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2.
Rev. colomb. cardiol ; 28(3): 207-216, mayo-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1341288

ABSTRACT

Resumen En las mujeres, la enfermedad cardiovascular y el cáncer de mama representan respectivamente la primera y la quinta causas de mortalidad, y tienen varios factores en común, como la edad, la dieta, la obesidad, el tabaquismo y el sedentarismo. En el cáncer de mama, el diagnóstico temprano y el tratamiento multimodal han mejorado el pronóstico y la supervivencia a largo plazo. Sin embargo, el cáncer de mama y las terapias utilizadas para su control (quimioterapia y radioterapia) pueden tener un impacto negativo en el sistema cardiovascular y producir alteraciones como disfunción ventricular, arritmias, miocarditis o enfermedad cardiovascular aterosclerótica acelerada. Cobran vital importancia la prevención, el diagnóstico y el tratamiento de la disfunción cardiaca y de otras complicaciones cardiovasculares, ya que para algunas la mortalidad es mayor que la del cáncer de mama. Es fundamental que toda paciente con cáncer de mama que vaya a iniciar tratamiento por oncología sea evaluada en cuanto a sus factores de riesgo para enfermedad cardiovascular. Los marcadores séricos, como la troponina y el péptido natriurético B, junto con el electrocardiograma y el ecocardiograma, pueden ser utilizados para la monitorización y la prevención de la cardiotoxicidad. Se resumen las recomendaciones para el diagnóstico y el tratamiento de la enfermedad cardiovascular de las pacientes en tratamiento para cáncer de mama.


Abstract Cardiovascular disease and breast cancer are the first and fifth cause of death among women worldwide, respectively. These diseases share several risk factors (age, diet, obesity, smoking, etc.) and early diagnosis and treatment have led to improving prognosis and survival. However, the increase in the risk of developing cardiotoxicity (manifested as ventricular dysfunction, arrhythmias, cardiovascular disease, etc.) associated with breast cancer treatment (chemotherapy and radiotherapy) could limit its use. Accordingly, there is an increasing importance of optimizing the prevention, diagnosis and treatment of cardiac dysfunction and cardiovascular complications developed as a result of breast cancer treatment. Risk factors for cardiovascular disease should be assessed for every patient with breast cancer scheduled to receive oncology treatment. This evaluation could include an electrocardiogram, an echocardiogram and biomarkers such as troponin levels and BNP in order to perform a risk assessment and monitoring of cardiotoxicity. Here, we summarize the recommendations regarding the diagnosis and management of breast cancer patients at risk of developing treatment-induced cardiotoxicity.


Subject(s)
Humans , Female , Adult , Breast Neoplasms , Cardiotoxicity , Cardiovascular Diseases , Heart Failure
3.
Arch. cardiol. Méx ; 91(2): 229-234, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1248790

ABSTRACT

Resumen Hoy una de las principales causas de mortalidad es el cáncer. La supervivencia en pacientes con cáncer ha incrementado de 1970 (25%) a la actualidad (80%). A raíz de la introducción de las antraciclinas como tratamiento de cáncer desde 1960-1970, más del 60% de los pacientes son tratados con estos agentes; sin embargo, la exposición de quimioterápicos conlleva las enfermedades cardiovasculares como la principal causa de mortalidad en enfermos supervivientes de cáncer en el s. XXI. Hay múltiples factores que incrementan la sensibilidad de cardiotoxicidad inducida por antracíclicos. En 1970 el estándar de oro para la detección de disfunción ventricular era la biopsia endomiocárdica, en forma posterior la detección y manejo de la cardiotoxicidad fue guiada por los síntomas, en 1981 la detección de cardiotoxicidad fue reportada con la determinación de la fracción de expulsión del ventrículo izquierdo (FEVI) por ecocardiografía 2D. En la actualidad el ecocardiograma 3D para FEVI y volúmenes sistólico y diastólico han presentado una alta correlación de los valores obtenidos por resonancia magnética para la evaluación de la función cardiaca. Hoy en día la ecocardiografía strain, strain-rate y speckle tracking se utilizan para determinar la función miocárdica regional y global. Para una valoración integral estos resultados se pueden complementar con biomarcadores cardiacos (troponinas y propéptido natriurético tipo B) y cambios electrocardiográficos. De esta forma se puede detectar insuficiencia cardiaca subclínica y dar un tratamiento oportuno.


Abstract Today one of the main causes of mortality is cancer. Survival in cancer patients has increased from 1970 (25%) to the present (80%). Following the introduction of anthracyclines as a cancer treatment since 1960-70, more than 60% of patients are treated with these agents, although chemotherapeutic exposure leads to cardiovascular diseases as the main cause of mortality in surviving patients. of cancer in the 21st Century. There are multiple factors that increase the sensitivity of anthracyclic-induced cardiotoxicity. In 1970 the gold standard for the detection of ventricular dysfunction was endomyocardial biopsy, subsequently the detection and management of cardiotoxicity was guided by symptoms, in 1981 the detection of cardiotoxicity was reported with the determination of the ejection fraction of the left ventricle (LVEF), by 2D echocardiography. Currently, the 3D echocardiogram for LVEF and systolic and diastolic volumes have presented a high correlation of the values obtained by magnetic resonance imaging for the evaluation of cardiac function. Today strain, strain-rate and speckle tracking echocardiography are used to determine regional and global myocardial function. For a comprehensive assessment, these results can be complemented with cardiac biomarkers (troponins) and electrocardiographic changes. In this way, subclinical heart failure can be detected and timely treatment can be given.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Echocardiography/methods , Echocardiography, Three-Dimensional/methods , Cardiotoxicity/diagnostic imaging , Heart Failure/diagnosis , Neoplasms/drug therapy , Antineoplastic Agents/toxicity , Heart Failure/etiology , Antineoplastic Agents/therapeutic use
4.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 513-516, Mar.-Apr. 2021. graf
Article in English | LILACS, VETINDEX | ID: biblio-1248925

