scholarly journals Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer

2020 ◽  
Vol 17 (6) ◽  
pp. 397-408
Author(s):  
Agneta Månsson Broberg ◽  
Jürgen Geisler ◽  
Suvi Tuohinen ◽  
Tanja Skytta ◽  
Þórdís Jóna Hrafnkelsdóttir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Heart Failure ◽  
Clinical Trials ◽  
Cardiovascular Risk ◽  
Early Detection ◽  
Cancer Patients ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Breast Cancer Patients

Abstract Purpose of Review Long-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment. Recent Findings Baseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin antagonists. Early detection of cardiotoxicity with cardiac imaging and circulating cardiovascular biomarkers is currently evaluated in clinical trials. Chest wall irradiation accelerates atherosclerotic processes and induces fibrosis. Immune checkpoint inhibitors require consideration for surveillance due to a small risk of severe myocarditis. Cyclin-dependent kinases4/6 inhibitors, cyclophosphamide, taxanes, tyrosine kinase inhibitors, and endocrine therapy have a lower-risk profile for cardiotoxicity. Summary Preventive and management strategies to counteract cancer treatment–related left ventricular dysfunction or heart failure in breast cancer patients should include a comprehensive cardiovascular risk assessment and individual clinical evaluation. This should include both patient and treatment-related factors. Further clinical trials especially on early detection, cardioprevention, and management are urgently needed.

scholarly journals Difference in Correlation Coefficient between Heart Rate Variability and Mechanical Dispersion in Breast Cancer Patients with and without Cardiovascular Risk Factors Post Anthracycline Chemotherapy

2020 ◽  
Vol 6 (1) ◽  
pp. 23-28
Author(s):  
Evi Fatimah ◽  
Erwan Martanto ◽  
Mohammad Iqbal ◽  
Januar W. Martha ◽  
M. Rizki Akbar
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Breast Cancer Patients ◽  
Group I ◽  
Group Ii

Background: Sympathetic hyperactivity is one of the several factors that influence left ventricular dyssynchrony post anthracycline. Cardiovascular risk factors affect the acceleration of left ventricular dyssynchrony. The purpose of this study is to assess the difference in correlation coefficient between HRV and mechanical dispersion in breast cancer patients with and without cardiovascular risk factors after anthracycline administration.Method: This was a cross sectional study with linear regression analysis conducted at Hasan Sadikin General Hospital Bandung between July-October 2018. Subjects were breast cancer patients who had received 6 cycles of FAS and were divided into 2 groups. Group I was patients with breast cancer who have cardiovascular risk factors and group II was without cardiovascular risk factors. Sympathetic hyperactivity was assessed using HRV baseline frequency with minimum duration of recording and left ventricular dyssynchrony was assessed using MD method by echocardiography.Result: This study involved 66 patients. Group I (n=34, age 50.3±6.3 years) and group II (n=32, age 48.5±9 years). The median of LF/HF ratio was 2.7 ms2 (group I) and 1.9 ms2 (group II). MD value in group I and group II was 52.2±13.6 ms and 45.7±8.8 ms, respectively. The result of linear regression analysis showed positive correlation between the LF/HF ratio and MD in group I (r=0.546, p=0.001) and group II (r=0.423, p=0.016) after adjusting three confounding factors (systolic blood pressure, cumulative dose of Doxorubicin, and age).Conclusion: Correlation coefficient of HRV with mechanical dispersion in post anthracycline breast cancer patients in those with cardiovascular risk factorswas worse compared to those without cardiovascular risk factors but was not statistically significant.

scholarly journals An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study

2021 ◽  
Vol 11 (3) ◽  
pp. 484-493
Author(s):  
Jukapun Yoodee ◽  
Aumkhae Sookprasert ◽  
Phitjira Sanguanboonyaphong ◽  
Suthan Chanthawong ◽  
Manit Seateaw ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
Palliative Intent ◽  
Increased Risk

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

Cardiotoxicity risks of adjuvant trastuzumab in Asian breast cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 561-561
Author(s):  
V. Shih ◽  
A. Chan ◽  
J. Chiang ◽  
C. Teo ◽  
J. Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Adjuvant Trastuzumab ◽  
Ventricular Ejection Fraction ◽  
Chi Square Test

