Cardiac toxicity of anthracycline antineoplastic drugs and its prevention and treatment / 心血管康复医学杂志

Objective :To study cardiac toxicity of anthracycline antineoplastic drugs and its preventive and therapeutic measures.Methods : A total of 160 patients undergoing anti—tumor treatment in our hospital from Jan 2014 to Jan 2015 were enrolled .According to accumulated dose of anthracycline (ANTH ) , patients were divided into high ANTH group (ANTH＞100mg／m2 ,n＝110) and low ANTH group (ANTH≤100mg／m2 ,n＝50) ,both groups were treated for 24 months.Levels of cardiac troponin I (cTnI) ,creatine kinase isoenzyme MB (CK—MB) ,brain natri—uretic peptide (BNP) ,left ventricular ejection fraction (LVEF) ,left ventricular fractional shortening (LVFS) ,left ventricular end—diastolic diameter (LVEDd) and left ventricular end—systolic diameter (LVESd) were measured and compared between two groups before and after treatment .Results : There were no significant differences in levels of cTnI and CK—MB between the two groups , P＞0.05 both .Compared with low ANTH group after 24—month treat—ment ,there were significant rise in BNP level [ (41.2 ± 15.1) ng／ml vs.(46. 9 ± 15. 2) ng／ml] ,LVEDd [ (32. 8 ± 4.3) mm vs.(34.6 ± 4.6) mm] and LVESd [(21. 4 ± 2.6) mm vs.(22. 7 ± 3.4) mm] ,and significant reductions in LVEF [ (71. 5 ± 5. 7)% vs.(65. 7 ± 7.1)%] and LVFS [ (38.9 ± 4.6)% vs.(37. 2 ± 4.2)%] in high ANTH group , P＜0. 05 or ＜0.01. There was no significant correlation among BNP level ,LVEF and LVFS before and after treat—ment ( P＞0. 05 all).Conclusion : Anthracycline antineoplastic drugs can induce cardiac toxicity or make it develop , so significantly increase BNP level and reduce LVEF in patients .Therefore ,certain preventive measures should be performed to reduce its adverse effects on heart .

Clinical value of high sensitive cardiac troponin Ⅰ in monitoring cardiac toxicity in patients treated with anthracycline / 心血管康复医学杂志

Objective :To explore value of high sensitive cardiac troponin I (hs-cTnI) in monitoring cardiac toxicity of patients with leukemia undergoing anthracycline chemotherapy .Methods :A total of 160 patients with acute myeloid leukemia ,who were treated in our department from Jan 2013 to Dec 2016 ,were enrolled .Patients were randomly divided into routine chemotherapy group and Dexrazoxane group (received Dexrazoxane on 30 min before chemo-therapy) ,both groups were treated for six periods (21d×6).Serum hs-cTnI level and incidence of cardiac toxicity events before and at different time points after chemotherapy were observed and compared between two groups .In-cidence rate of cardiac toxicity events was compared between groups with different serum hs-cTnI level.ROC curve was used to analyze predictive value of serum hs-cTnI for cardiac toxicity .Results :Compared with before chemo-therapy ,after chemotherapy ,there was significant rise in serum hs-cTnI level in each period in two groups ( P＝0.001 all) ,and it rose along with time passed .Compared with routine chemotherapy group from second period , there was significant reduction in serum hs-cTnI level [2nd21d :(7.59 ± 0.85) 10－2ng/ml vs.(7.27 ± 0.86) 10－2ng/ml ,] in Dexrazoxane group , P＜ 0.05 or ＜ 0.01. Total incidence rate of cardiac toxicity events of Dexrazoxane group was significantly lower than that of routine chemotherapy group (5.00% vs.25.00%) ,P＝0.001. Incidence rate of cardiac toxicity event in hs-cTnI＞0.100ng/ml group was significantly higher than that of hs-cTnI≤0.100ng/ml group (31.25% vs.4.17%) ,P＝0.001. ROC curve suggested that AUC was 0.825 ,cutoff point was 0.121 ng/ml ,sensitivity and specificity was 90.27% and 92. 35% respectively for serum hs-cTnI predicting cardiac toxicity in these patients .Conclusion : Serum hs-cTnI level rises in early period of chemotherapy in patients with leukemia un- dergoing anthracycline chemotherapy , so it possesses high predictive value for cardiac toxicity events .

O papel do ecocardiograma na quimioterapia / The role of echocrdiography in chemotherapy / El Papel del ecocardiograma en la quimioterapia

Trata-se de uma revisão a respeito da importância do ecocardiograma na detecção precoce da disfunção cardíaca diastólica e/ou sistólica nos pacientes submetidos à quimioterapia, visando a evidenciação precoce das alterações anatômicas causadas por estes agentes antes do seu estabelecimento de forma irreversível. Serão abordados tanto os parâmetros clássicos na avaliação sisto-diastólica, como a definição do papel do strain bidimensional na atualidade.