ABSTRACT

A doxorrubicina (dox) é um medicamento antineoplásico que induz cardiotoxicidade por estresse oxidativo. Os flavonoides são antioxidantes extraídos de plantas como Camellia sinensis e Arrabidaea chica (Fridericia chica). Esta pesquisa objetivou avaliar efeitos protetores do extrato de A. chica (AC), comparado ao de C. sinensis (CS), frente ao estresse oxidativo induzido pela dox, no coração. Cardiomiócitos e células neoplásicas MDA-MB 231 foram incubados com AC e CS. Depois, adicionou-se dox e avaliaram-se taxas de viabilidade e morte celular. A citometria de fluxo para o ensaio de iodeto de propídeo (IP) em cardiomiócitos mostrou as seguintes taxas de morte celular: controle 53%; dox 78% (maior que controle, P=0,015); AC_12,5µg/mL + dox 65% (menor que dox, P=0,031); AC_25µg/mL + dox 62% (menor que dox, P=0,028); AC_50µg/mL + dox 63% (menor que dox, P=0,030); CS_12,5µg/mL + dox 71% (menor que dox, P=0,040); CS_25µg/ml + dox 69% (menor que dox, P=0,037); CS_50µg/mL + dox 74% (menor que dox, P=0,044). Resultados das células MDA-MB 231 mostraram que nenhum extrato interferiu na atividade antitumoral da dox. Os dados de IP foram corroborados pelos de MTT. Este estudo reporta promissora utilização de A. chica na prevenção da cardiotoxicidade induzida pela dox.(AU)


Subject(s)
Animals , Rats , Plant Extracts/therapeutic use , Doxorubicin , Bignoniaceae/chemistry , Cardiotoxicity/therapy , Cardiotoxicity/veterinary , Plants, Medicinal , Flavonoids/therapeutic use
5.
CorSalud ; 13(1): 86-92, 2021. graf
Article in Spanish | LILACS | ID: biblio-1345923

ABSTRACT

RESUMEN El bacilo de la tuberculosis existe hace 3 millones de años. Esta es una enfermedad infectocontagiosa causada por el complejo Mycobacterium tuberculosis. Básicamente se puede presentar de tres formas: tuberculosis pulmonar, miliar y extrapulmonar, dentro de esta última se encuentra la tuberculosis pericárdica. En el caso específico de la Imagenología se han descrito signos radiológicos con importantes hallazgos en el área cardíaca. El ecocardiograma podría considerarse como el mejor método diagnóstico no invasivo para detectar la presencia de engrosamiento pericárdico y derrame pericárdico con o sin fibrina. La tomografía axial computarizada de tórax proporciona una excelente evaluación de la anatomía del corazón y el pericardio, el grosor del mismo y la presencia de líquido entre sus capas. El estudio mediante tomografía por emisión de positrones (PET) puede ser muy útil para discriminar la pericarditis tuberculosa de la idiopática. La resonancia magnética es muy sensible para valorar la estructura miocárdica, la función, la inflamación y la fibrosis. La infección pericárdica por tuberculosis sigue constituyendo un problema de salud mundial y su diagnóstico un reto para los especialistas que la enfrentan, lo que requiere de varias técnicas de imágenes diagnósticas y de pruebas bacteriológicas, en aras de lograr su confirmación.


ABSTRACT Tuberculosis bacillus has been around for 3 million years. This is an infectious disease caused by the Mycobacterium tuberculosis complex. It basically has three presentation forms: pulmonary, miliary and extrapulmonary tuberculosis, within the latter pericardial tuberculosis is included. Regarding the specific case of Imaging, radiological signs have been described with important findings in the cardiac area. Echocardiogram could be considered the best noninvasive diagnostic method for detecting the presence of pericardial thickening and pericardial effusion with or without fibrin. Chest computed tomography scan provides an excellent assessment of the anatomy of the heart and pericardium, the thickness of the latter, and the presence of fluid between its layers. Positron emission tomography (PET) study is very useful in discriminating tuberculous pericarditis from idiopathic one. Magnetic resonance imaging is very sensitive to assess myocardial structure, function, inflammation, and fibrosis. Pericardial tuberculosis infection remains a global health problem with challenging diagnosis for those specialists facing it, which requires several diagnostic imaging techniques and bacteriological tests, in order to achieve its confirmation.


Subject(s)
Sprains and Strains , Echocardiography , Drug Therapy , Cardiotoxicity , Heart Failure
6.
CorSalud ; 13(1): 32-43, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1345918

ABSTRACT

RESUMEN Introducción: Los avances en la detección precoz y el tratamiento del cáncer han reducido de manera significativa la mortalidad. El resultado neto es el surgimiento de una cohorte de pacientes cuya supervivencia es suficiente para evidenciar los efectos secundarios de las terapias utilizadas. La cardiotoxicidad es el conjunto de enfermedades cardiovasculares derivadas de los tratamientos onco-hematológicos. Objetivos: Evaluar el papel de la deformación miocárdica (strain) longitudinal global en la detección precoz de cardiotoxicidad en pacientes con tratamiento quimioterápico. Método: Se realizó un estudio cuantitativo, analítico, longitudinal, prospectivo en 44 pacientes con diagnóstico de cáncer de mama o linfoma, que iniciaron tratamiento con quimioterapia en el Instituto de Oncología y Radiobiología de Cuba, en el período comprendido entre febrero de 2017 y abril de 2018. Se utilizaron métodos primarios y secundarios para la recolección del dato primario y se emplearon varias pruebas estadísticas para su análisis. Resultados: Las medias de edad y tiempo de tratamiento fueron de 47,7 años y 5,05 meses, respectivamente. Predominó la hipertensión arterial (18,1%) como factor de riesgo y la mayor cardiotoxicidad (27,8%) en pacientes con disfunción diastólica previa. Entre los que desarrollaron cardiotoxicidad, la variable que demostró mayor afectación fue el strain longitudinal global (p<0,0001), con una reducción de 19,6% respecto al basal. Conclusiones: El strain longitudinal global es un índice ecocardiográfico de deformación miocárdica, que presentó un valor discriminante significativo con respecto a la cardiotoxicidad en pacientes que recibieron tratamiento quimioterápico.


