Cardiotoxicity of Epirubicin/Paclitaxel–Containing Regimens: Role of Cardiac Risk Factors

1999 ◽  
Vol 17 (11) ◽  
pp. 3596-3602 ◽  
Author(s):  
Alessandra Gennari ◽  
Barbara Salvadori ◽  
Sara Donati ◽  
Carmelo Bengala ◽  
Cinzia Orlandini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Cumulative Risk ◽  
Metastatic Breast ◽  
Cardiac Risk ◽  
High Dose Chemotherapy ◽  
Left Ventricular ◽  
Cardiac Risk Factor ◽  
High Dose ◽  
Cardiac Risk Factors

PURPOSE: To evaluate the incidence of clinically relevant cardiac toxicity after treatment with epirubicin/paclitaxel-containing regimens in patients with metastatic breast cancer and to identify high-risk patients in whom the benefit of chemotherapy may be negated by the occurrence of congestive heart failure (CHF). PATIENTS AND METHODS: A total of 105 patients who were referred for epirubicin/paclitaxel treatment were included in this study. Treatment regimens were as follows: (1) epirubicin 90 mg/m2 plus paclitaxel 135 to 225 mg/m2 over 3 hours (n = 76); and (2) gemcitabine 1,000 mg/m2 on days 1 and 4 plus epirubicin/paclitaxel (n = 29). The occurrence of CHF was detected by physical examination, and left ventricular function was evaluated by bidimensional echocardiography to support the diagnosis. Cardiac risk factors examined in this study included age, prior radiotherapy to the chest, hypertension, and diabetes. RESULTS: No patient experienced CHF while on treatment. Nine patients (9%) developed CHF after cumulative epirubicin doses of 1,080 mg/m2 (n = 4), 720 mg/m2 (n = 2), 630 mg/m2 (n = 1), and 540 mg/m2 (n = 2). One of the two patients who developed CHF after a cumulative epirubicin dose of 540 mg/m2 had received consolidation with high-dose chemotherapy. Median time to appearance of cardiologic symptoms was 3 months after the end of treatment (range, 3 to 6 months). Overall, the incidence of CHF was 13% and 4% in patients with or without cardiac risk factors, respectively. The cumulative risk of developing CHF was estimated as 7.7% at a cumulative doses of 720 mg/m2 and 48.7% at a cumulative dose of 1,080 mg/m2. CONCLUSION: This study shows that the incidence of CHF after an epirubicin/paclitaxel regimen is low up to cumulative epirubicin doses of 990 mg/m2, thus allowing the safe administration of this regimen even in patients who received epirubicin in the adjuvant setting. However, the risk of developing CHF increases when a cumulative dose exceeding 990 mg/m2 is reached, concomitantly with the presence of an additional cardiac risk factor.

Abstract 3635: Weight Loss Reverses Left Ventricular Structural Changes In Subjects With Severe Uncomplicated Obesity. A One year Follow Up Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Oliver J Rider ◽  
Jane M Francis ◽  
Mohammed K Ali ◽  
Monique R Robinson ◽  
Stefan Neubauer
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Structural Changes ◽  
Total Body Weight ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Cardiac Risk Factors ◽  
Co Morbidity ◽  
Lv Mass ◽  
One Year

Objective Obesity has been linked to a spectrum of cardiovascular abnormalities from subclinical changes in cardiac structure to overt heart failure. Uncomplicated obesity (i.e. obesity without any other co-morbidity or cardiovascular risk factors) has been shown to cause increased LV mass and LV dilatation. Our hypothesis was that these changes are, at least in part, reversible following significant weight loss over one year. Method Forty-one obese (BMI 37.7 ± 7.4 SD) and 12 age, sex matched controls (BMI 21.6 ± 1.8 SD) with no identifiable cardiac risk factors underwent cardiac MR imaging for the assessment of LV Mass (g), LV end-diastolic volume (EDV; ml), stroke volume (SV; ml) and LV EF (%). Fourteen obese subjects underwent repeat imaging after a one year period of weight loss, averaging 14.6 ± 11.5 % total body weight. Results Obesity per se was associated with elevated LV mass (125 ± 27 vs 89 ± 23g; p<0.001), LV mass indexed to height (74.4 ± 14.3 vs 52.3 ± 11.4g/m; p<0.001) and EDV (147 ± 28 vs 119 ± 24 ml; p<0.001). ESV and SV were also elevated in obesity (47 ± 12 vs 39 ± 12ml; p=0.05, and 100 ± 14 vs 80 ± 18 ml; p<0.001, respectively). LV EF was similar between groups (p=0.83). After weight loss, there was a significant reduction in LV mass (by 16 ± 11g; 135 ± 31 vs 119 ± 28g; p<0.001), LV mass indexed to height (76.4 ± 15.7 vs 68.9 ± 12 g/m; p<0.001). EDV and ESV were significantly smaller after weight loss (146 ± 25 vs 133 ± 23 ml; p<0.001, and 43 ± 12 vs 41 ± 10 ml; p<0.001 respectively). LV EF and SV did not change significantly. Conclusion In subjects with obesity in the absence of identifiable cardiac risk factors, LV hypertrophy and LV dilatation were partially reversible after a one year period of weight loss.