Se trata de una revisión respecto a la importancia del ecocardiograma en la detección precoz de la disfunción cardíaca diastólica y/o sistólica en los pacientes sometidos a la quimioterapia, buscando la evidencia precoz de las alteraciones anatómicas causadas por estos agentes antes de su establecimiento de forma irreversible. Serán abordados tanto los parámetros clásicos en la evaluación sisto-diastólica, como la definición del papel del strain bidimensional en la actualidad

Applications of global left ventricular myocardial strain in detection of anthracycline-induced cardiotoxicity in breast cancer survivors with postoperative chemotherapy / 中华超声影像学杂志

Objective To assess the clinical significance of three-dimensional speckle tracking imaging (3D-STI) in the evaluation of left ventricular myocardial function in breast cancer survivors with postoperative anthracycline-based chemotherapy.Methods A total of 51 breast cancer survivors with postoperative anthracycline-based chemotherapy were recruited and 31 female healthy volunteers as the controls.Conventional echocardiography and 3D-STI derived parameters [including global longitudinal strain (GLS) and global area strain (GAS)] were measured before and at 3 and 6 anthracycline-based chemotherapeutic cycles.The receiver operating characteristics (ROC) curve was constructed to determine optimal sensitivity and specificity of 3ID-STI derived parameters for the prediction of future cardiotoxicity.Results In comparison with the controls and baseline cases,GLS and GAS deteriorated significantly (P ＜ 0.05 for both).No statistical difference in GCS and conventional parameters showed before and after the initiation of chemotherapy (P ＜0.05,respectively).The ROC curves showed that GAS as the best 3D-STI predictor of patients who develop cardiotoxicity during the follow-up.The area under ROC(AUC) of GAS was 0.894,and its optimal cut-off value was-28.4％,with a specificity of 88.0％ and a sensitivity of 82.9％.AUC of GLS was 0.802,and its optimal cut-off value was-14.3％,with a specificity of 62.0％ and a sensitivity of 85.4％.Conclusions Early decreases in GAS and GLS based on 3D-STI may allow the prediction of subsequent cardiotoxic development accurately in breast cancer survivors with postoperative anthracycline-based chemotherapy.

Cardiac Toxicities Associated with Herbal Remedies

PURPOSE: Herbal preparations have long been used for medical purposes by traditional cultures, and their use is increasing in modern societies. However, many herbal agents produce specific cardiovascular toxicities in humans. We performed this study in order to investigate the clinical characteristics of the cardiac toxicities associated with herbal remedies. METHODS: We conducted a retrospective study of 45 patients (mean age 57+/-10 years) who presented with cardiotoxicity between January 2007 and May 2011 due to ingestion of herbal remedy substances. Patients were identified as suffering cardiotoxicity if they presented with chest pain, EKG abnormality, and elevation of cardiac enzyme. RESULTS: Of the 45 total cases, 17 included hemodynamic instability (37.8%), 7 with increasing cardiac enzyme (15.6%), 2 with cardiac arrest (4.4%) and one case of mortality (2.2%). The cardiotoxic herb group that demonstrated the worst clinical course was Ranunculaceae. CONCLUSIONS: In our study results, 57.6% of the herbal intoxication patients demonstrated the effects of cardiotoxicity. Thus, we recommend careful monitoring of herbal intoxication patients.

Toxicidad por anestésicos locales: revisión de la literatura / Toxicity due to local anesthetic agents: literature review

Los anestésicos locales (AL) son medicamentos muy empleados en la práctica anestésica, con baja presentación de efectos adversos y, en el caso de toxicidad, una alta mortalidad. Actualmente las tasas de toxicidad sistémica han disminuido, del 0,2 % al 0,01 %, por el uso de medidas preventivas y desarrollo de medicamentos más seguros. Dado el riesgo de mortalidad latente, los estudios en humanos no son factibles, siendo la fuente de información disponible la extrapolación de estudios animales o reportes de caso. Las manifestaciones de toxicidad severa por AL, se dan principalmente con la administración intravascular más que por la absorción tisular; siendo así la bupivacaína el AL con mayor riesgo. Clínicamente se observa alteración del estado de conciencia y convulsiones tónico-clónicas seguidas de compromiso cardiovascular, dado por bloqueos de la conducción y colapso cardiovascular de difícil manejo. En cuanto al manejo, la prevención es la base de éste seguido de una técnica anestésica adecuada; rápido reconocimiento y diagnostico e inicio temprano de medidas de rescate según el ACLS y más recientemente el uso concomitante de emulsiones lipídicas al 20 %, soportado en reportes de caso con resucitación exitosa.

Local anesthetics (LA) are drugs widely used in the practice of anesthesia, with low incidence of adverse events; however, in case of toxicity, mortality is very high. Currently, the systemictoxicity rates have dropped from 0.2 % to 0.01 %, thanks to the use of preventive measures and to the development of safer drugs. Inview of the high risk of latent mortality, studies in humans are not feasible and hence the available sources of information are extrapolated animal studies or case reports. Severe LA toxicity manifestations occur mainlyas a result of intravascular administration rather than due to tissue absorption; hence, bupivacaine is the LA that exhibits the highest risk. Clinically there are awareness disorders and tonic-clonic seizures followed by cardiovascular involvement resulting from conduction blocks and difficult to manage cardiovascular collapse. With regards to management, prevention is the key, followed by an adequate anesthetic technique; rapid identification and diagnosis and early application of ACLS rescue measures.More recently, the concomitant use of 20 % lipid emulsions has been supported by successful resuscitation case reports.