ABSTRACT Introduction: Advances in early detection and treatment of cancer have significantly reduced mortality. The net result is the emergence of a cohort of patients whose survival is sufficient to evidence the side effects of the used therapies. Cardiotoxicity is the set of cardiovascular diseases resulting from onco-hematological treatments. Objectives: To evaluate the role of global longitudinal strain in the early detection of cardiotoxicity in patients undergoing chemotherapy. Method: A quantitative, analytical, prospective, longitudinal study was carried out in 44 patients diagnosed with breast cancer or lymphoma, who started chemotherapy treatment at the Instituto de Oncología y Radiobiología of Cuba, from February 2017 to April 2018. Primary and secondary methods were used for raw data collection and several statistical tests were used for its analysis. Results: The mean age and treatment period were 47.7 years old and 5.05 months, respectively. The most prevalent risk factor was high blood pressure and cardiotoxicity was higher (27.8%) in patients with previous diastolic dysfunction. Among those who developed cardiotoxicity, the variable that showed the greatest affectation was global longitudinal strain (p<0.0001), with a reduction of 19.6% with respect to the basal one. Conclusions: Global longitudinal strain is an echocardiographic index of myocardial performance, which presented a significant discriminating value with respect to cardiotoxicity in patients who received chemotherapeutic treatment.


Subject(s)
Sprains and Strains , Echocardiography , Drug Therapy , Cardiotoxicity
7.
CorSalud ; 13(1): 44-50, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1345919

ABSTRACT

RESUMEN Introducción: La evaluación de la función miocárdica es fundamental para la toma de decisiones durante el seguimiento de pacientes con enfermedades oncológicas que reciben quimioterapia. Con las técnicas de speckle-tracking bidimensional se puede determinar el grado de deformación de la fibra miocárdica y obtener una medida más directa de la función sistólica que la que aporta la fracción de eyección del ventrículo izquierdo (FEVI). Objetivo: Evaluar la función miocárdica, mediante ecocardiografía, en pacientes con enfermedades oncológicas y tratamiento quimioterápico. Método: Se realizó un estudio descriptivo longitudinal prospectivo en 21 pacientes con diagnóstico de enfermedad oncoproliferativa e indicación de quimioterapia con trastuzumab, en el Hospital de Fuerteventura (España), entre enero de 2017 y mayo de 2020. A todos se les realizó ecocardiograma transtorácico con técnica de speckle-tracking (strain longitudinal global) antes del tratamiento y durante el seguimiento. Resultados: Predominaron las mujeres (95,2%) con diagnóstico de cáncer de mama (90,5%) y la edad promedio fue de 53,8 años (rango 38-75). La FEVI y el strain longitudinal global fueron normales (100%) antes del inicio de la quimioterapia. Fue necesario suspender el tratamiento en 3 pacientes (14,3%); pero solo en 2 de ellos (9,5%) por cardiotoxicidad detectada por ecocardiografía. Cinco pacientes (23,8%) presentaron síntomas de insuficiencia cardíaca, 1 (4,8%) tenía cardiotoxicidad y en los otros 4 (19,0%) se demostró ausencia de disfunción miocárdica, por lo que se pudo continuar el tratamiento con seguridad. Conclusiones: El ecocardiograma con técnica de speckle-tracking bidimensional fue de vital importancia para evaluar la función miocárdica y guiar el tratamiento quimioterápico en pacientes con enfermedades oncológicas.


ABSTRACT Introduction: Assessment of myocardial function is critical for decision making during the follow-up of patients with oncologic diseases undergoing chemotherapy. Two-dimensional speckle-tracking techniques help to determine the degree of myocardial fiber deformation and provide a more direct measure of systolic function than left ventricular ejection fraction (LVEF). Objective: To evaluate myocardial function by means of echocardiography in patients with oncological diseases undergoing chemotherapy. Methods: A prospective longitudinal descriptive study was performed in 21 patients diagnosed with cancer and with indication for chemotherapy with trastuzumab, in the Hospital of Fuerteventura (Spain), between January 2017 and May 2020. All underwent transthoracic echocardiography with speckle-tracking technique (global longitudinal strain) before treatment and during follow-up. Results: Women (95.2%) with a diagnosis of breast cancer (90.5%) predominated and the mean age was 53.8 years (range 38-75). Left ventricular ejection fraction and global longitudinal strain were normal (100%) before starting chemotherapy. It was necessary to suspend treatment in 3 patients (14.3%); but only in 2 of them (9.5%) due to cardiotoxicity detected by echocardiography. Five patients (23.8%) presented symptoms of heart failure, 1 (4.8%) had cardiotoxicity and in the other 4 (19.0%) the absence of myocardial dysfunction was demonstrated, so that treatment could be continued safely. Conclusions: Two-dimensional speckle-tracking echocardiography was of vital importance for assessing myocardial performance and guiding chemotherapy in patients with oncologic diseases.


Subject(s)
Echocardiography , Drug Therapy , Cardiotoxicity , Heart Failure
8.
Rev. cuba. hematol. inmunol. hemoter ; 37(1): e1249, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251713

ABSTRACT

Introducción: Con el protocolo LPM-TOA para tratamiento de la leucemia promielocítica, se han obtenido excelentes resultados, ya que se logra sobrevida global prolongada y posible curación de los enfermos. En la inducción se utilizan dos drogas cardiotóxicas: las antraciclinas y el trióxido de arsénico y en la consolidación los enfermos reciben una dosis elevada de arsénico. Objetivo: Evaluar la toxicidad cardíaca tardía en pacientes con leucemia promielocítica tratados según el protocolo LPM-TOA. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y longitudinal que incluyó 20 pacientes tratados con protocolo LPM-TOA, seguidos en consulta entre enero y julio 2019. Los pacientes tenían más de dos años de haber recibido las drogas cardiotóxicas. Se revisaron las historias clínicas y se determinó la fracción de eyección ventricular izquierda y la deformidad longitudinal global, mediante ecocardiograma. Resultados: Se presentaron hombres y mujeres con igual frecuencia, edad promedio 41,5 ± 11,0 años. Durante la inducción, en menos de la mitad de los enfermos se suspendió el arsénico por elevación del segmento QT corregido; en la mayoría solo se suspendió por uno o dos días. La mayor parte de los pacientes tuvo la fracción de eyección ventricular izquierda con valores entre 61 y 70 por ciento y la deformidad longitudinal global fue - 24 - 22 por ciento Conclusiones: En los pacientes estudiados, el tiempo de haber recibido el trióxido de arsénico y la dosis recibida, no influyó en la función cardíaca(AU)


