Limits...
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

Bull’s-eye plot of a 60-year-old patient with breast cancer who received anthracycline-based chemotherapy followed by trastuzumab. Cardioprotective therapy was started due to early detection of abnormal global longitudinal strain (GLS) representing subclinical myocardial dysfunction. Almost complete normalization of speckle-tracking echocardiography parameters was noticed. (Courtesy J. Liu, MD)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-10.1177_1179546817697983: Bull’s-eye plot of a 60-year-old patient with breast cancer who received anthracycline-based chemotherapy followed by trastuzumab. Cardioprotective therapy was started due to early detection of abnormal global longitudinal strain (GLS) representing subclinical myocardial dysfunction. Almost complete normalization of speckle-tracking echocardiography parameters was noticed. (Courtesy J. Liu, MD)

Mentions: In a meta-analysis of 16 articles with 5721 patients with varied causes of underlying cardiac dysfunctions, such as heart failure, acute myocardial infarction, and valvular heart disease, GLS was proven to be superior compared with LVEF for predicting overall mortality and major cardiac events.12 The advantages of STE for evaluation and cardiotoxicity monitoring have been well documented. In a large cohort of cancer survivors, almost one-third of patients with a normal 3D LVEF have abnormal GLS. Also, early changes in GLS predicted reduction in LVEF and subsequent clinical heart failure at 15 months of followup.56 In the same way, it has been shown that in patients treated with trastuzumab, change in GLS was able to predict its detrimental effects on LV systolic function, well before any decrease in LVEF occurred.57,58 In an observational study, GLS reduction was significantly higher in the group receiving both anthracyclines and trastuzumab than that in the group receiving trastuzumab only. Of the 52 patients with a significant change of GLS in this study, only 14 had a decrement of EF that would have justified a diagnosis of CTRCD based on current criteria. Notably, treatment with β-blockers significantly improved the LVEF and GLS.59 Thus, GLS might be helpful in identifying patients with early evidence of subclinical LV dysfunction who will benefit from the initiation of cardioprotective therapy which could prevent subsequent progression to heart failure (Figure 5). Observational nature of this study precludes its generalization; nevertheless, it gives a signal of future trial design.


Diagnostic Strategies for Early Recognition of Cancer Therapeutics – Related Cardiac Dysfunction
Bull’s-eye plot of a 60-year-old patient with breast cancer who received anthracycline-based chemotherapy followed by trastuzumab. Cardioprotective therapy was started due to early detection of abnormal global longitudinal strain (GLS) representing subclinical myocardial dysfunction. Almost complete normalization of speckle-tracking echocardiography parameters was noticed. (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

f5-10.1177_1179546817697983: Bull’s-eye plot of a 60-year-old patient with breast cancer who received anthracycline-based chemotherapy followed by trastuzumab. Cardioprotective therapy was started due to early detection of abnormal global longitudinal strain (GLS) representing subclinical myocardial dysfunction. Almost complete normalization of speckle-tracking echocardiography parameters was noticed. (Courtesy J. Liu, MD)
Mentions: In a meta-analysis of 16 articles with 5721 patients with varied causes of underlying cardiac dysfunctions, such as heart failure, acute myocardial infarction, and valvular heart disease, GLS was proven to be superior compared with LVEF for predicting overall mortality and major cardiac events.12 The advantages of STE for evaluation and cardiotoxicity monitoring have been well documented. In a large cohort of cancer survivors, almost one-third of patients with a normal 3D LVEF have abnormal GLS. Also, early changes in GLS predicted reduction in LVEF and subsequent clinical heart failure at 15 months of followup.56 In the same way, it has been shown that in patients treated with trastuzumab, change in GLS was able to predict its detrimental effects on LV systolic function, well before any decrease in LVEF occurred.57,58 In an observational study, GLS reduction was significantly higher in the group receiving both anthracyclines and trastuzumab than that in the group receiving trastuzumab only. Of the 52 patients with a significant change of GLS in this study, only 14 had a decrement of EF that would have justified a diagnosis of CTRCD based on current criteria. Notably, treatment with β-blockers significantly improved the LVEF and GLS.59 Thus, GLS might be helpful in identifying patients with early evidence of subclinical LV dysfunction who will benefit from the initiation of cardioprotective therapy which could prevent subsequent progression to heart failure (Figure 5). Observational nature of this study precludes its generalization; nevertheless, it gives a signal of future trial design.

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