Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Abstract

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation.

Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

“…This parameter is considered an important and reliable early predictor for the development cardiac dysfunction in other causes of cardiac disease (Nikitin and Witte, 2004). From several small studies in adult childhood cancer survivors, it seemed to be a valuable parameter in defining diastolic (dys-) function (Kapusta et al, 2001;Brouwer et al, 2006;Tassan-Mangina et al, 2006;Galderisi et al, 2007). E/E 0 is a derivative of TVI Et and the E velocity, thereby including the end-diastolic left ventricular filling pressure in addition to myocardial velocities.…”

Reversible cardiotoxicity in a 54-year-old woman treated with trastuzumab

“…Nevertheless, adverse effects including cardiotoxicity, are growing in frequency and deserve a close accurate follow-up 11 . A major concern is about patients with cardiopathy, old age, and previous utilization of cardiotoxic drugs or thoracic irradiation, because they are more prone to develop severe cardiotoxicity 1,3,7,12 . Other potential risk factors include diabetes mellitus, high or low body mass index, hyperlipidemia, hypertension, thyroid dysfunction, and tobacco smoking 8,13,14 .…”

“…Better knowledge about risk factors for cardiotoxicity related to CT contributes to reduce the cardiovascular adverse effects. Early and long term control by serial echocardiograms is needed to characterize this condition and play a role in favorable outcomes by avoiding the progression of mild ventricular dysfunction to a more severe and irreversible cardiac failure 1,3,8,12 . Tissue velocity imaging is another non-invasive method to evaluate the left ventricle function in patients under CT with trastuzumab.…”

“…Other potential risk factors include diabetes mellitus, high or low body mass index, hyperlipidemia, hypertension, thyroid dysfunction, and tobacco smoking 8,13,14 . Cardiotoxicity may be acute (soon after the administration of CT agents) or late (up to 12 years after the completion of CT course) 12 . Systematic evaluation of heart function must precede treatment and the careful cardiologic follow-up of patients receiving CT agents must be longstanding 11,13,14 .…”

“…Systematic evaluation of heart function must precede treatment and the careful cardiologic follow-up of patients receiving CT agents must be longstanding 11,13,14 . Echocardiogram is the non-invasive test of choice for assessment of the LVEF, contributing to the early detection and prompt management of systolic and/or diastolic dysfunction secondary to treatment 1,[12][13][14] .…”