Introduction: The PML-ATO protocol for the treatment of promyelocytic leukemia has obtained excellent results, achieving high overall survival rates and the possible healing of patients. Two cardiotoxic drugs are used in the induction process: anthracyclines and arsenic trioxide, whereas during consolidation patients receive a high dose of arsenic. Objective: Evaluate the late cardiotoxicity in patients with promyelocytic leukemia treated by the PML-ATO protocol. Methods: An observational prospective longitudinal descriptive study was conducted of 20 patients treated with the PML-ATO protocol and followed-up in outpatient consultation from January to July 2019. More than two years had elapsed since the patients received the cardiotoxic drugs. A review was carried out of the patients' medical records and echocardiographic determination was made of left ventricular ejection fraction and overall longitudinal deformity. Results: Men and women presented the same frequency; mean age was 41.5 ± 11.0 years. During induction, arsenic was suspended in less than half the patients due to corrected QT elevation. In most it was only suspended for one or two days. Most patients had left ventricular ejection fraction values between 61 percent and 70 percent, whereas overall longitudinal deformity was - 24 percent - 22 percent. Conclusions: In the patients studied, cardiac function was not affected by the time elapsed since arsenic trioxide administration or the dose received(AU)


Subject(s)
Humans , Leukemia, Promyelocytic, Acute/mortality , Leukemia, Promyelocytic, Acute/therapy , Anthracyclines , Arsenic Trioxide/therapeutic use , Medical Records , Survival Rate , Cardiotoxicity/drug therapy
9.
Chinese Journal of Lung Cancer ; (12): 668-672, 2021.
Article in Chinese | WPRIM | ID: wpr-922239

ABSTRACT

Immune checkpoint inhibitors (ICIs) is a negative regulatory factor antibody, which activates T cells to play an anti-tumor effect in immunotherapy, and can also cause immune-related adverse responses, thereby inducing a series of immune related adverse events (irAEs). Among these irAEs, although the incidence of ICIs-related myocarditis is very low, the fatality rate is significantly higher than other adverse reactions, close to 50%. Clinicians should be vigilant when applying ICIs, but the pathogenesis of ICIs-related myocarditis is still unclear. This article combines the recent research results of ICIs to summarize the mechanism and clinical manifestations of ICIs-related myocarditis, so as to improve clinicians' understanding of the adverse reactions.
.


Subject(s)
Biomedical Research/trends , Cardiotoxicity/physiopathology , Humans , Immune Checkpoint Inhibitors/therapeutic use , Immunotherapy/adverse effects , Myocarditis/physiopathology , Neoplasms/drug therapy
10.
Article in English | WPRIM | ID: wpr-921883

ABSTRACT

Rapid development of anticancer treatments in recent years has greatly improved prognosis of cancer patients. However, with extension of survival time of cancer patients, various short-term and long-term side effects brought about by anticancer treatments, especially cardiotoxicity, have become increasingly prominent. Nonetheless, at present, there is few diagnostic methods with extremely high sensitivity and specificity to detect and accurately predict whether patients with anticancer treatment will experience cardiovascular complications. Inflammation, fibrosis and oxidative stress are considered to be important mechanisms involved in cardiotoxicity anticancer treatments. The cardiovascular biomarkers having the ability to predict and detect cardiovascular dysfunction earlier than clinical symptoms as well as left ventricular ejection fraction monitored by echocardiography, are of great value to timely treatment adjustment and prognosis evaluation. Cardiac troponin T/I and brain natriuretic peptide/N-terminal prohormone of brain natriuretic peptide have been routinely used in clinical practice to monitor cardiotoxicity, and some new biomarkers such as soluble suppression of tumorigenecity-2, myeloperoxidase, growth differentiation factor-15, galectin-3, endothelin-1, have potential in this area. In the future, larger-scale experimental studies are needed to provide sufficient evidences, and how to detect them quickly and at low cost is also a problem to be dealed with.


Subject(s)
Biomarkers , Cardiotoxicity/diagnosis , Humans , Natriuretic Peptide, Brain , Stroke Volume , Ventricular Function, Left
11.
Rev. urug. cardiol ; 36(3): e401, 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1367036

ABSTRACT

Las nuevas terapias oncológicas han logrado aumentar la sobrevida del paciente con cáncer, observando, sin embargo, un incremento de la morbilidad y mortalidad vinculadas a sus efectos secundarios. El desarrollo de eventos cardiovasculares adversos impacta negativamente en el pronóstico durante el tratamiento del cáncer, pero también en los supervivientes al cáncer, donde las enfermedades cardiovasculares (ECV) y las segundas neoplasias son la principal causa de muerte1-5. La cardiotoxicidad inducida por el tratamiento del cáncer se define como el conjunto de ECV derivadas de los tratamientos oncológicos. Su manifestación es variada e incluye el desarrollo de disfunción ventricular, insuficiencia cardíaca (IC), isquemia miocárdica, hipertensión arterial (HTA) y arritmias, entre otras. Puede ser consecuencia tanto del efecto directo del tratamiento sobre la estructura y función cardíacas, como del desarrollo acelerado de enfermedad cardiovascular6-9. Con frecuencia, se utiliza el término cardiotoxicidad como sinónimo de disfunción ventricular por quimioterapia (DV-QT). Dado que la cardiotoxicidad abarca un espectro más amplio de afectación cardiovascular, creemos conveniente hablar de DV-QT para referirnos a la afectación de la función sistólica del ventrículo izquierdo. La DV-QT y el desarrollo de IC representan una de las complicaciones más temidas por su impacto pronóstico en la esfera cardiovascular y oncológica, dado que limitan el arsenal terapéutico para el tratamiento del cáncer5,10. Han sido creadas diversas sociedades de cardio-onco-hematología con el fin de generar recomendaciones de práctica clínica y formar profesionales capacitados para el manejo de las complicaciones CV del tratamiento del cáncer11. La cardio-oncología es una disciplina en creciente y continuo desarrollo. Creemos que es fundamental realizar tareas de formación médica continua, así como también estimular el trabajo conjunto de diversas especialidades para brindar una mejor asistencia. Este texto es el resultado del trabajo de un equipo multidisciplinario que incluye cardiólogos, hematólogos y oncólogos, y pretende brindar información a los integrantes del equipo de salud involucrados en la asistencia de pacientes oncológicos. Debido a la extensión del presente texto, hemos decidido fraccionar el contenido en tres partes para facilitar su difusión.


