Cancer-therapy related cardiotoxicity (CTRCT) is a significant and frequent complication of monoclonal antibody directed therapy, especially Trastuzumab, for human epidermal growth factor receptor 2 ...(HER2) overexpressing breast cancers. Reliable, clinically available molecular predictive markers of CTRCT have not yet been developed. Identifying specific genetic variants and their molecular markers, which make the host susceptible to this complication is key to personalised risk stratification. A systematic review was conducted until April 2021, using the Medline, Embase databases and Google Scholar, to identify studies genetic and RNA-related markers associated with CTRCT in HER2 positive breast cancer patients. So far, researchers have mainly focused on HER2 related polymorphisms, revealing codons 655 and 1170 variants as the most likely SNPs associated with cardiotoxicity, despite some contradictory results. More recently, new potential genetic markers unrelated to the HER2 gene, and linked to known cardiomyopathy genes or to genes regulating cardiomyocytes apoptosis and metabolism, have been detected. Moreover, microRNAs are gaining increasing recognition as additional potential molecular markers in the cardio-oncology field, supported by encouraging preliminary data about their relationship with cardiotoxicity in breast cancers. In this review, we sought to synthesize evidence for genetic variants and RNA-related molecular markers associated with cardiotoxicity in HER2-positive breast cancer.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Acute right-sided heart failure (RHF) is a complex clinical syndrome, with a wide range of clinical presentations, associated with increased mortality and morbidity, but about which there is a ...scarcity of evidence-based literature. A temporary right-ventricular assist device (t-RVAD) is a potential treatment option for selected patients with severe right-ventricular dysfunction as a bridge-to-recovery or as a permanent solution. We sought to conduct a systematic review to determine the safety and efficacy of t-RVAD implantation. Thirty-one studies met the inclusion criteria, from which data were extracted. Successful t-RVAD weaning ranged between 23% and 100%. Moreover, 30-day survival post-temporary RAVD implantation ranged from 46% to 100%. Bleeding, acute kidney injury, stroke, and device malfunction were the most commonly reported complications. Notwithstanding this, t-RVAD is a lifesaving option for patients with severe RHF, but the evidence stems from small non-randomized heterogeneous studies utilizing a variety of devices. Both the etiology of RHF and time of intervention might play a major role in determining the t-RVAD outcome. Standardized endpoints definitions, design and methodology for t-RVAD trials is needed. Furthermore, efforts should continue in improving the technology as well as improving the timely provision of a t-RVAD.
Fluctuating stress on the implanted coronary stents within cardiac cycle is an important mechanism of fatigue fracture, which is associated with in-stent restenosis and stent thrombosis. We developed ...a novel computational modelling to calculate the dynamic stress of stents based on the time sequence angiography immediately after treatment. Two groups of patient-specific cases (one same stent design treated in 4 different coronary arteries and one same artery actually/virtually implanted one stent with 3 different designs) were performed the dynamic stress analysis by this computational modelling and subsequently assessed the fatigue fracture risk by Goodman method. The motion of target arteries significantly impacts on distribution of the stress and the risk of stent fracture, particularly in the site of hinge motion. Both the location of stent stress concentration in the obtuse marginal artery and the “unsafe” region in the inverse fatigue safety factor contour co-registered with the position of complete transverse fracture 13 months later after implantation. Three stents with different designs had the same location of highest stress concentration at the hinge motion site of the actually/virtually treated artery. Higher strength stent materials are significantly lower the risk of stent fracture rather than stent designs. This new computational modelling might be a useful tool in assessment of fracture risk of the implanted stent and in optimizing new design of dedicated stent treated specific coronary arteries and mechanical properties in vivo of bioresorbable scaffold during degradation process.
Schematic diagram of this computational modelling for dynamic stress analysis of coronary stents in vivo.(a) Visible contour of balloon inflation during PCI for marking the proximal and distal end of the implanted stents; (b) The stent configuration after implantation at initial time instant; (c) Coronary angiography immediately after PCI; (d) Angiography-based 3-dimensional reconstruction of arterial geometric model; (e) Dynamic stress analysis of the stent under the kinematic couple of coronary artery in vivo. Yellow arrows: the proximal and distal end of the implanted stent. Display omitted
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Left ventricular assist device (LVAD) therapy has been instrumental in saving lives of patients with end-stage heart failure (HF). Recent generation devices have short-to-mid-term survival rates ...close to heart transplantation. Unfortunately, up to 1 in 4 patients develop a life-threatening right-sided HF (RHF) early post LVAD implantation, with high morbidity and mortality rate, necessitating prolonged ICU stay, prolonged inotropic support, and implantation of a right-ventricular assist device. Pre-operative optimization of HF therapy could help in prevention, and/or mitigation of RHF. Levosimendan (LEVO) is a non-conventional inotropic agent that works by amplifying calcium sensitivity of troponin C in cardiac myocytes, without increasing the intra-cellular calcium or exacerbating ischemia. LEVO acts as an inodilator, which reduces the cardiac pre-, and after-load. LEVO administration is associated with hemodynamic improvements. Despite decades long of the use of LVAD and more than two decades of the use of LEVO for HF, the literature on LEVO use in LVAD is very limited. In this paper, we sought to conduct a systematic review to synthesize evidence related to the use of LEVO for the mitigation and/or prevention of RHF in patients undergoing LVAD implantation.
