scholarly journals Prevention of chemotherapy-induced left ventricular dysfunction

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E28-E32
Author(s):  
Irma Bisceglia ◽  
Maria Laura Canale ◽  
Domenico Cartoni ◽  
Sabrina Matera ◽  
Sandro Petrolati
Keyword(s):  
Cardiovascular Risk ◽  
Left Ventricular Dysfunction ◽  
Cancer Survival ◽  
Ventricular Dysfunction ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Convincing Evidence ◽  
Left Ventricular Ejection ◽  
Anthracycline Cardiotoxicity ◽  
Ventricular Ejection Fraction

Abstract Prevention of left ventricular dysfunction predominantly induced by anthracyclines and/or trastuzumab still represents a challenge for cardio-oncology today. Indeed, this complication threatens to limit the significant gain in cancer survival achieved to date. Oncology strategies with cumulative dose limitation, continuous infusion, dexrazoxane, and liposomal formulations have been shown to decrease the risk of anthracycline cardiotoxicity. The preventive use of ace inhibitors, sartans, and/or beta-blockers has not yet provided convincing evidence and the positive effect on left ventricular ejection fraction decline appears poor without a clear clinical relevance. Assessment of the cardiovascular risk profile is a key aspect of the baseline evaluation of any patient scheduled for cancer therapy. Control and/or correction of modifiable cardiovascular risk factors is the first form of primary prevention of cardiotoxicity. It will be necessary to select populations at higher risk of developing cardiac dysfunction, identify patients genetically predisposed to develop cardiotoxicity in order to build the most appropriate strategies to correctly and timely target cardioprotective therapies.

scholarly journals Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hanwei Tang ◽  
Kai Chen ◽  
Jianfeng Hou ◽  
Xiaohong Huang ◽  
Sheng Liu ◽  
...  
Keyword(s):  
Left Ventricular Dysfunction ◽  
Beta Blocker ◽  
Ventricular Dysfunction ◽  
Operative Mortality ◽  
Beta Blockers ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Quality Metric

Abstract Background The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction. Methods The authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1–1 propensity scores matched analysis was performed. Results Of 6116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs. 3.0% for the beta-blocker group; adjusted odds ratio [OR] 0.82 [95% CI 0.58–1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs. 0.3 for the beta-blocker group; adjusted OR 0.39 [95% CI 0.16–0.96]). Results of propensity-matched analyses were broadly consistent. Conclusions In this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.

scholarly journals Preoperative Beta-Blocker in Ventricular Dysfunction Patients: Need a More Granular Quality Metric.

2021 ◽  
Author(s):  
Hanwei Tang ◽  
Kai Chen ◽  
Jianfeng Hou ◽  
Xiaohong Huang ◽  
Sheng Liu ◽  
...  
Keyword(s):  
Left Ventricular Dysfunction ◽  
Beta Blocker ◽  
Ventricular Dysfunction ◽  
Operative Mortality ◽  
Beta Blockers ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Quality Metric

Abstract BackgroundThe use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction.MethodsThe authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1 to 1 propensity scores matched analysis was performed.ResultsOf 6,116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs 3.0% for the beta-blocker group; adjusted odds ratio [OR], 0.82 [95% CI, 0.58-1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs 0.3 for the beta-blocker group; adjusted OR, 0.39 [95% CI, 0.16-0.96]). Results of propensity-matched analyses were broadly consistent.ConclusionsIn this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.

scholarly journals Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Vol 10 (14) ◽  
pp. 3013
Author(s):  
Juyoun Kim ◽  
Jae-Sik Nam ◽  
Youngdo Kim ◽  
Ji-Hyun Chin ◽  
In-Cheol Choi
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Lvef

Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.

Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention

Heart ◽  
2017 ◽  
Vol 104 (12) ◽  
pp. 971-977 ◽  
Author(s):  
Peter A Henriksen
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anthracycline Cardiotoxicity ◽  
High Risk Patients ◽  
Risk Patients ◽  
Clinical Heart Failure

Anthracycline chemotherapy causes dose-related cardiomyocyte injury and death leading to left ventricular dysfunction. Clinical heart failure may ensue in up to 5% of high-risk patients. Improved cancer survival together with better awareness of the late effects of cardiotoxicity has led to growing recognition of the need for surveillance of anthracycline-treated cancer survivors with early intervention to treat or prevent heart failure. The main mechanism of anthracycline cardiotoxicity is now thought to be through inhibition of topoisomerase 2β resulting in activation of cell death pathways and inhibition of mitochondrial biogenesis. In addition to cumulative anthracycline dose, age and pre-existing cardiac disease are risk markers for cardiotoxicity. Genetic susceptibility factors will help identify susceptible patients in the future. Cardiac imaging with echocardiographic measurement of global longitudinal strain and cardiac troponin detect early myocardial injury prior to the development of left ventricular dysfunction. There is no consensus on how best to monitor anthracycline cardiotoxicity although guidelines advocate quantification of left ventricular ejection fraction before and after chemotherapy with additional scanning being justified in high-risk patients. Patients developing significant left ventricular dysfunction with or without clinical heart failure should be treated according to established guidelines. Liposomal encapsulation reduces anthracycline cardiotoxicity. Dexrazoxane administration with anthracycline interferes with binding to topoisomerase 2β and reduces both cardiotoxicity and subsequent heart failure in high-risk patients. Angiotensin inhibition and β-blockade are also protective and appear to prevent the development of left ventricular dysfunction when given prior or during chemotherapy in patients exhibiting early signs of cardiotoxicity.

Ivabradine in Cancer Treatment-Related Left Ventricular Dysfunction

Chemotherapy ◽  
2018 ◽  
Vol 63 (6) ◽  
pp. 315-320 ◽  
Author(s):  
Matteo Sarocchi ◽  
Eleonora Arboscello ◽  
Giorgio Ghigliotti ◽  
Roberto Murialdo ◽  
Claudia Bighin ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Angiotensin Receptor Blockers ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiovascular Side Effects

Background: Patients developing cancer treatment-related left ventricular dysfunction (CTrLVD) require a prompt therapy. Hypotension, dizziness, and fatigue often limit the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and β-blockers (BB) in cancer patients who may already be afflicted by these symptoms. Ivabradine is a heart rate-lowering drug that does not cause hypotension and may be used in heart failure with reduced left ventricular ejection fraction (LVEF). Objective: The aim of this paper was to investigate the role of ivabradine to treat CTrLVD. Methods: A retrospective analysis in a cohort of 30 patients with CTrLVD (LVEF < 50%) receiving ivabradine on top of the maximal tolerated dose of ACEi/ARB and BB was performed. We evaluated cardiovascular treatment, oncologic treatment, LVEF, functional class (New York Heart Association [NYHA]), and fatigue during the study period. Results: Ivabradine was initially started at the dose of 2.5 mg/b.i.d. in most patients and then carefully titrated. Hypotension (70%) and fatigue (77%) were the main causes limiting the treatment with ACEi/ARB and BB. After a mean follow-up of 6.5 months, LVEF increased from 45.1% (SD = 6.4) to 53.2% (SD = 3.9; p < 0.001). When patients were analyzed according to the type of cancer therapy, no difference in LVEF changes across the groups was found. NYHA class ameliorated in 11 patients, while fatigue improved in 8 patients. No serious cardiovascular side effects were reported. Conclusions: The ability to improve symptoms and LVEF in unfit cancer patients makes ivabradine a reasonable pharmacological tool for treating CTrLVD.

scholarly journals Parasympathetic effects on cardiac electrophysiology during exercise and recovery in patients with left ventricular dysfunction