New oncological therapies have been successful in increasing cancer patient survival, but they have also led to an increase in morbidity and mortality linked to their side effects. During cancer treatment, the development of cardiovascular side effects has a negative impact in prognosis, but also in cancer survivors, in whom cardiovascular diseases and secondary malignancies are the main cause of death. Cancer related cardiotoxicity is defined as the development of cardiovascular diseases related to cancer treatment. Clinical presentation is broad involving ventricular dysfunction, heart failure, myocardial ischemia, arterial hypertension and arrhythmias among others. This may result from the direct cardiovascular effect of a cancer treatment or accelerated development of cardiovascular diseases. Frequently, in the literature cardiotoxicity and chemotherapy related ventricular dysfunction are used as synonyms. However, cardiotoxicity includes a broad spectrum of cardiovascular manifestations, thus in this text we refer to chemotherapy related ventricular dysfunction as the presence of left ventricular systolic impairment. Chemotherapy related ventricular dysfunction and heart failure are two of the most feared complications of cancer treatment due to its impact on cardiovascular and oncological prognosis, affecting treatment options. Numerous worldwide cardio-onco-hematology societies have emerged to generate clinical practice guidelines and improve the diagnosis and evaluation of cardiovascular cancer treatment side effects. Cardio-Oncology is a discipline in continuous growth and development. We strongly believe that continuum medical education and a multidisciplinary approach is necessary to provide a quality health care. This text is the result of a multidisciplinary work involving cardiologists, hematologists and oncologists. It is our goal to provide information to the health care team involved in the assistance of cancer patients. Due to its extension, it will be divided in three parts.


O desenvolvimento de novas terapias oncológicas levou a um aumento na sobrevida dos pacientes, mas ao mesmo tempo traz consigo morbidades relacionadas aos tratamentos. O desenvolvimento de efeitos cardiovasculares adversos tem um impacto negativo no prognóstico dos pacientes em tratamento, bem como nos pacientes considerados curados, nos quais doença cardiovascular e malignidades secundárias são as principais causas de morte. Cardiotoxicidade relacionada ao câncer é definida como o desenvolvimento de doença cardiovascular secundária ao tratamento. A gama de apresentações clínicas é ampla, podendo se manifestar como disfunção ventricular, insuficiência cardíaca, isquemia miocárdica, hipertensão arterial, arritmias, entre outras. Isto pode ser resultante de desenvolvimento e progressão acelerados de doença cardiovascular ou por efeito direto das terapias. Frequentemente é dito na literatura que cardiotoxicidade e disfunção ventricular relacionada à quimioterapia são sinônimos. Entretanto, cardiotoxicidade engloba um amplo espectro de manifestações cardiovasculares. Neste texto, portanto, nos referimos à disfunção ventricular causada por quimioterápicos exclusivamente como a presença de disfunção sistólica ventricular esquerda. Disfunção ventricular relacionada à quimioterapia e insuficiência cardíaca são duas das mais temidas complicações do tratamento oncológico devido ao seu impacto no prognóstico cardiovascular e oncológico, podendo afetar ainda a escolha e manutenção das opções terapêuticas. Diversas sociedades cardio-onco-hematológicas surgiram ao redor do mundo com o objetivo de gerar diretriz clínicas práticas e melhorar o diagnóstico e tratamento das complicações cardiovasculares resultantes das terapias oncológicas. A cardio-oncologia é uma disciplina em contínuo crescimento e desenvolvimento. Nós acreditamos fortemente que educação médica continuada e uma abordagem multidisciplinar são necessárias para um cuidado médico de qualidade. Este texto é o resultado de um trabalho multidisciplinar envolvendo cardiologistas, hematologistas e oncologistas. Nosso objetivo é de oferecer informação à equipe de cuidados em saúde envolvido na assistência destes pacientes. Devido à sua extensão, este texto será dividido em três partes.


Subject(s)
Humans , Cardiotoxins/adverse effects , Cardiotoxicity/drug therapy , Heart Diseases/diagnosis , Heart Diseases/chemically induced , Heart Diseases/drug therapy , Antineoplastic Agents/adverse effects
12.
ABC., imagem cardiovasc ; 34(4): eabc215, 2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1358883

ABSTRACT

Fundamento: A quimioterapia para o câncer de mama está associada a complicações cardiovasculares graves, como a insuficiência cardíaca. A fração de ejeção do ventrículo esquerdo é o principal parâmetro para avaliar a função sistólica nessas pacientes. Todavia, a ocorrência de disfunção diastólica pode preceder à disfunção sistólica. Objetivos: Avaliar as funções diastólica e sistólica do ventrículo esquerdo de portadoras de câncer de mama em tratamento quimioterápico com antraciclinas. Métodos: Trata-se de estudo observacional, longitudinal, analítico e prospectivo. Estudaram-se 62 mulheres com câncer de mama, com idades de 21 a 75 anos, que realizaram ecocardiogramas basais e após 3 meses de tratamento. Avaliaram-se parâmetros de função diastólica, e as pacientes foram classificadas em disfunção diastólica tipos:1, 2 ou 3. Definiu-se a disfunção sistólica como fração de ejeção do ventrículo esquerdo ≤ 53%. Resultados: Decorridos 3 meses de tratamento, 35 pacientes (56,4%) apresentavam disfunção diastólica tipo 1, e apenas uma (1,6%) do tipo 2. A disfunção diastólica ocorreu em 26 pacientes já na etapa basal e surgiu em dez indivíduos no decurso do tratamento. Os parâmetros de função diastólica velocidade de onda E e relação E/A diminuíram significativamente (p < 0,05) com a quimioterapia, todavia, os demais não tiveram variação significativa. Apenas três pacientes apresentaram disfunção sistólica, porém verificou-se maior redução da fração de ejeção do ventrículo esquerdo no grupo que desenvolveu disfunção diastólica durante o tratamento comparativamente ao grupo que apresentava já disfunção diastólica no período basal (p = 0,04). Conclusão: A disfunção diastólica ocorre precocemente em portadoras de câncer de mama submetidas à quimioterapia. O surgimento de disfunção diastólica no decurso do tratamento se associa à redução significativa da fração de ejeção do ventrículo esquerdo. (AU)


