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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

Global longitudinal strain assessed by speckle-tracking echocardiography. Measurements are obtained from the 3 apical views and averaged. Bull’s-eye plot is built from global and regional longitudinal systolic strain measurements representing the left ventricular myocardial function. (Courtesy J. Liu, MD)
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f4-10.1177_1179546817697983: Global longitudinal strain assessed by speckle-tracking echocardiography. Measurements are obtained from the 3 apical views and averaged. Bull’s-eye plot is built from global and regional longitudinal systolic strain measurements representing the left ventricular myocardial function. (Courtesy J. Liu, MD)

Mentions: In the recent years, there have been significant advances in the field of echocardiography, especially strain imaging using speckle tracking, also known as deformation imaging. Strain is calculated as the fractional change in the length of a myocardial segment and is expressed as a percentage. In addition, strain rate is the temporal change of strain and measures the velocity at which myocardial deformation occurs. Strain and strain rate can be measured in 3 dimensions—longitudinal, radial, and circumferential—each of which can be measured for a predefined region or globally for the entire ventricle. Average peak systolic GLS is calculated using the average of longitudinal strain measurements from 3 long-axis views of the heart (Figure 4). Until now, of the 3 dimensions, only GLS has reliably and consistently shown to be of significance in predicting progression to CTRCD.55 During the chemotherapy, more than 15% change in GLS from baseline is considered as abnormal and a likely predictor of CTRCD.8 However, this cutoff of 15% is based on limited data, and large studies are needed to confirm this threshold.


Diagnostic Strategies for Early Recognition of Cancer Therapeutics – Related Cardiac Dysfunction
Global longitudinal strain assessed by speckle-tracking echocardiography. Measurements are obtained from the 3 apical views and averaged. Bull’s-eye plot is built from global and regional longitudinal systolic strain measurements representing the left ventricular myocardial function. (Courtesy J. Liu, MD)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-10.1177_1179546817697983: Global longitudinal strain assessed by speckle-tracking echocardiography. Measurements are obtained from the 3 apical views and averaged. Bull’s-eye plot is built from global and regional longitudinal systolic strain measurements representing the left ventricular myocardial function. (Courtesy J. Liu, MD)
Mentions: In the recent years, there have been significant advances in the field of echocardiography, especially strain imaging using speckle tracking, also known as deformation imaging. Strain is calculated as the fractional change in the length of a myocardial segment and is expressed as a percentage. In addition, strain rate is the temporal change of strain and measures the velocity at which myocardial deformation occurs. Strain and strain rate can be measured in 3 dimensions—longitudinal, radial, and circumferential—each of which can be measured for a predefined region or globally for the entire ventricle. Average peak systolic GLS is calculated using the average of longitudinal strain measurements from 3 long-axis views of the heart (Figure 4). Until now, of the 3 dimensions, only GLS has reliably and consistently shown to be of significance in predicting progression to CTRCD.55 During the chemotherapy, more than 15% change in GLS from baseline is considered as abnormal and a likely predictor of CTRCD.8 However, this cutoff of 15% is based on limited data, and large studies are needed to confirm this threshold.

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