2009 ◽  
Vol 297 (2) ◽  
pp. H743-H749 ◽  
Author(s):  
Alexandru B. Chicos ◽  
Prince J. Kannankeril ◽  
Alan H. Kadish ◽  
Jeffrey J. Goldberger
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Sudden Death ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Cardiac Electrophysiology ◽  
Cycle Length ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Depressed parasympathetic activity has been proposed to be associated with an increased risk of sudden death. Parasympathetic effects (PE) on cardiac electrophysiology during exercise and recovery have not been studied in patients with left ventricular dysfunction. We performed noninvasive electrophysiological studies (NI-EPS) and characterized the electrophysiological properties of the sinus node, atrioventricular (AV) node, and ventricle in subjects with depressed left ventricular ejection fraction and dual-chamber defibrillators. NI-EPS were performed during rest, exercise, and recovery at baseline and after parasympathetic blockade with atropine to assess PE (the difference between parameter values in the 2 conditions). Ten subjects (9 men: age, 60 ± 9 yr; and left ventricular ejection fraction, 29 ± 8%) completed the study. All NI-EPS parameters decreased during exercise and trended toward rest values during recovery. PE at rest, during exercise, and during recovery, respectively, were on sinus cycle length, 320 ± 71 ( P = 0.0001), 105 ± 60 ( P = 0.0003), and 155 ± 82 ms ( P = 0.0002); on AV block cycle length, 137 ± 136 ( P = 0.09), 37 ± 19 ( P = 0.002), and 61 ± 39 ms ( P = 0.006); on AV interval, 58 ± 32 ( P = 0.035), 22 ± 13 ( P = 0.002), and 36 ± 20 ms ( P = 0.001); on ventricular effective refractory period, 15.8 ± 11.3 ( P = 0.02), 4.7 ± 15.2 ( P = 0.38), and 6.8 ± 15.5 ms ( P = 0.20); and on QT interval, 13 ± 12 ( P = 0.13), 3 ± 17 ( P = 0.6), and 20 ± 23 ( P = 0.04). In conclusion, we describe for the first time the changes in cardiac electrophysiology and PE during rest, exercise, and recovery in subjects with left ventricular dysfunction. PEs are preserved in these patients. Thus the role of autonomic changes in the pathophysiology of sudden death requires further exploration.

Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients

2001 ◽  
Vol 101 (6) ◽  
pp. 601-607 ◽  
Author(s):  
Tapio NOUSIAINEN ◽  
Esko VANNINEN ◽  
Esa JANTUNEN ◽  
Jouko REMES ◽  
Eira RITANEN ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Low Frequency ◽  
Radionuclide Ventriculography ◽  
Left Ventricular ◽  
Sympathetic Tone ◽  
Plasma Noradrenaline ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Doxorubicin-induced cardiotoxicity was used as a model to prospectively investigate neuroendocrine changes during the development of left ventricular dysfunction. Radionuclide ventriculography, frequency domain analysis of heart rate variability (HRV), and plasma noradrenaline and natriuretic peptide measurements were performed in 27 adult lymphoma patients at baseline and after cumulative doxorubicin doses of 200, 400 and 500mg/m2. The left ventricular ejection fraction (LVEF) decreased from 58.1±1.4% to 50.3±1.1% (P < 0.001) and 49.3±1.7% (P < 0.001) after cumulative doxorubicin doses of 400 and 500mg/m2 respectively. With a doxorubicin dose of up to 400mg/m2 there was an increase in sympathetic tone, characterized by a decrease in the normalized high-frequency (HFnu) power (P = 0.011), and increases in the normalized low-frequency (LFnu) power (P = 0.011), the LF/HF ratio (P = 0.021) and the plasma noradrenaline concentration (P = 0.034). The decrease in LVEF was correlated with the changes in LFnu and HFnu power (r = 0.540, P =0.012) and LF/HF ratio (r =-0.452, P =0.04). However, after the cumulative doxorubicin dose of 500mg/m2 the changes in HRV components and plasma noradrenaline levels returned towards baseline. This was accompanied by increased concentrations of plasma atrial natriuretic peptide (P = 0.004) and brain natriuretic peptide (P = 0.021). Our findings suggest that doxorubicin-induced left ventricular dysfunction is associated with an early change in sympathovagal balance towards sympathetic predominance. Along with further progression of left ventricular dysfunction, there is an attenuation of sympathetic tone, which may be attributable to sympatho-adrenal inhibition by increased secretion of natriuretic peptides.

scholarly journals Association between Smoking and In-hospital mortality in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery: A Propensity-matched Study

2021 ◽  
Author(s):  
Hanwei Tang ◽  
Jianfeng Hou ◽  
Kai Chen ◽  
Xiaohong Huang ◽  
Sheng Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract BackgroundData on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction.MethodsA retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1 to 1 propensity scores matched analysis was performed. Our study (n=6,531) consisted of 3,635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n=2373) and current smokers (n=1262).ResultsThe overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers (2.3% vs 4.9%; adjusted odds ratio [OR], 0.612 [95%CI, 0.395-0.947]). No difference was detected in mortality between ex-smokers and non-smokers (3.6% vs 4.9%; adjusted OR, 0.974 [0.715-1.327]). No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent.ConclusionsIt is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this ‘smoker’s paradox’ phenomenon.

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