Background: Chemotherapy for breast cancer is associated with serious cardiovascular complications such as heart failure. The left ventricular ejection fraction is the main parameter used to assess systolic function in these patients. However, the occurrence of diastolic dysfunction may precede that of systolic dysfunction. Objectives: To evaluate left ventricle diastolic and systolic functions in women with breast cancer undergoing chemotherapy using anthracyclines. Methods: This observational, longitudinal, analytical, and prospective study included 62 women with breast cancer aged 21­75 years old who underwent echocardiography at baseline and after three months of treatment. Diastolic function parameters were evaluated, and the patients were classified as diastolic dysfunction type 1, 2, or 3. Systolic dysfunction was defined as a left ventricular ejection fraction ≤ 53%. Results: After three months of treatment, 35 patients (56.4%) had type 1 diastolic dysfunction, while one (1.6%) had type 2. Diastolic dysfunction was identified in 26 patients at baseline and developed in 10 patients during treatment. Diastolic function parameters, E wave velocity, and E/A ratio decreased significantly (p < 0.05) with chemotherapy; however, the others showed no significant variations. Only three patients had systolic dysfunction, but there was a greater reduction in left ventricular ejection fraction in the group that developed diastolic dysfunction during treatment versus the group with diastolic dysfunction at baseline (p = 0.04). Conclusion: Diastolic dysfunction occurs early in women with breast cancer undergoing chemotherapy. Its onset during the course of treatment is associated with a significantly reduced left ventricular ejection fraction. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Young Adult , Breast Neoplasms/drug therapy , Ventricular Dysfunction, Left/etiology , Cardiotoxicity/complications , Heart Failure/physiopathology , Heart Failure/mortality , Time Factors , Echocardiography/methods , Anthracyclines/administration & dosage , Anthracyclines/toxicity , Anthracyclines/therapeutic use
14.
Arq. bras. cardiol ; 115(5): 885-893, nov. 2020. tab, graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1142279

ABSTRACT

Resumo Fundamento: A cardiotoxicidade pode ser uma consequência do tratamento com doxorrubicina (DOX). Objetivos: Verificar o efeito do exercício aeróbio na prevenção da disfunção cardíaca de murinos expostos à DOX. Método: Uma busca abrangente foi realizada em nove bases de dados, em dezembro de 2017. Estudos que avaliaram a função cardíaca de murinos expostos à DOX foram incluídos. O nível de significância adotado foi de 5%. Resultados: Na comparação entre 230 murinos submetidos a exercício aeróbio mais DOX e 222 controles (tratados somente com DOX), a fração de encurtamento mostrou uma melhora de 5,33% a favor do grupo experimental (p = 0,0001). A pressão desenvolvida no ventrículo esquerdo também mostrou um aumento de 24,84 mmHg a favor do grupo de 153 murinos que realizaram exercício em comparação com o grupo controle de 166 murinos (p = 0,00001). Conclusão: Estudos pré-clínicos incluídos nesta metanálise indicaram que o exercício é uma boa estratégia não farmacológica para preservar a função cardíaca pós-DOX.


Abstract Background: Cardiotoxicity may be a consequence of treatments with doxorubicin (DOX). Objectives: To investigate the effect of aerobic exercise on the prevention of cardiac dysfunction in murines exposed to DOX. Method: A comprehensive search was conducted in 9 databases in December 2017. Studies that evaluated the cardiac function of murines exposed to DOX were included. The significance level adopted was 5%. Results: In a comparison between 230 murines that underwent aerobic exercise plus DOX treatment and 222 control murines (DOX treatment only), fractional shortening showed an improvement of 5.33% in favor of the experimental group (p = 0.00001). Left ventricle developed pressure also showed an increase of 24.84 mm Hg in favor of the group of 153 murines that performed exercise in comparison to the control group of 166 murines (p = 0.00001). Conclusion: Preclinical studies included in this meta-analysis indicated that exercise is a good nonpharmacological strategy for preserving post-DOX cardiac function.


Subject(s)
Animals , Rats , Physical Conditioning, Animal , Heart Diseases , Exercise , Doxorubicin/adverse effects , Cardiotoxicity/etiology , Antibiotics, Antineoplastic
15.
Article in Portuguese | LILACS | ID: biblio-1354982

ABSTRACT

RESUMO: O uso de substâncias psicoativas pode induzir complicações cardiovasculares. O objetivo deste relato é descrever o caso de um paciente jovem com cardiomiopatia dilatada secundária ao uso de cocaína. Paciente com dispneia há seis meses, com piora progressiva, dispneia paroxística noturna, ortopneia e edema de membros inferiores. Ao exame físico apresentava taquicardia (110 bpm), com demais sinais vitais sem alterações, presença de estertores crepitantes em bases e campos médios, ascite de moderado volume e edema importante de membros inferiores. No eletrocardiogra-ma, apresentava ritmo sinusal com sobrecarga de câmaras esquerdas; na radiografia de tórax, apenas cardiomegalia acentuada. O ecocardiograma evidenciou fração de ejeção (FE) do ventrículo esquerdo (VE) reduzida (7%), aumento de átrio esquerdo e ventrículo direito (VD), com hipertrofia excêntrica e disfunção sistólica acentuada do VE, com disfunção moderada do VD e hipertensão pulmonar (39 mmHg). Na ressonância, apresentou dilatação discreta do átrio direito, VD com dilatação importante, disfunção sistólica biventricular importante, com hipocinesia difusa (FE 8% de VD), além de fibrose miocárdica de padrão não coronariano inferosseptal. O caso relatado evidencia um diagnóstico cujo mecanismo fisiopatológico da cardiomiopatia dilatada não está claro. A associação mais coerente da cardiomiopatia dilatada apre-sentada pelo paciente está relacionada ao uso abusivo de cocaína, devido ao estímulo recorrente e de longa duração que o excesso de catecolaminas provocou no miocárdio. Tendo em vista o espectro de cardiomiopatia, infarto e arritmias que potencialmente podem ocorrer associados ao uso de cocaína, deve-se considerar a hipótese de cardiotoxicidade na avaliação de paciente com história de abuso de cocaína. (AU)


