Abstract
We investigated time trends and factors associated with the use of cardiac imaging among women with early-stage breast cancer prior to the initiation of treatment. Of 11,732 women ages 24-64, diagnosed with stage I-III breast cancer in 2006-2011, 2550 (22%) received anthracycline-based chemotherapy. Baseline cardiac imaging was used in 79% of patients receiving anthracyclines and increased over time. Of 2277 (20%) women who received non-anthracycline therapy, 16% received cardiac imaging. Women receiving cardiac imaging in non-anthracycline therapy group were more likely to have higher cardiovascular risk, as well as higher cancer stage and worse histological tumor grade suggesting that results of imaging might have influenced the choice of cancer therapy. Our findings indicate the need for cardio-oncology collaboration in identification and treatment of women at high risk for adverse oncology and cardiovascular outcomes.
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Population pharmacokinetics of ceftazidime in critically ill children: impact of cystic fibrosis.
J Antimicrob Chemother2020 May;():. doi: dkaa170.
Bui S, Facchin A, Ha P, Bouchet S, Leroux S, Nacka F, Fayon M, Jacqz-Aigrain E, ,
Abstract
BACKGROUND:
Pharmacokinetics data on ceftazidime are sparse for the paediatric population, particularly for children with cystic fibrosis (CF) or severe infections.
OBJECTIVES:
To characterize the population pharmacokinetics of ceftazidime in critically ill children, identify covariates that affect drug disposition and evaluate the current dosing regimens.
METHODS:
The study was registered with Clinicaltrials.gov (NCT01344512). Children receiving ceftazidime were selected in 13 French hospitals. Plasma concentrations were determined by UPLC-MS/MS. Population pharmacokinetic analyses were performed using NONMEN software.
RESULTS:
One hundred and eight patients, aged 28?days to 12?years, with CF (n?=?32), haematology and/or oncology disorders (n?=?47) or severe infection (n?=?29) were included. Ceftazidime was administered by continuous or intermittent infusions; 271 samples were available for analysis. A two-compartment model with first-order elimination and allometric scaling was developed and covariate analysis showed that ceftazidime pharmacokinetics were also significantly affected by CLCR and CF. Ceftazidime clearance was 82% higher in CF than in non-CF patients. Monte Carlo simulations showed that the percentage of target attainment (PTA) for the target of T>MIC?=?65% was (i) lower in CF than in non-CF children with intermittent infusions and (ii) higher with continuous than intermittent infusion in all children.
CONCLUSIONS:
The population pharmacokinetics model for ceftazidime in children was influenced by body weight, CLCR and CF. A higher PTA was obtained with continuous versus intermittent infusions. Further studies should explore the benefits of continuous versus intermittent infusion of ceftazidime, including current versus increased doses in CF children.
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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An FGFR/AKT/SOX2 Signaling Axis Controls Pancreatic Cancer Stemness.
Front Cell Dev Biol2020 ;8():287. doi: 10.3389/fcell.2020.00287.
Quan Mei-Yu, Guo Qiang, Liu Jiayu, Yang Ruo, Bai Jing, Wang Wei, Cai Yaxin, Han Rui, Lv Yu-Qing, Ding Li, Billadeau Daniel D, Lou Zhenkun, Bellusci Saverio, Li Xiaokun, Zhang Jin-San,
Abstract
Cancer stemness is associated with high malignancy and low differentiation, as well as therapeutic resistance of tumors including pancreatic ductal adenocarcinoma (PDAC). Fibroblast growth factors (FGFs) exert pleiotropic effects on a variety of cellular processes and functions including embryonic stem cell pluripotency and cancer cell stemness via the activation of four tyrosine kinase FGF receptors (FGFRs). FGF ligands have been a major component of the cocktail of growth factors contained in the cancer stemness-inducing (CSI) and organoid culture medium. Although FGF/FGFR signaling has been hypothesized to maintain cancer stemness, its function in this process is still unclear. We report that inhibition of FGF/FGFR signaling impairs sphere-forming ability of PDAC , and knocking down and decreased their tumorigenesis abilities . Mechanistically, we demonstrated that SOX2 is down-regulated upon loss of FGFR signaling. The overexpression of in SOX2-negative cells, which normally do not display stemness capabilities, is sufficient to induce spheroid formation. Additionally, we found that AKT phosphorylation was reduced upon FGFR signaling inhibition. The inhibition of AKT using specific pharmacological inhibitors in the context of CSI medium leads to the loss of spheroid formation associated with loss of SOX2 nuclear expression and increased degradation. We demonstrate that an FGFR/AKT/SOX2 axis controls cancer stemness in PDAC and therefore may represent an important therapeutic target in the fight against this very aggressive form of cancer.
Copyright © 2020 Quan, Guo, Liu, Yang, Bai, Wang, Cai, Han, Lv, Ding, Billadeau, Lou, Bellusci, Li and Zhang.
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ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma.
Eur Respir J2020 May;():. doi: 1900953.