561 Background: Adjuvant trastuzumab (T)-based chemotherapy has been shown to reduce relapse and improve survival in breast cancer patients but has been associated with increased risks of cardiotoxicity. Our study aims to define the incidence and severity of cardiotoxicity amongst Asian breast cancer patients. Methods: This is a retrospective review of patients who have received adjuvant T from June 2005 to 2007. Cardiotoxicity was defined as a drop in left ventricular ejection fraction (LVEF) to less than 50% and/or reduction of > 10% of baseline. Cardiovascular (CVS) risk factors were defined as having a family history or presence of CAD, hypertension, diabetes mellitus, hyperlipidemia and smoking. We used pair sampled t-test to evaluate the mean LVEF change and Chi-square test to evaluate the association of cardiotoxicity and demographics. Results: There were 179 female patients. Cardiotoxicity was reported in 70 (39.1%), of whom 59 had asymptomatic decline in LVEF and 11 experienced CHF. Mean LVEF, comparing various time points (3, 6, 9 and 12 months) against baseline showed statistically significant decline (p<0.05). T was withheld (n=33) due to asymptomatic decline in LVEF (n=24), symptomatic heart failure (n=4) and both (n=5). Twenty-one with resolution of CHF (n=7) or LVEF recovery (n=14) were rechallenged. Cardiotoxicity recurred in 9 - asymptomatic decline in LVEF (n=8) and recurrent CHF (n=1). There were no cardiac-related deaths. Neither patient demographics nor CVS risk factors predicted for cardiotoxicity. Conclusions: This is one of the largest series reported in Asians receiving T. As previously reported, T-induced cardiotoxicity resulted in mostly asymptomatic reversible decline in LVEF. Our incidence of cardiotoxicity appeared higher (39.1%) in Asians and more importantly, almost half of the patients experienced cardiotoxicity upon rechallenge. It would be prudent to explore whether there is any difference in susceptibility to T-induced cardiotoxicity between the different races. [Table: see text] No significant financial relationships to disclose.

Cardiac safety of continuous trastuzumab therapy in breast cancer patients with asymptomatic left ventricular dysfunction.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e11602-e11602
Author(s):  
Anthony Francis Yu ◽  
Nandini U Yadav ◽  
Anne Eaton ◽  
Betty Y Lung ◽  
Howard T. Thaler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Cardiac Safety ◽  
Trastuzumab Therapy

Association of baseline cardiovascular risk factors and health care utilization and costs in elderly breast cancer patients enrolled in SWOG clinical trials.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11508-11508
Author(s):  
Dawn L. Hershman ◽  
Cathee Till ◽  
Jason Dennis Wright ◽  
Melissa Kate Accordino ◽  
Riha Vaidya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Healthcare Costs ◽  
Disease Risk ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Clinical Records ◽  
The Impact

11508 Background: Cardiovascular-disease risk factors (CVD-RFs) increase the risk of cardiac events in women undergoing chemotherapy. Less is known about the impact of CVD-RFs on healthcare utilization and costs. Methods: We examined breast cancer patients treated uniformly on SWOG clinical trials from 1999-2011. We identified baseline diabetes, hypertension, hypercholesterolemia, and coronary artery disease (CAD) by linking trial records to Medicare claims; obesity was identified using clinical records. The outcomes were emergency room visits (ER), hospitalizations and costs. Multivariable logistic and linear regression were used. Results: Among the 708 patients included in the analysis, 160 (22.6%) experienced 234 separate hospitalizations, and 193 (27.3%) experienced 311 separate ER visits. Diabetes, hypertension, hypercholesterolemia, and CAD were all associated with increased risk of hospitalizations and ER visit. Hypertension had the strongest association, with more than a threefold risk of hospitalization for those with hypertension compared to those without (OR [95% CI], 3.16 [1.85-5.40], p<0.001). For those with ≥3 CVD-RFs, the risk of hospitalization was greater compared to 0 or 1 CVD-RFs (OR [95% CI], 2.74 [1.71-4.38], p<0.001). Similar results were seen for ER visits. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23.9% increase, p=0.05), hypercholesterolemia ($34,168 vs $30,661, 11.4% increase, p=0.02), and CAD ($37,781 vs $31,698, 19.2% increase, p=0.04) had statistically significantly higher total healthcare costs. Additionally, those with 2 significant CVD-RFs ($35,353 vs. $28,899, 22.3% increase, p=.005) had higher total healthcare costs. Conclusions: Our study demonstrates that the presence of both CVD-RFs and ER visits and hospitalizations are frequent among elderly BC patients. The risk of ER visits and hospitalizations is higher among patients with CVD-RFs, and increases with the number of RFs. Better management of CVD-RFs and more aggressive symptom management may be required to reduce both physical and financial toxicities to elderly patients undergoing BC therapy.

scholarly journals Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

2015 ◽  
Vol 20 (10) ◽  
pp. 1105-1110 ◽  
Author(s):  
Anthony F. Yu ◽  
Nandini U. Yadav ◽  
Anne A. Eaton ◽  
Betty Y. Lung ◽  
Howard T. Thaler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Trastuzumab Therapy

scholarly journals The effect of prophylactic carvedilol on subclinical left ventricular dysfunction after 1 cycle FAC chemotherapy in breast cancer patients

2020 ◽  
Vol 29 ◽  
pp. 100575
Author(s):  
Januar Wibawa Martha ◽  
Dery A. Soedarsono ◽  
Mohammad Iqbal ◽  
Astri Astuti ◽  
Erwan Martanto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Breast Cancer Patients ◽  
Fac Chemotherapy
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