ABSTRACT: The use of psychoactive substances can induce cardiovascular complications. The purpose of this report is to describe the case of a young patient with dilated cardiomyopathy secondary to cocaine use. Patient with dyspnea for six months, with progressive worsening, paroxysmal nocturnal dyspnea, orthopnea, and lower limb edema. Physical examination showed tachycardia (110 bpm), with other vital signs without alterations, presence of crackling rales in the bases and middle fields, moderate volume ascites, and significant lower limb edema. Electrocardiogram showed sinus rhythm with left chamber overload; chest X-ray only marked cardiomegaly. The echocardiogram showed reduced left ventricular (LV) ejection fraction (7%), enlarged left atrium, and right ventricle (RV), with eccentric hypertrophy and severe left ventricular systolic dysfunction, with moderate RV dysfunction and pulmonary hyper-tension (39 mmHg). Resonance presented mild right atrial dilatation, RV with significant dilatation, significant biven-tricular systolic dysfunction, with diffuse hypokinesia, and myocardial fibrosis of non-coronary pattern. The reported case shows a diagnosis whose pathophysiological mechanism of dilated cardiomyopathy is not clear. The most coher-ent association of dilated cardiomyopathy presented by the patient is related to cocaine abuse, due to the long-term recurrent stimulus that excess catecholamines caused in the myocardium. Given the spectrum of cardiomyopathy, infarction, and arrhythmias that may potentially occur associated with cocaine use, the hypothesis of cardiotoxicity should be considered in the evaluation of a patient with a history of cocaine abuse. (AU)


Subject(s)
Humans , Male , Adult , Ventricular Dysfunction , Cocaine-Related Disorders , Cardiotoxicity , Hypertension, Pulmonary , Cardiomyopathies
16.
Biosci. j. (Online) ; 36(6): 2281-2287, 01-11-2020. tab, graf
Article in English | LILACS | ID: biblio-1148386

ABSTRACT

Many therapies used for cancer (pathology whose cases are progressively increasing in the world) such as chemotherapy and radiotherapy have numerous adverse effects, with cardiotoxicity being one of the most important. This can be defined from the detection, by an imaging method, of a reduction of at least 10% in the left ventricular ejection fraction (LVEF), bringing it to a value below 53%. Anthracyclines (such as Doxorubicin), Trastuzumab, and Taxanes (Docetaxel) are among the most associated chemotherapeutics. To emphasize the importance of optimized treatment for heart failure and to review the main updates on the theme of cardiotoxicity. Case report and bibliographic review on the latest updates to the management of cardiotoxicity and associated heart failure. When correctly identifying the main risk factors associated with chemotherapy and the individual to develop myocardial injury, it is possible to perform the monitoring by means of two main predictors: the myocardial tension strength and the biomarkers. In this sense, changes associated with these predictors may allow early intervention through appropriate treatment and, with the advancement of research, even prevention, mainly using the association of Carvedilol with Enalapril. Continuous monitoring and early initiation of drug therapy for heart failure are clearly associated with a lower degree of myocardial injury and a lower rate of complications. In addition, there is still an increasingly promising possibility in relation to preventive drug therapy, however, there is still a lack of studies on this topic.


Muitas terapias utilizadas para o câncer (patologia cujos casos estão aumentando progressivamente no mundo) como a quimioterapia e a radioterapia possuem inúmeros efeitos adversos, sendo a cardiotoxicidade um dos mais importantes. Esta pode ser definida a partir da detecção, por um método de imagem, de uma redução de, pelo menos, 10% na fração de ejeção do ventrículo esquerdo (FEVE), levando a mesma para um valor inferior a 53%. As Antraciclinas (como a Doxorrubicina), o Trastuzumab, e os Taxanos (Docetaxel) estão entre os quimioterápicos mais associados. Enfatizar a importância do tratamento otimizado para insuficiência cardíaca e revisar sobre as principais atualizações do tema cardiotoxicidade. Relato de caso e revisão bibliográfica sobre últimas atualizações de condutas referentes ao manejo da cardiotoxicidade e insuficiência cardíaca associada. Ao se identificar corretamente os principais fatores de risco associados à quimioterapia e ao indivíduo para desenvolver a injúria miocárdica, é possível realizar o monitoramento por meio de dois preditores principais: a força de tensão miocárdica e os biomarcadores. Nesse sentido, alterações associadas a esses preditores podem permitir a intervenção precoce por meio do tratamento adequado e, com o avanço das pesquisas, até mesmo a realização da prevenção, principalmente utilizando-se a associação de Carvedilol com Enalapril. Monitorização contínua e início precoce da terapia medicamentosa para insuficiência cardíaca estão claramente associadas com um menor grau de injúria miocárdica e um menor índice de complicações. Além disso, ainda há a possibilidade cada vez mais promissora em relação à terapia medicamentosa preventiva, porém, ainda há carência de estudos em relação a este tema.


