Catching broken hearts: pre-clinical detection of doxorubicin and trastuzumab mediated cardiac dysfunction in the breast cancer setting

2014 ◽  
Vol 92 (7) ◽  
pp. 546-550 ◽  
Author(s):  
Mahwash F. Saeed ◽  
Sheena Premecz ◽  
Vineet Goyal ◽  
Pawan K. Singal ◽  
Davinder S. Jassal
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Beneficial Effects ◽  
Non Invasive ◽  
Clinical Detection ◽  
Cancer Setting ◽  
End Stage

Although breast cancer is one of the leading causes of death in women worldwide, there is an overall improvement in the survival of this patient population. This is likely due to a combination of early detection through screening and awareness, improved targeted biological therapy, and an overall improvement in disease management. Despite the beneficial effects of the 2 anti-cancer drugs doxorubicin (DOX) and trastuzumab (TRZ) in women with breast cancer, development of cardiotoxicity is a major concern. The occurrence of left ventricular systolic dysfunction is unacceptably high in nearly 1 in 4 women treated with DOX+TRZ in the breast cancer setting. In this review, we explore the use of non-invasive cardiac imaging for the early detection of chemotherapy-mediated cardiotoxicity in women with breast cancer, in the hope of preventing end-stage heart disease in this cancer population.

scholarly journals Diagnosis and Treatment of Asymptomatic Left Ventricular Systolic Dysfunction after Myocardial Infarction

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Laura Ajello ◽  
Giuseppe Coppola ◽  
Egle Corrado ◽  
Eluisa La Franca ◽  
Antonino Rotolo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Early Detection ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Diagnosis And Treatment ◽  
Ventricular Systolic Dysfunction

The increased survival after acute myocardial infarction induced an increase in heart failure with left ventricular systolic dysfunction. Early detection and treatment of asymptomatic left ventricular systolic dysfunction give the chance to improve outcomes and to reduce costs due to the management of patients with overt heart failure.

Two-Dimensional Speckle Strain for Evaluation of Left Ventricular Systolic Deformation in Children with Thalassemia Major.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4520-4520
Author(s):  
Osama Abd Rab-Rassol Tolba ◽  
Mohamed Ramadan El-Shanshory ◽  
Adel Abd El-Halum Hagag
Keyword(s):  
Early Detection ◽  
Conflicts Of Interest ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Mitral Annulus ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Systolic Strain ◽  
2D Strain ◽  
Significant Difference

Abstract Abstract 4520 Objective In β-thalassemia major, Identifying early myocardial insult is important since significant cardiac involvement may predate a decrease in left ventricular systolic functions. The aim of this study is to clarify the value of 2 D-strain (2DS) in early detection of segmental and global left ventricular systolic dysfunction in thalassemic children. Subjects and Methods This study included two age-matched groups:Group 1 (n=30) thalassemic children and Group 2 (n=10) healthy control children. They undergo conventional echo-Doppler measures of left ventricular (LV) systolic and diastolic functions. The pulsed tissue Doppler of lateral mitral annulus was recorded. Longitudinal 2D strain in 18 left ventricular segments using 2 dimensional (2DS) speckle-tracking imaging from apical 4, 2, and 3-chamber views, using a Vivid 7 ultrasound system. The images were analyzed using Echopac soft ware. Results There was no significant difference among thalassemic patients and controls in LV fraction shortening, peak systolic and diastolic tissue velocities of lateral mitral annulus. But by the 2 D strain study there were a significant multi-segmental affection of the LV mainly the posterior, anterior walls with predilection mainly to the apical segments, also there was a significant affection of the peak global LV systolic strain with a median value (-17.7 versus -20.75; P = 0.008.). There was no significant correlation between all segmental or global LV systolic strain and the serum ferretin. Conclusion 2DS is a sensitive and accurate tool for early detection of segmental and global cardiac insult in thalassemic children. Disclosures: No relevant conflicts of interest to declare.

Safety of adjuvant trastuzumab (T) in elderly patients with breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 282-282 ◽  
Author(s):  
L. Militello ◽  
P. Carli ◽  
S. Spazzapan ◽  
C. Lestuzzi ◽  
G. Miolo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Elderly Patients ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Her2 Breast Cancer ◽  
Minor Adverse Event

282 Background: T is a mainstay in adjuvant therapy for HER2+ breast cancer (BC) patients (pts). Safety and efficacy of T in elderly patients are largely unknown. In HERA trial, NSABP B-31, NCCTG N9831 only 16% of pts were older than 60 years. Risk factors for T related cardiotoxicity are age (>50 y/o), hypertension, baseline LVEF (left ventricular ejection fraction <55%), previous antracycline therapy and BMI. Methods: Charts of pts >65 y/o with early HER2+ BC treated with T as adjuvant or neoadjuvant therapy at our institution were retrospectively reviewed. Primary endpoint was the evaluation of T cardiac toxicity and safety. Results: 22 elderly out of 172 pts (12%) were identified: 19 pts were treated only with surgery and adjuvant chemotherapy with concomitant or sequential T, 3 more pts also received neoadjuvant chemotherapy concomitant with T. According to Balducci’s criteria, fit, vulnerable and frail pts were 20, 2, 0 respectively. Median age was 69 y/o (range 65-76). Hormonal status was negative in 10/22 (45%). 21/22 were histologic grade 3. Median follow-up was 33 months. Baseline comorbidities were the following: hypertension (G2-3) in 17 pts, diabetes mellitus in 1, supra/infraventricular arrhythmia (G1-2) in 3 and 1 pts. Antracyclines were administered in 16 pts (liposomal-doxorubicin in 5 pts), a sequential taxane-regimen was used in 3 more pts. Neoadjuvant weekly Paclitaxel and concomitant T was used in 3 pts. Median basal LVEF was 65% (range 59-74%). 2 pts developed an asymptomatic 10% LVEF drop from baseline (left ventricular systolic dysfunction G1) during T treatment. Known cardiac risk factors were hypertension in 1 pt and previous antracycline based chemotherapy in both. They recovered within 9 months. One minor adverse event was atrial fibrillation (G2) during T treatment. Conclusions: T was well tolerated in elderly pts. More data are needed in order to understand the correlations between T related toxicity and cardiovascular risk factors. Long term safety of T treatment should verify the reversibility of cardiac T related toxicity on elderly pts.

