The asymptomatic progression of chemotherapy-induced cardiotoxicity poses a significant risk to breast cancer patients. In the present single-center cohort study, a predictive model for evaluating ...the risk of cardiotoxicity during or by the end of chemotherapy was designed. The risk-prediction nomogram was delineated and assessed. In total, 34 patients out of 120 developed asymptomatic cardiotoxicity (28.3%). Of six explored biomarkers, only B-type natriuretic peptide showed a reliable pattern of incremental increase, revealing statistical significance between cardiotoxicity "+" and "-" groups by visit 4 or by the 9th month of monitoring (
0.006). The following predictors were included in the model: age, hypertension, diabetes mellitus, baseline glomerular filtration rate, 6 min walk test measured at visit 4, BNP values at visit 4, left ventricular ejection fraction levels at visit 4, a total dose of radiotherapy received, and anthracycline cumulative doses. The model's AUC was 0.72 (95% CI 0.59; 0.86), evidencing the satisfactory predictive ability of the model; sensitivity 100% (95% CI 90.36; 100.0) at a specificity of 66.67% (95% CI 50.33; 79.79); PPV 54.1% 95% CI 47.13; 60.91; PVN 100% 95% CI 94.64; 100.00. The calibration plot showed satisfactory agreement between predicted and actual chances (
= 0.98). The designed model can be applied in settings lacking speckle tracking echocardiography.
The prognosis of cancer treatment depends on, among other aspects, the cardiotoxicity of chemotherapy. This research aims to create a feasible algorithm for the early diagnosis of antitumor therapy ...cardiotoxicity in breast cancer patients. The paper represents a protocol for a prospective cohort study with N 120 eligible participants admitted for treatment with anthracyclines and/or trastuzumab. These patients will be allocated into four risk groups regarding potential cardiotoxic complications. Patients will be examined five times every three months for six biomarkers: cardiac troponin I (cTnI), brain natriuretic peptide (BNP), C-reactive protein (CRP), myeloperoxidase (MPO), galectin-3 (Gal-3), and D-dimer, simultaneously with echocardiographic methods, including speckle tracking. The adjusted relative risk (aOR) of interrupting an entire course of chemotherapy due to cardiotoxic events will be assessed using multiple analyses of proportional Cox risks. The Cox model will also assess associations between baseline biomarker values and time to cardiotoxic events. Moreover, partly conditional survival models will be applied to determine associations between repeated assessments of changes in biomarkers from baseline and time to cancer therapy-related cardiac dysfunction. All models will be adjusted for cancer therapy regimen, baseline LVEF, groups at risk, baseline biomarker values, and age. The decision-tree and principal component analysis (PCA) methods will also be applied. Thus, feasible patterns will be detected.
A majority of modern antitumor pharmaceuticals are accompanied by cardiotoxicity. The study aims to present practical approaches to stratifying the baseline risk of antitumor therapies' ...cardiotoxicity in patients newly diagnosed with breast cancer started on anthracyclines and/or trastuzumab.
Material and methods: Stratifying the risks of antitumor therapy was carried out according to the European Society of Cardiology recommendations. A therapist examined all patients for existing cardiovascular diseases and risk factors detection. The blood levels of glucose, cholesterol, creatinine, cardiac troponin I, and brain natriuretic peptide were determined. Electrocardiography and echocardiography with an assessment of the myocardium global longitudinal strain were performed.
Results: In total, 128 breast cancer patients with a mean age of 54.3±11.0 years were included in the study. Of them, 84.4% had tumor stages I and II, and 21.1% were HER2-positive. Chronic heart failure and ischemic heart disease were detected in 2.3%. Among the risk factors, the most common were arterial hypertension (51.6%), obesity (29.7%), age 65-70 years (18%), significant smoking history (15.6%), and diabetes mellitus (11.7%). Elevated cardiac troponin I and brain natriuretic peptide baseline levels were present in 5.5% and 7.0% of patients, respectively. To a high-risk group for cardiotoxic complications, 7.8% were allocated, 35.7% were assigned to the moderate-risk group, and 54.7% had low risk. High/very high and moderate-risk patients (43.5%) were referred to a cardiologist. Cardioprotective treatment was started immediately in high/very high-risk patients.
Conclusion: All revealed differences between the cardiovascular risk groups were related to age, cardiovascular system condition, and the severity of comorbid pathologies. The baseline stratification of patients into risk groups is a crucial step in preventing the cardiotoxicity of anticancer therapy. Comprehensive assessing the patient's condition before and during chemotherapy allows for avoiding the development of fatal cardiovascular complications in at-risk patients.