Subject(s)
Pharmaceutical Preparations , Biomarkers , Cardiotoxicity , Heart Failure
17.
Rev. salud pública ; 22(3): e184770, May-June 2020. tab
Article in English | LILACS | ID: biblio-1127227

ABSTRACT

ABSTRACT The objective of this paper is to propose a conceptual tool for consideration by medical professionals and cardiologists, based on the concept of prudential judgment or Aristotelian phronesis to confront the problems of cardiotoxicity resulting from cancer treatments. We start by analyzing the case of a young female patient who received two types of therapies: the first with anthracyclines (adriamycin), which produces type I damage, as stated in the consensus of 2014; and the second treatment, one month later, with trastuzumab, an agent that produces type II damage not dependent on dose. In this case, the patient manifested acute cardiac insufficiency, with a decrease of LVEF to 28% on the echocardiogram and to 27% on magnetic resonance imaging. Reports have indicated that treatment with beta blockers and the suspension or decrease of the dose limits damage, but during preclinical stages. Awareness and early attention to subclinical damage have thus become extremely relevant to substantiate treatments based not only on clinical evidence but also on the ability of medical professionals to rely on prudential judgment--which moves away from the medical practices that are developed on a daily basis in order to influence and reduce the cases of irreversible heart failure known as cardiotoxicity.(AU)


RESUMEN Este trabajo tiene como objetivo proponer el juicio prudencial o phrónesis aristotélica como herramienta conceptual para la deliberación de los profesionales de la medicina y cardiólogos para afrontar la problemática que implica la cardiotoxicidad como resultado de los tratamientos contra el cáncer. Partimos desde el análisis de caso de una paciente joven que recibió dos tipos de terapias: la primera con antraciclinas (adriamicina) que produce daño por el mecanismo tipo I, propuesto en el consenso del 2014, y un mes después con trastuzumab, agente que produce daño tipo II no dependiente de dosis. En este caso la paciente presentó insuficiencia cardiaca aguda, con disminución de la FEVI a 28% por ecocardiograma y de 27% por resonancia magnética cardiaca. Se ha reportado que el tratamiento con betabloqueadores y la suspensión o disminución de la dosis limita el daño cuando se encuentra en etapas preclínicas. Por ello el pensamiento y el abordaje temprano en búsqueda de daño subclínico ha tomado extrema relevancia para fundamentar los tratamientos no solo desde la evidencia clínica, sino también en el juicio prudencial que dejan las prácticas médicas desarrolladas día a día para impactar y reducir estos casos de falla cardiaca irreversible conocidos como cardiotoxicidad.(AU)


Subject(s)
Professional Competence/legislation & jurisprudence , Ethics, Medical , Medication Therapy Management , Cardiotoxicity , Neoplasms/drug therapy
18.
Gac. méd. Méx ; 156(3): 218-224, may.-jun. 2020. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1249897

ABSTRACT

Resumen Introducción: La cardiotoxicidad es una reacción adversa asociada al uso de antraciclinas. Objetivo: Estimar los factores asociados al desarrollo de cardiotoxicidad por antraciclinas en pacientes pediátricos supervivientes de cáncer. Método: Cohorte retroprolectiva de niños con diagnóstico de cáncer tratados con antraciclinas. Se realizó determinación ecocardiográfica basal de la fracción de expulsión (FEVi0) antes del inicio del tratamiento y a los 12 meses (FEVi1). Del expediente se obtuvieron las características demográficas y el tratamiento. Se realizó un modelo de regresión logística múltiple (RLM); la FEVi1 < 50 % fue la variable dependiente, que se ajustó por las principales variables confusoras. Resultados: Se incluyeron 65 pacientes, 36.9 % fue del sexo femenino y 56.8 % presentó un tumor sólido. La FEVi0 fue de 74.79 ± 7.3 % y la FEVi1, de 67.96 ± 6.7 % (p = 0.001); 60 % desarrolló cardiotoxicidad. En la RLM solo la dosis acumulada > 430 mg se asoció a cardiotoxicidad (p = 0.001). Conclusiones: En los niños mexicanos se debe evitar una dosis acumulada > 430 mg de antraciclinas para evitar la cardiotoxicidad.


Abstract Introduction Cardiotoxicity is an adverse reaction associated with the use of anthracyclines. Objective: To estimate the factors associated with the development of anthracycline cardiotoxicity in pediatric patients surviving cancer. Method: Retro-prolective cohort of children diagnosed with cancer and treated with anthracyclines. Baseline echocardiographic determination of ejection fraction (LVEF0) was carried out before the start of treatment and again at 12 months (LVEF1). Demographic characteristics and treatment were obtained from the medical record. A multiple logistic regression (MLR) model was constructed; LVEF1 < 50 % was the dependent variable, which was adjusted for the main confounding variables. Results: Sixty-five patients were included, out of which 36.9 % were females and 56.8 % had a solid tumor. LVEF0 was 74.79 ± 7.3 % and LVEF1, 67.96 ± 6.7 % (p = 0.001); 60 % developed cardiotoxicity. In the MLR, only a cumulative dose > 430 mg was associated with cardiotoxicity (p = 0.001). Conclusions: In Mexican children, an anthracycline cumulative dose > 430 mg should be avoided in order to prevent cardiotoxicity.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Anthracyclines/adverse effects , Cardiotoxicity/epidemiology , Neoplasms/drug therapy , Stroke Volume , Risk Factors , Cohort Studies , Ventricular Function, Left , Anthracyclines/administration & dosage , Dose-Response Relationship, Drug , Cardiotoxicity/etiology , Cancer Survivors , Mexico
20.
Rev. méd. Chile ; 148(1): 93-102, Jan. 2020. graf
Article in Spanish | LILACS | ID: biblio-1094211

ABSTRACT

Cardiovascular diseases and cancer account for 27 and 25% of mortality in Chile, respectively. In the last decades, survival of people with cancer has improved due to preventive programs, early detection strategies, advances in technology and development of new antineoplastic therapies. Consequently, a progressive number of cancer-surviving patients have been generated, who may develop cardiovascular diseases, secondary to the same cancer therapy. Cardio-Oncology has emerged as the necessary link between both specialties to promote the prevention and early detection of cardiac complications, in patients undergoing oncological therapies. The aim is to curb cardiovascular complications. Also, to acquire knowledge about the mechanisms and effects of drugs that lead to heart damage aiming to develop efficient cardioprotective therapies. In this article we review and propose a didactic organization and classification of the main cardiovascular effects of cancer control therapy. We recognize that there is still a knowledge gap in basic sciences about the mechanisms that underlie these alterations.


Subject(s)
Humans , Cardiovascular Diseases , Neoplasms , Chile , Cardiotoxicity , Antineoplastic Agents
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