Scherpereel Arnaud, Opitz Isabelle, Berghmans Thierry, Psallidas Ioannis, Glatzer Markus, Rigau David, Astoul Philippe, Bölükbas Servet, Boyd Jeanette, Coolen Johan, De Bondt Charlotte, De Ruysscher Dirk, Durieux Valerie, Faivre-Finn Corinne, Fennell Dean, Galateau-Salle Francoise, Greillier Laurent, Hoda Mir Ali, Klepetko Walter, Lacourt Aude, McElnay Phil, Maskell Nick A, Mutti Luciano, Pairon Jean-Claude, Van Schil Paul, van Meerbeeck Jan P, Waller David, Weder Walter, Cardillo Giuseppe, Putora Paul Martin,
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ?10% of cases, justifying the use of specific markers, including and () for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pre-therapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
The article has been co-published with permission in the European Respiratory Journal and the European Journal of Cardio-Thoracic Surgery. All rights reserved in respect of European Respiratory Journal, © European Respiratory Society 2020 and European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2020. The articles are identical except for minor stylistic and spelling differences in keeping with each journal?s style. Either citation can be used when citing this article.
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Cardiac magnetic resonance assessment of left ventricular dilatation in chronic severe left-sided regurgitations: comparison with standard echocardiography.
Diagn Interv Imaging2020 May;():. doi: S2211-5684(20)30125-X.
Capron T, Cautela J, Scemama U, Miola C, Bartoli A, Theron A, Pinto J, Porto A, Collart F, Lepidi H, Bernard M, Guye M, Thuny F, Avierinos J-F, Jacquier A,
Abstract
PURPOSE:
The purpose of this study was to investigate the potential additional value of cardiac magnetic resonance (CMR) in the assessment of left ventricular (LV) dilatation and dysfunction by comparison to standard echocardiography in patients with chronic left-sided valvular regurgitation.
MATERIALS AND METHODS:
We prospectively enrolled patients with chronic severe mitral regurgitation (MR) or aortic regurgitation (AR). They underwent standard echocardiography and CMR using aortic flow and LV-function sequences. LV dilatation or dysfunction was assessed with each technique, based on thresholds used for surgery indication. Reference regurgitation severity was defined following previously reported CMR-based regurgitant volume thresholds.
RESULTS:
A total of 71 patients with chronic severe MR (n=44) or severe AR (n=27) were prospectively included. There were 60 men and 11 women with a mean age of 61±14 (SD) years (range: 18-83 years). CMR-based regurgitation severity was significantly greater in the LV dysfunction group when assessed with CMR (MR, P=0.011; AR, P=0.006) whereas it was not different when LV dysfunction was assessed using standard echocardiography. Among standard echocardiography and CMR volumetric indices, CMR-derived end-diastolic volume showed the best ability to predict regurgitation severity (area under the curve [AUC]=0.78 for MR; AUC=0.91 for AR). Diagnostic thresholds identified on receiver operating characteristics-curve analysis were lower than those of current European recommendations and closer to North-American guidelines.
CONCLUSION:
CMR assessment of LV end-diastolic volume in chronic severe left-sided regurgitations is more reliably associated with CMR-based regurgitant volume by comparison with standard echocardiography diameter. CMR may provide useful evaluation before surgery decision for severe asymptomatic regurgitations.
Copyright © 2020 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.
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ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma.
Eur J Cardiothorac Surg2020 May;():. doi: ezaa158.
Opitz Isabelle, Scherpereel Arnaud, Berghmans Thierry, Psallidas Ioannis, Glatzer Markus, Rigau David, Astoul Philippe, Bölükbas Servet, Boyd Jeanette, Coolen Johan, De Bondt Charlotte, De Ruysscher Dirk, Durieux Valerie, Faivre-Finn Corinne, Fennell Dean A, Galateau-Salle Francoise, Greillier Laurent, Hoda Mir Ali, Klepetko Walter, Lacourt Aude, McElnay Phil, Maskell Nick A, Mutti Luciano, Pairon Jean-Claude, Van Schil Paul, van Meerbeeck Jan P, Waller David, Weder Walter, Putora Paul Martin, Cardillo Giuseppe,
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ?10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
© The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. All rights reserved in respect of European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2020 and European Respiratory Journal, © European Respiratory Society 2020. The articles are identical except for minor stylistic and spelling differences in keeping with each journal?s style. Either citation can be used when citing this article.
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Clinical Practice and Research in Cardio-Oncology: Finding the "Rosetta Stone" for Establishing Program Excellence in Cardio-oncology.
J Cardiovasc Transl Res2020 May;():. doi: 10.1007/s12265-020-10010-x.
Adusumalli Srinath, Alvarez-Cardona Jose, Khatana Sameed M, Mitchell Joshua D, Blaes Anne H, Casselli Stephen J, O'Quinn Rupal, Lenihan Daniel J,
Abstract
The burgeoning field of cardio-oncology (C-O) is now necessary for the delivery of excellent care for patients with cancer. Many factors have contributed to this increasing population of cancer survivors or those being treated with novel and targeted cancer therapies. There is a tremendous need to provide outstanding cardiovascular (CV) care for these patients; however, current medical literature actually provides a paucity of guidance. C-O therefore provides a novel opportunity for clinical, translational, and basic research to advance patient care. This review aims to be a primer for cardio-oncologists on how to develop a vibrant and comprehensive C-O program, use practical tools to assist in the construction of C-O services, and to proactively incorporate translational and clinical research into the training of future leaders as well as enhance clinical care.
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