Rehabilitación cardíaca en la cardiotoxicidad. A propósito de un caso / Cardiac rehabilitation in cardiotoxicity. A case report

La toxicidad cardiovascular es una de las complicaciones más devastadoras del tratamiento del cáncer de mama. La mayoría de los fármacos antineoplásicos tienen toxicidad cardíaca. El objetivo del estudio es revisar, mediante un caso clínico, los efectos de la rehabilitación cardíaca en pacientes tratados con trastuzumab. La paciente inició un cuadro de disnea a mínimos esfuerzos. Con el diagnóstico de insuficiencia cardiaca secundaria a trastuzumab (FEVI, 35%), fue remitida a rehabilitación. Tras el programa de rehabilitación cardíaca durante 2 meses, se revaloró a la paciente: la capacidad funcional se había incrementado de forma significativa con normalización de FEV1. Los programas de rehabilitación cardíaca antes y durante la quimioterapia se podrían convertir en un posible tratamiento con efecto cardioprotector(AU)

Cardiovascular toxicity is one of the most devastating complications of breast cancer treatment. Most of the anticancer medicines have cardiac toxicity. The purpose of our study has been to review the effects of cardiac rehabilitation in trastuzumab-treated patients based on a case report. After the patient was diagnosed with trastuzumab-induced cardiac failure (LVEF 35%), she initiated cardiac rehabilitation. After 2 months of our rehabilitation program her functional capacity increased significantly, with normalization of her LVEF. Cardiac rehabilitation programs during and after chemotherapy may become a possible treatment with cardioprotective effect(AU)

[Patency study of internal mammary artery grafts: the usefulness of echo-enhancers for identifying the flow signal by color Doppler echocardiography]. / Estudio de la permeabilidad de los injertos de arteria mamaria interna: utilidad de los ecopotenciadores para identificar la señal de flujo mediante ecocardiografía-Doppler color.

OBJECTIVES: a) To study the capacity of the technique of high-frequency color Doppler to detect flow signal of left internal mammary artery grafts; b) to assess the usefulness of an echo-enhancer agent to facilitate the detection of the signal, and c) to evaluate the patency of the graft according to its pulsed Doppler velocity profile pattern. METHODS: 39 consecutive patients were studied. A Hewlett-Packard 5500 echocardiograph was used, with a high-frequency probe (S12) applied at the high left parasternal border. When a graft signal was not elicited after a predetermined 5-minute check period, an intravenous dose of 4 g of Levovist (Schering España) at 400 mg/ml was administrated. According to previous studies, a pulsed Doppler flow profile with a predominantly diastolic pattern was considered a normal graft patency, while a systolic one was deemed as abnormal. RESULTS: Graft flow was identified by color Doppler in 33/39 patients (85%). The additional use of an echo-enhancer in 6 patients with no detected signal increased this proportion to 38/39 (97%). Normal flow patterns were seen in 34/38 (89%). Among the four patients with abnormal pattern, 1 case of early myocardial infarction was observed, while angiographic studies showed distal occlusion of the graft in 1 or the presence of competitive flow in 2 patients. CONCLUSIONS: The high-frequency color Doppler technique allows the detection of a flow signal from internal mammary artery grafts in most patients. The administration of an echo-enhancer agent is useful in those with non detectable signals. An abnormal pulsed Doppler velocity pattern indicates graft malfunction.

[Evaluation of the patency of left internal mammary artery graft by transcutaneous Doppler flow velocity analysis]. / Evaluación de la permeabilidad de los injertos de arteria mamaria interna izquierda mediante análisis de la velocidad del flujo por técnica Doppler transcutánea.

OBJECTIVE: To analyze the features of Doppler flow velocity curve of left internal mammary artery by-pass grafts in relation with their permeability as assessed by selective angiography. METHODS: Twenty-five consecutive patients with a left mammary artery graft were studied by angiography and transcutaneous Doppler technique. From the Doppler tracings, peak velocity and time-velocity integral of the systolic and diastolic components were determined. Patency of the graft and the characteristics of the distal native coronary artery were evaluated at angiography. RESULTS: Doppler flow signal was obtained in 23 (92%) of 25 analyzed patients. The graft was angiographically patent in 17 (68%) of 25 patients; in 15 (88%) of them the Doppler flow velocity signal was mainly diastolic and in only 2 (12%) it was predominantly systolic. In 8 (32%) of the 25 patients the graft was angiographically occluded, 6 (75%) of these patients showing a predominantly systolic Doppler signal, while the remaining 2 (25%) patients were those in whom the signal could not be elicited. Sensitivity and specificity of a predominantly diastolic Doppler flow pattern for the presence of graft patency was 88% and 100% respectively, with a predictive positive value of 100% and a negative one of 80%. CONCLUSIONS: Doppler flow velocity pattern of internal mammary artery by-pass grafts is related with patency of the graft, the presence of a predominantly diastolic curve being highly indicative of a patent graft.