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Diagnostic Strategies for Early Recognition of Cancer Therapeutics – Related Cardiac Dysfunction

View Article: PubMed Central - PubMed

ABSTRACT

Cardiovascular toxicity in the form of cardiac dysfunction continues to be an obstacle for patients with cancer. Survival and quality of life of cancer survivors are frequently affected by increased incidence of cardiovascular disease. The involvement of the cardiovascular system by primary or secondary malignancies, as well as its dysfunction secondary to the administration of antineoplastics, has led to the development of a new discipline called Cardio-Oncology, an exciting cardiology subspecialty with more questions than answers and as a result an enormous opportunity for research in the field. Multidisciplinary efforts have been focused on the prevention, diagnosis, and treatment of cancer therapeutics–related cardiovascular dysfunction (CTRCD). This review article will focus on the early diagnosis of left ventricular dysfunction associated with chemotherapy. Currently, the identification of cardiac toxicity associated with cancer treatment is the cornerstone for critical decisions regarding anticancer therapy and cardioprotective strategies. Its early detection, especially in subclinical phases, allows immediate intervention to prevent further impairment of the myocardium and other cardiovascular structures. The most significant published studies were selected for this revision, providing an updated document for the health professionals involved in the care of patients with cancer. We examined the current evidence and recommendations for biochemical and noninvasive diagnostic techniques, including their specific role for identification of CTRCD. Traditional and advanced imaging modalities, used alone or in combination with cardiovascular biomarkers, are essential for the recognition of cardiotoxicity during cancer therapy. Evolving basic and clinical research are focused on the development of more sensitive and specific diagnostic tools and for the recognition of cardiac toxicity.

No MeSH data available.


Related in: MedlinePlus

Progression of cancer therapeutics–related cardiac dysfunction. LV indicates left ventricular.
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f1-10.1177_1179546817697983: Progression of cancer therapeutics–related cardiac dysfunction. LV indicates left ventricular.

Mentions: Methods for early detection of subclinical cardiac injury are useful for selecting individuals who might benefit from therapeutic interventions to prevent further deterioration in left ventricular (LV) function with progression to subsequent cardiovascular events.8,9Figure 1 highlights the progression of cardiovascular impairment after exposure to cancer therapy. The cornerstone for evaluating CTRCD is the use of noninvasive imaging techniques to assess the LV systolic function displacing cardiac biopsy as the preferred method. According to the last expert consensus for multimodality imaging evaluation of patients with cancer from the American Society for Echocardiography and the European Association of Cardiovascular Imaging, as well as the European Task Force, CTRCD is defined as a decrease in LVEF >10% to a value of <53% (or the lower limit of normality) with a repeat performed 2 to 3 weeks after the initial decrease is observed.9,10 However, despite significant advancements in imaging techniques and medical technology, there are several limitations conducting this assessment. There is considerable heterogeneity in technique and interpretation of the images, cumbersome to use on a regular basis, limited availability, and multiple contraindications to some of the imaging modalities.11 Most notably, traditional noninvasive tests frequently used for evaluation of the LV function (ie, echocardiography and multigated blood pool imaging [multiple-gated acquisition (MUGA) scan]) may not detect significant CTRCD until there has been profound and likely irreversible myocardial damage.12,13


Diagnostic Strategies for Early Recognition of Cancer Therapeutics – Related Cardiac Dysfunction
Progression of cancer therapeutics–related cardiac dysfunction. LV indicates left ventricular.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5392033&req=5

f1-10.1177_1179546817697983: Progression of cancer therapeutics–related cardiac dysfunction. LV indicates left ventricular.
Mentions: Methods for early detection of subclinical cardiac injury are useful for selecting individuals who might benefit from therapeutic interventions to prevent further deterioration in left ventricular (LV) function with progression to subsequent cardiovascular events.8,9Figure 1 highlights the progression of cardiovascular impairment after exposure to cancer therapy. The cornerstone for evaluating CTRCD is the use of noninvasive imaging techniques to assess the LV systolic function displacing cardiac biopsy as the preferred method. According to the last expert consensus for multimodality imaging evaluation of patients with cancer from the American Society for Echocardiography and the European Association of Cardiovascular Imaging, as well as the European Task Force, CTRCD is defined as a decrease in LVEF >10% to a value of <53% (or the lower limit of normality) with a repeat performed 2 to 3 weeks after the initial decrease is observed.9,10 However, despite significant advancements in imaging techniques and medical technology, there are several limitations conducting this assessment. There is considerable heterogeneity in technique and interpretation of the images, cumbersome to use on a regular basis, limited availability, and multiple contraindications to some of the imaging modalities.11 Most notably, traditional noninvasive tests frequently used for evaluation of the LV function (ie, echocardiography and multigated blood pool imaging [multiple-gated acquisition (MUGA) scan]) may not detect significant CTRCD until there has been profound and likely irreversible myocardial damage.12,13

View Article: PubMed Central - PubMed

ABSTRACT

Cardiovascular toxicity in the form of cardiac dysfunction continues to be an obstacle for patients with cancer. Survival and quality of life of cancer survivors are frequently affected by increased incidence of cardiovascular disease. The involvement of the cardiovascular system by primary or secondary malignancies, as well as its dysfunction secondary to the administration of antineoplastics, has led to the development of a new discipline called Cardio-Oncology, an exciting cardiology subspecialty with more questions than answers and as a result an enormous opportunity for research in the field. Multidisciplinary efforts have been focused on the prevention, diagnosis, and treatment of cancer therapeutics&ndash;related cardiovascular dysfunction (CTRCD). This review article will focus on the early diagnosis of left ventricular dysfunction associated with chemotherapy. Currently, the identification of cardiac toxicity associated with cancer treatment is the cornerstone for critical decisions regarding anticancer therapy and cardioprotective strategies. Its early detection, especially in subclinical phases, allows immediate intervention to prevent further impairment of the myocardium and other cardiovascular structures. The most significant published studies were selected for this revision, providing an updated document for the health professionals involved in the care of patients with cancer. We examined the current evidence and recommendations for biochemical and noninvasive diagnostic techniques, including their specific role for identification of CTRCD. Traditional and advanced imaging modalities, used alone or in combination with cardiovascular biomarkers, are essential for the recognition of cardiotoxicity during cancer therapy. Evolving basic and clinical research are focused on the development of more sensitive and specific diagnostic tools and for the recognition of cardiac toxicity.

No MeSH data available.


Related in: MedlinePlus