scholarly journals Cross-sectional study of the health of southern African truck drivers

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032025 ◽  
Author(s):  
Samanta Tresha Lalla-Edward ◽  
Alex Emilio Fischer ◽  
W D Francois Venter ◽  
Karine Scheuermaier ◽  
Ruchika Meel ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Status ◽  
Working Conditions ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Truck Drivers ◽  
Truck Driver ◽  
Secondary Outcome ◽  
Cardiac Risk Factors

ObjectivesLifestyle and working conditions of truck drivers predisposes them to risk-factors associated with communicable and non-communicable diseases, but little is known about the health status of African truck driver. This study aims to assess a cross-section of truckers in South Africa to describe their health information.SettingThe study took place across three truck-stop rest areas in the South African provinces of Free State and Gauteng.ParticipantsEligibility criteria included being males aged 18 years and older, full-time employment as a long-distance truck driver. A total of 614 male truck drivers participated; 384 (63%) were Zimbabwean and 325 (55%) completed high-school.Primary and secondary outcome measuresThe trucker survey explored demographics; working conditions; sexual, eating and sleeping behaviours; mental health status, medical history and cardiac risk-factors. Medical assessments included physical measurements, glucose and lipid measurements, ECG, carotid intima-media thickness (CIMT) and cardiac ultrasound.ResultsIn the previous month, 554 (91%) participants were sexually active; 522 (86%) had sex with a regular partner; 174 (27%) with a casual partner; 87 (14%) with a sex worker. Average time driving was 10 hours/day, 20 days/month, 302 (50%) never worked night shifts and 74 (12%) worked nights approximately four times per week. 112 (18%) experienced daytime sleepiness and 59 (10%) were ever hospitalised from an accident. Forty-seven (8%, 95% CI 5.3 to 9.5) were HIV-positive, with half taking antiretrovirals. Forty-eight (8%) truckers had some moderate depression, while 21 (4%) suffered from post-traumatic stress disorder. Reported tuberculosis, myocardial infarction, and diabetes were <3%. Prominent cardiac risk-factors included smoking (n=63, 11%), consuming alcohol (>15 drinks/week) (n=54, 9%), overweight/obesity (n=417, 69%), and hypertension (n=220, 36%,95% CI 32.1 to 39.7). ECG results showed 23 (4.9%) and 29 (5.3%) drivers had left ventricular hypertrophy using the Cornell criterion and product, respectively. CIMT measurements indicated nine (4.2%) drivers had a carotid atherosclerotic plaque.ConclusionThis first holistic assessment of health among southern African male truck drivers demonstrates substantial addressable cardiovascular risk factors, mental health issues and sexual risk behaviours.

Subclinical Late Cardiomyopathy After Doxorubicin Therapy for Lymphoma in Adults

2004 ◽  
Vol 22 (10) ◽  
pp. 1864-1871 ◽  
Author(s):  
O. Hequet ◽  
Q.H. Le ◽  
I. Moullet ◽  
E. Pauli ◽  
G. Salles ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Hodgkin’S Lymphoma ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Older Age ◽  
Hodgkin's Lymphoma ◽  
Smoking History ◽  
High Dose ◽  
Male Sex

