Anthracycline-Induced Cardiotoxicity: Cardiac Monitoring by Continuous Wave-Doppler Ultrasound Cardiac Output Monitoring and Correlation to Echocardiography

Geiger, S.; Stemmler, Hans Joachim; Suhl, Patricia; Stieber, P.; Lange, Veronika; Baur, Dorothee M.; Hausmann, Andreas; Tischer, Johanna; Horster, Sophia

doi:10.1159/000338335

Cited by 12 publications

(7 citation statements)

References 30 publications

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“…This characteristic may help identify vulnerable populations with pre-existing subclinical disease in addition to patients sensitive to chemotherapy induced damage [87,103,104]. …”

Section: Discussionmentioning

confidence: 99%

Use of biomarkers for the assessment of chemotherapy-induced cardiac toxicity

Christenson

James

Agrawal

et al. 2015

Clinical Biochemistry

105

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Objectives To review the evidence for the use of various biomarkers in the detection of chemotherapy associated cardiac damage. Design and methods Pubmed.gov was queried using the search words chemotherapy and cardiac biomarkers with the filters of past 10 years, humans, and English language. An emphasis was placed on obtaining primary research articles looking at the utility of biomarkers for the detection of chemotherapy-mediated cardiac injury. Results Biomarkers may help identify patients undergoing treatment who are at high risk for cardiotoxicity and may assist in identification of a low risk cohort that does not necessitate continued intensive screening. cTn assays are the best studied biomarkers in this context and may represent a promising and potentially valuable modality for detecting cardiac toxicity in patients undergoing chemotherapy. Monitoring cTnI levels may provide information regarding the development of cardiac toxicity before left ventricular dysfunction becomes apparent on echocardiography or via clinical symptoms. A host of other biomarkers have been evaluated for their utility in the field of chemotherapy related cardiac toxicity with intermittent success; further trials are necessary to determine what role they may end up playing for prediction and prognostication in this setting. Conclusions Biomarkers represent an exciting potential complement or replacement for echocardiographic monitoring of chemotherapy related cardiac toxicity which may allow for earlier realization of the degree of cardiac damage occurring during treatment, creating the opportunity for more timely modulation of therapy.

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“…This characteristic may help identify vulnerable populations with pre-existing subclinical disease in addition to patients sensitive to chemotherapy induced damage [87,103,104]. …”

Section: Discussionmentioning

confidence: 99%

Use of biomarkers for the assessment of chemotherapy-induced cardiac toxicity

Christenson

James

Agrawal

et al. 2015

Clinical Biochemistry

105

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“…Due to differences in conclusion, study design and importantly the majority of the studies are based on <50 patients it is difficult to draw definite conclusions [26]–[31].…”

Section: Discussionmentioning

confidence: 99%

BNP Predicts Chemotherapy-Related Cardiotoxicity and Death: Comparison with Gated Equilibrium Radionuclide Ventriculography

2014

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Cardiotoxicity is a dose-limiting side-effect of cancer chemotherapeutics such as anthracyclines. The drug-induced cardiac toxicity is currently monitored with repeated assessments of the left ventricular ejection fraction (LVEF) using multigated equilibrium radionuclide ventriculography (MUGA) or echocardiography. However, the plasma cardiac biomarker B-type natriuretic peptide (BNP) has been suggested for early identification of cardiac dysfunction. The aim of the study was to compare LVEF obtained by MUGA and plasma BNP as predictors of developing congestive heart failure (CHF) or death in a population of anthracycline-treated cancer patients.MethodsWe prospectively followed 333 cancer patients referred to our department for routine monitoring of LVEF with MUGA and measurement of BNP, January-December 2004. Study end points were hospitalization for CHF and death during follow-up 2004-2010. Data were obtained from the Danish National Patient Registry.ResultsDuring follow-up (mean 1,360 days), 21 of the patients were admitted to hospital with a diagnosis of CHF and 194 of the patients died. BNP levels were significantly higher and LVEF lower in the group of patients that developed CHF. Using cut-off points of BNP>100 pg/ml (HR 5.5; CI 1.8–17.2; p = 0.003) and LVEF <50% (HR 7.9; CI 3.0–21.4; p<0.001) both significantly predicted CHF. Using the same cut-off points only BNP (HR 1.9; CI 1.3-2.9; p = 0.002) and not LVEF (HR 1.1; CI 0.7–1.8; p = 0.58) was predictive of overall death. In multivariate Cox analysis both BNP and LVEF were independent predictors of CHF while age remained the only independent predictor of overall death.ConclusionIn cancer patients treated with cardiotoxic chemotherapy both BNP and LVEF can significantly predict subsequent hospitalization with CHF. In addition, BNP and not LVEF has a prognostic value in detecting overall death. This prospective study based on the hitherto largest study population supports BNP as a clinical relevant method for monitoring chemotherapy-related cardiac failure and death.