Kazakhstan: coronary and structural heart interventions from 2010 to 2015 Sakhov, Orazbek S; Kuzhukeyev, Murat E; Kodasbayev, Almat T ...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,
05/2017, Volume:
13, Issue:
Z
Journal Article
Peer reviewed
This paper presents data on the nascence and development of the interventional cardiology service in Kazakhstan. It provides details of the structure of the Kazakhstan interventional cardiology ...service, staff training, the number of coronary and structural heart interventions for the period of 2010-2015, as well as the peculiarities of the capitation payment method. The number of coronary interventions is increasing year by year, though the number of intracoronary imaging techniques and intracoronary flow/pressure techniques remains inadequate. Structural heart interventions are mostly performed at tertiary hospital level, with an ever increasing number of transcatheter aortic valve implantation (TAVI) procedures.
Atrial fibrillation is the most common arrhythmia that physicians face in their clinical practice. Atrial fibrillation is associated with a higher risk of thromboembolic events, all-cause mortality, ...frequent hospitalizations, decreased quality of life. Early detection of atrial fibrillation is important for optimal management and improvement the prognosis of atrial fibrillation patients. Evidence on new methods of atrial fibrillation screening discussed in this review, allows considering them more accurate than simple pulse palpation.
As known, the clinical efficacy of chemotherapy is limited by the cardiotoxicity of drugs used.
The study aimed to clarify cardiotoxic complications of chemotherapy from the Aktobe Medical Center ...database for 2018-2019.
Material and methods: We performed a register study on essential parameters of the oncological process, drugs used, duration of chemotherapy, types of complications, and outcomes, including survival.
Results: We found a total of 305 breast cancer cases. Chemotherapy was completed without complications in 65.9% of patients; treatment was interrupted due to complications - 10.5%; 6.2% of cardiovascular complications were identified. The two groups of patients, EchoCG + and EchoCG -, showed significant difference in the number of detected CV complications (p<.001) but no difference in the survival rate (p .814). The survival rate in patients with documented CV complications was 28.1 months vs. 34.3 months in the group without ones (p.005). The survival rate in those who completed the treatment without complications, was 34.9 months vs. 17.6 in individuals whose treatment was interrupted due to complications (p<.001). We performed a detailed review of four cases of cardiotoxicity with fatal outcomes.
Conclusion: The analysis indicates the absence of a systematic approach to recording crucial information regarding cardiotoxicity. There is a lack of concordance in the actions of cardiologists and oncologists in the management of BC patients. The presence of lethal outcomes of chemotherapy with an established cause of cardiac death indicates the need to revise the cancer register management from the standpoint of cardio-oncology. In general, there is a need to develop local protocols for screening and monitoring patients undergoing cardiotoxic chemotherapy and radiation therapy.
A 74-year-old Asian female with a history of hypertension and chronic obstructive pulmonary disease was admitted to hospital for coughing, shortness of breath and fatigue; her nasopharyngeal swab was ...positive for COVID-19.
Lopinavir/ritonavir 800mg/200 mg, daily was started. On the third day of antiviral therapy, the patient complained of dizziness, nausea, she was disorientated, and electrocardiogram showed sinus arrest, junctional escape rhythm 36 beats per min. Patient was successfully treated by temporary pacemaker, normal sinus rhythm was reverted on a 3rd day after stopping the lopinavir/ritonavir treatment. She was discharged home in stable condition.
Bradyarrhythmia in form of sinus arrest can develop during treatment with lopinavir/ritonavir. The temporal nature of the observed changes and the ECG finding suggests the use of L/R contributed to the changes.
This case highlights off-label prescribing lopinavir/ritonavir outside of a clinical trial setting should be avoided until the data have proven that treatment benefit over placebo.
In 2016 a new edition of the European guidelines on cardiovascular disease prevention in clinical practice was published. Guidelines based on evidence-based medicine are a guide to primary and ...secondary prevention of cardiovascular diseases for health workers. The ofcial translation of the Russian version is expected in July 2017. This article is devoted to a review of the main provisions of these guidelines. In the updated version, compared with the version of 2012, more attention is paid to the population approach, specifc interventions, special groups of patients, the classes of evidence have been changed for a number of recommendations, and emphasis is placed on a multidisciplinary approach to the prevention of cardiovascular diseases. For the frst time, experts point out the inexpediency of assessing cardiovascular risk in men under 40 and women under 50 without known risk factors due to possible false positive results. Patients with erectile dysfunction are not recommended to conduct routine screening of cardiovascular diseases. In addition, much attention is paid to the defnition of quality of life, diagnosis and treatment of anxiety and depression of the patient, as these conditions increase cardiovascular risk and affect patient adherence to therapy.
PDF