scholarly journals Echocardiographic assessment of cardiac dysfunction in maintenance hemodialysis patients

2017 ◽  
Vol 5 (2) ◽  
pp. 97-100
Author(s):  
Md Zahid Alam ◽  
Mohammad Zakir Hossain
Keyword(s):  
Wall Motion ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Ventricular Systolic Dysfunction ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: The hemodialysis (HD) procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the echocardiographic parameters in patients with End Stage Renal Disease (ESRD) on HD and to correlate those with clinical findings, more specifically to see whether there is any change in ejection fraction (EF) by developing new regional wall motion abnormality (RWMA) after hemodialysis, and to correlate these changes with the symptoms & hemodynamic condition of the patients.Methodology: This prospective observational study was carried on a total of 100 adult ambulant patients with end stage renal disease (ESRD) on maintenance hemodialysis in the department of Hemodialysis, BIRDEM General Hospital, Shahbag, Dhaka. Their echocardiogram was done 30 min before and after the hemodialysis.Result: It was revealed that majority of the patients were above 60 years (39%), and male to female ratio of about 3:2. The study subjects had diabetes mellitus (79%), hypertension (96%), dyslipidemia (42%), and family history of ischemic heart disease (24%). Chest pain and breathlessness were present in 31% and 42% subjects respectively before hemodialysis. Palpitation (23%), dizziness (19%), oedema (43%) and raised JVP (15%) were seen in the study subjects. Mean (±SD) serum creatinine level was 9.38 (±2.22) mg/dl and hemoglobin level was 9.0 (±1.08) g/dl. Ejection fraction (EF) before hemodialysis were ?55, 40-54 & 30-39 in 62%, 34% and 4% study subjects respectively and after hemodialysis it was ?55, 40-54 & 30-39 in 44%, 46% and 10% study subjects respectively. After HD, left ventricular failure (LVF) occurred in 32% subjects. HD-induced regional left ventricular systolic dysfunction occurred in total 36 patients (36%) and total 14 (14%) patients developed LVF 30 minutes after dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more in those who had worse predialysis EF. Blood pressure, heart rate, chest pain, palpitation, raised Jugular Venous Pressure (JVP) and edema did not differ significantly before and after hemodialysis. Simple regression analysis revealed that the hemodialysis procedure significantly (P<0.05) induce regional left ventricular systolic dysfunction.Conclusions: HD acutely induces regional wall motion abnormalities in a significant proportion of patients. It occurs within 30 min after hemodialysis and is not related to changes in blood pressure, heart rate, JVP and oedema.Bangladesh Crit Care J September 2017; 5(2): 97-100

P1812Speckle tracking echocardiography for early detection of left ventricular systolic dysfunction in patients with Chagas disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M C P Nunes ◽  
A L P Ribeiro ◽  
O R S Junior ◽  
C D L Olivera ◽  
C S Cardoso ◽  
...  
Keyword(s):  
Early Detection ◽  
Chagas Disease ◽  
Longitudinal Strain ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Lv Dysfunction

Abstract Introduction Longitudinal strain by speckle tracking echocardiography (STE) imaging is a reliable tool for quantitative measurement of myocardial contractility. Assessment of left ventricular (LV) systolic function has a central role in the evaluation of patients with Chagas disease, particularly for identification of subtle changes that could predict disease progression. Purpose We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in patients with Chagas disease and its relationship to other echocardiographic and laboratory parameters. Methods Eight-hundred and fifty patients with Chagas disease (mean age of 60±12 years, 70% female) who live in remote areas in Brazil were enrolled. Clinical evaluation, ECG, N-terminal pro-brain natriuretic peptide (NT-ProBNP), and echocardiogram were performed. LV GLS was assessed offline on the four-, three- and two-chamber views. Patients were divided into tertiles according to the LV strain. Data were analyzed using One-way ANOVA. Results The ECG was normal in 19%, whereas typical ECG abnormalities related to Chagas cardiomyopathy were found in 58% of the patients. Overall mean LV ejection fraction (LVEF) was 59±11%, and LV GLS was - 14.1±4.4%. Apical aneurysm was detected in 34 patients (4%).The prevalence of LV systolic dysfunction, defined as LVEF <54% and GLS ≤ |16|%, was 19% and 66%, respectively. Abnormal GLS was observed in 408 (48%) patients despite a normal LVEF. Stratified according to tertiles of LV GLS, patients in the first tertile (strain <|10.7|%), had a significantly decreased in LVEF (Fig 1, A), increased E/e' ratio (Fig 2,B), left atrial volume (Fig 1,C), and NT-proBNP levels (Fig 1,D), indicating severity of LV dysfunction (n=215). Similarly, the patients in the third tertile (strain >|17|%), had normal standard echo parameters and NT-proBNP levels (n=210). However, patients in the second tertile (|10.7|% to |17|%; n=425), the strain was abnormal while other parameters were normal, showing LV impairment that was not evidenced by conventional exams. Conclusions LV longitudinal strain assessed by STE in a general population of Chagas disease provided diagnostic information beyond conventionally measured LVEF. Early detection of ventricular impairment may help to identify Chagas disease patients at risk for development of heart failure.

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