Purpose To assess the cardiac status of the long-term survivors and to estimate the incidence and the features of subclinical cardiotoxicity induced after conventional treatment with doxorubicin for non-Hodgkin's lymphoma or Hodgkin's lymphoma. Patients and Methods We analyzed a group of patients who previously received doxorubicin-based chemotherapy for lymphoma. Echocardiograms were performed at least 5 years after therapy with anthracyclines. Clinical cardiomyopathy was defined by the presence of clinical signs of congestive heart failure (CHF). Subclinical cardiomyopathy was defined by decrease of left ventricular fractional shortening (FS) without clinical signs of CHF. Cumulative dose of doxorubicin, male sex, older age, relapse, radiotherapy (mediastinal or total-body irradiation), autologous stem-cell transplantation, high-dose cyclophosphamide, and cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, familial history of cardiac disease, being overweight, and smoking history) were evaluated as potential risk factors for the development of cardiac dysfunction. Results Of 141 assessable patients (median age, 54 years; median cumulative dose of doxorubicin, 300 mg/m2), only one developed CHF. Criteria of subclinical cardiomyopathy were found in 39 patients. In multivariate analysis, factors that contributed to decreased FS were male sex (P < .01), older age (P < .01), higher cumulative dose of doxorubicin or association with another anthracycline (P = .04), radiotherapy (P = .04), and being overweight (P = .04). Conclusion Cardiac abnormalities can occur in patients treated with doxorubicin for lymphoma in the absence of CHF, even in patients who received moderate anthracycline doses. Male sex, older age, higher dose of doxorubicin, radiotherapy, and being overweight were risk factors for the development of cardiomyopathy.

scholarly journals Determination of Relation of Gender Variation in Age and Cardiac Risk Factors in Unstable Angina in Bangladeshi Population

2012 ◽  
Vol 23 (1) ◽  
pp. 42-45
Author(s):  
SM Suhrawardy ◽  
Momtaz Begum ◽  
Nayeema Akhter ◽  
Jahid Hossain Sharif ◽  
Md Jashim Uddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Unstable Angina ◽  
Troponin I ◽  
Cardiac Risk ◽  
Cardiac Risk Factor ◽  
Age Difference ◽  
Cardiac Risk Factors ◽  
Medical College ◽  
Case Series Study ◽  
Significant Difference

The incidence of Unstable Angina is increasing. More than 80% of CAD is attributed to different modifiable cardiac risk factors. Evidence of effect of sex on different cardiac risk factor and as well as effect of age in different sex for CAD is still limited and needs evaluation. An observational case series study conducted on 50 consecutive cases following appropriate inclusion and exclusion criteria in the Department of Physiology, Chittagong Medical College in collaboration with CCU of Chittagong Medical College Hospital from September 2006 to July 2008. The cases of unstable angina were diagnosed on the basis of clinical criteria and ECG findings. Serum Troponin I level were estimated to exclude Non-STE MI. There were statistically significant difference of cardiac risk factors (smoking, hypertension and diabetes mellitus) with sex variation (p value<0.05) Smoking habits were less in female, hypertension and diabetes detected more in female. This study concludes that significant difference of cardiac risk factors and age difference in both sexes may explain the outcome of UA in female. JCMCTA 2012; 23(1): 42-45

Abstract 17059: Ocrelizumab Induced Kounis Syndrome

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mian Tanveer Ud Din ◽  
Kushani Gajjar ◽  
Valentyna Ivanova
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Fluid Resuscitation ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Lv Function ◽  
Type I ◽  
Kounis Syndrome ◽  
Cardiac Risk Factors ◽  
Coronary Syndrome

Kounis syndrome(KS), first described in 1991, is defined as concurrence of acute coronary syndrome and anaphylactic events. Primary mechanism of KS is interaction of mast cells with T-lymphocytes and macrophages via multidirectional stimuli leading to platelets activation. Case presentation: A 35 y.o. tennis coach with multiple sclerosis is admitted to the medical ICU with anaphylaxis after receiving Ocrelizumab infusion. Vital signs on presentation are significant for hypotension with blood pressure of 69/30 mm Hg, sinus tachycardia to 110 bpm and hypoxia with SatO2 88% on room air. Other investigations including chest x-ray, EKG and blood work are unrevealing for secondary pathological process outside of anaphylaxis. She undergoes fluid resuscitation followed by epinephrine drip for persistent hypotension. In addition methylprednisolone, famotidine and diphenhydramine are administered. She requires escalating doses of epinephrine and subsequently develops chest pain with troponin elevation to 0.29 ng/ml and EKG concerning for new ST depression and T wave inversion in II, III, aVF, V2 - V6 leads. Urgent echocardiography revealed normal biventricular function with no wall motion abnormalities and is only significant for moderate MR. Given excellent underlying functional capacity and no underlying cardiac risk factors, she was treated for Kounis syndrome by treating underlying anaphylaxis and weaning epinephrine as able with additional fluid resuscitation. Her chest pain resolved and EKG normalized with eventual discontinuation of epinephrine. Repeat echocardiography revealed preserved left ventricular (LV) function and mild MR. Discussion: KS is not a rare disease but easily overlooked and infrequently diagnosed. Our patient had the type I variant: endothelial dysfunction or microvascular angina in absence of cardiac risk factors. Inflammatory mediators can cause vasospasm and catecholamines used for treatment may potentiate it therefore requiring thoughtful dosing and appropriate duration of treatment. Prompt recognition is crucial for appropriate management of anaphylatic shock followed by that of ACS if LV function declines or risk factors for cardiac disease are present.