The new-generation ACURATE neo2 system was commercially released in September 2020. In this study, we sought to compare the aortic regurgitation (AR) severity of the ACURATE neo2 versus the ACURATE ...neo transcatheter heart valve, using quantitative videodensitometric angiography (qAR). This is a retrospective, Corelab analysis of final post-transcatheter aortic valve implantation (TAVI) aortograms of patients treated with the ACURATE neo2 and ACURATE neo systems. The ACURATE neo2 cohort comprised consecutive patients treated between September 2020 and January 2021 at two centers. The ACURATE neo cohort included consecutive patients treated before September 2020. Our primary objective was to compare AR severity on qAR following TAVI with ACURATE neo2 and ACURATE neo. Out of 401 aortograms, 228 (56.9%) were analyzable, with 120 in the ACURATE neo2 cohort, and 108 in the ACURATE neo cohort. The mean AR fraction was 4.4 ± 4.8% in the neo2 cohort, and 9.9 ± 8.2% in the neo cohort (p < 0.001). Furthermore, moderate or severe AR (qAR > 17%) was detected in 2 aortograms (1.7%) in the neo2 cohort and 15 aortograms (13.9%) in the neo cohort (p < 0.001). Quantitative aortography shows a lower rate of moderate or severe paravalvular AR in what is the first European experience of the new-generation, self-expanding ACURATE neo2 when compared to the first-generation ACURATE neo. Moreover, aortographic data need to be correlated and compared to Core Laboratory-adjudicated 30-day echocardiographic data.
Balloon rupture during transcatheter aortic valve replacement (TAVR) is a rare but serious complication. Here, we present two cases of balloon rupture in patients with severe aortic stenosis and type ...0 bicuspid aortic valves. Three-dimensional models based on pre-procedure cardiac CT angiography were used to investigate these cases post hoc. The models revealed asymmetrical distribution of calcifications with sharply spiked features in the bicuspid aortic valves. The narrow calcified orifices resulted in uneven force distribution on the expanded balloon, thus leading to balloon rupture. We additionally review the classification and causes of balloon rupture, summarize methods for avoiding complications, and describe treatment options. Accurate pre-procedural anatomy evaluation and computer modeling are crucial for planning and managing TAVR procedures. Further investigation through computer simulation is necessary to determine the appropriate balloon size and inflation locations, to provide a reference for pre-procedural preparation.
Acute morphological changes in de novo coronary lesions after drug-coated balloon (DCB) angioplasty can affect endothelial mechanics and consequently clinical outcomes. Angiography-based ...computational modeling has been validated to assess endothelial dynamic strain (EDS) in coronary arteries in vivo. The EDS was calculated on the basis of pre- and post-DCB angiography. Parameters of quantitative coronary angiography and EDS were quantified at cross-sections in the treated segments. A total of 336 and 348 lesion cross-sections were included in the small/large vessel groups, respectively. The acute lumen gain after DCB was significantly higher in large than small vessels (relative changes: 21.3% 17.4%, 25.1% vs. 7.4% 4.8%, 10.1%, P < 0.001). Before treatment, three indices of EDS were significantly higher in small than large vessels (for ED-EDS: 29.2% 19.8%, 44.8% vs. 20.4% 14.3%, 30.2%; for ES-EDS: 26.8% 18.9%, 37.7% vs. 18.3% 13.9%, 25.4%; for TA-EDS: 19.1% 13.9%, 27.8% vs. 14.3% 10.5%, 20.1%, P < 0.001). After treatment, the EDS in small vessels significantly decreased (P < 0.001). ED-EDS showed the highest correlation with pre-DCB DSP (r = 0.43, P < 0.001) and post-DCB MLD (r = 0.35, P < 0.001). The levels of EDS parameters for small or large vessel lesions significantly differed. Further study is required to examine the clinical value of EDS in predicting cardiac events after DCB treatment.
This paper looks to validate the risk score from the Heart Failure Association of the European Society of Cardiology and the International Cardio-Oncology Society (HFA-ICOS) for predicting potential ...cardiotoxicity from anticancer therapy for patients positive for human epidermal growth factor receptor 2.
A total of 507 patients with at least five years since index diagnosis of breast cancer were retrospectively divided according to the HFA-ICOS risk proforma. According to level of risk, these groups were assessed for rates of cardiotoxicity via mixed-effect Bayesian logistic regression model.
A follow-up of five years observed cardiotoxicity of 3.3% (
= 3) in the low-risk, 3.3% (
= 10) in the medium-risk, 4.4% (
= 6) in the high-risk, and 38% (
= 6) in the very-high-risk groups respectively. For cardiac events related to treatment, the risk was significantly higher for the very-high-risk category of HFA-ICOS compared to other categories (Beta = 3.1, 95% CrI: 1.5, 4.8). For overall cardiotoxicity related to treatment, the area under the curve was 0.643 (CI 95%: 0.51, 0.76), with 26.1% (95% CI: 8%, 44%) sensitivity and 97.9% (95% CI: 96%, 99%) specificity.
The HFA-ICOS risk score has moderate power in predicting cancer therapy-related cardiotoxicity in HER2-positive breast cancer patients.
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a ...recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI's procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm
, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.
Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised ...transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges.
To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS.
We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 66.3, 77.0 years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 12.2, 18.3 months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 8, 16.5 mmHg, effective orifice area 1.7 1.4, 1.9 cm
, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient.
TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes.
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