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“…Although they are normally undetectable, troponins may increase within 2 or 3 hours after cardiac damage occurs . Studies have shown that troponins may detect cardiotoxicity at a preclinical phase, long before any reduction in LVEF has occurred, in patients treated with antitumor drugs (Table ) . Measurement of troponins may provide additional information, including: Prediction of the severity of future LVD, because the peak value of troponin after chemotherapy is closely correlated to the extent of LVEF reduction; Stratification of cardiac risk after chemotherapy, which allows for the personalization of the intensity of postchemotherapy monitoring of cardiac function; Selection of patients more prone to develop cardiotoxicity, in whom a cardioprotective therapy can be considered; and Exclusion of most patients from prolonged cardiologic monitoring. …”

Section: Detection Of Cardiac Dysfunction and Evidence For Cardiotoximentioning

confidence: 99%

Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management

Curigliano

Cardinale

Dent

et al. 2016

CA A Cancer J Clinicians

595

427

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Answer questions and earn CME/CNE Cancer and heart disease are the leading causes of morbidity and mortality in the industrialized world. Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer; however, these gains can come at a cost. Patients may experience adverse cardiovascular events related to their cancer treatment or as a result of an exacerbation of underlying cardiovascular disease. With longer periods of survival, late effects of cancer treatment may become clinically evident years or decades after completion of therapy. Current cancer therapy incorporates multiple agents whose deleterious cardiac effects may be additive or synergistic. Cardiac dysfunction may result from agents that can result in myocyte destruction, such as with anthracycline use, or from agents that appear to transiently affect left ventricular contractility. In addition, cancer treatment may be associated with other cardiac events, such as severe treatment-induced hypertension and vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including QTc prolongation, that may be rarely life-threatening. Early and late effects of chest radiation can lead to radiation-induced heart disease, including pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease, valvular disease, and arrhythmias, in the setting of myocardial fibrosis. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of cancer patients, whether they are receiving active treatment or are long-term survivors. Strategies to prevent or mitigate cardiovascular damage from cancer treatment are needed to provide the best cancer care. This review will focus on the common cardiovascular issues that may arise during or after cancer therapy, the detection and monitoring of cardiovascular injury, and the best management principles to protect against or minimize cardiotoxicity during the spectrum of cancer treatment strategies. CA Cancer J Clin 2016;66:309-325. © 2016 American Cancer Society.

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Anthracycline-Induced Cardiotoxicity: Cardiac Monitoring by Continuous Wave-Doppler Ultrasound Cardiac Output Monitoring and Correlation to Echocardiography

Cited by 12 publications

References 30 publications

Use of biomarkers for the assessment of chemotherapy-induced cardiac toxicity

Use of biomarkers for the assessment of chemotherapy-induced cardiac toxicity

BNP Predicts Chemotherapy-Related Cardiotoxicity and Death: Comparison with Gated Equilibrium Radionuclide Ventriculography

Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management

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