The association between obesity, hypertension and left ventricular mass in adolescents

2017 ◽  
Vol 30 (2) ◽  
Author(s):  
Saime Ergen Dibeklioglu ◽  
Berna Şaylan Çevik ◽  
Banu Acar ◽  
Zeynep Birsin Özçakar ◽  
Nermin Uncu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Left Ventricular Mass ◽  
Clinical Examination ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Normal Weight ◽  
Obese Adolescents ◽  
Cardiac Risk Factors ◽  
Ventricular Mass

AbstractBackground:Obesity and hypertension (HT) are well known cardiac risk factors. Our goal was to show that even if arterial blood pressure (BP) measurements of obese adolescents are normal during clinical examination, ambulatory blood pressure monitoring (ABPM) can be high, may include cardiac involvement and can also detect left ventricular mass indices (LVMI) value for obese adolescents to diagnose left ventricular hypertrophy (LVH).Methods:This study included 130 children (57 obese hypertensive, 36 obese normotensive, 14 normal weight hypertensive and 23 normal weight normotensive). Adolescents whose BP was measured during clinical examination, after 24-h BP was detected using ABPM, were examined with echocardiography for calculation of LVMI to determine cardiac risk factors for LVH.Results:There was a significant difference between the LVMI of obese-normotensive and obese-hypertensive adolescents, which showed the effect of obesity on LVMI independent of HT. Twenty (35.7%) of 56 obese adolescents with HT detected with ABPM had normal BP measurements during clinical examination. Dipper and nondipper features of obese adolescents were significantly higher in ABPM than those with normal body mass index. When the cutoff LVMI value for LVH was set at ≥38 g/mConclusions:Obesity is a risk factor for LVH independent of HT. To identify masked HT, 24-h ABPM and cardiac examination should be routinely performed in obese adolescents. Using a limit of LVMI ≥38 g/m

scholarly journals Left ventricular geometry and cardiac risk factors define high and low risk subgroups among essential hypertensives

1990 ◽  
Vol 15 (2) ◽  
pp. A111 ◽  
Author(s):  
Michael J. Koran ◽  
Paul N. Casale ◽  
Daniel D. Savage ◽  
John H. Laragh ◽  
Richard B. Devereux
Keyword(s):  
Risk Factors ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Low Risk ◽  
Left Ventricular Geometry ◽  
Cardiac Risk Factors ◽  
Ventricular Geometry

Early detection of cardiotoxicity during chemotherapy using biomarkers

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19521-19521 ◽  
Author(s):  
D. J. Lenihan ◽  
M. R. Massey ◽  
K. Baysinger ◽  
D. Steinert ◽  
L. Fayad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Myocardial Injury ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Cardiac Risk Factor ◽  
Cardiac Events ◽  
Before And After ◽  
The Mean

19521 Cancer chemotherapy (CHEMO), especially anthracycline-containing regimens, may result in heart failure and left ventricular dysfunction (LVD) due to cardiotoxicity (CVTx). The ability to detect CVTx currently utilizes techniques to assess LVD, such as MUGA or echocardiography (Echo), which have substantial limitations and only detect LVD well after it occurs. Cardiac biomarkers, troponin (Trop I) and B-Type Natriuretic Peptide (BNP) are well established for detecting myocardial injury and LVD in patients without cancer. Limited evidence suggests that these may be important predictors of subsequent CVTx during CHEMO, but these markers have not been systematically investigated prospectively. Methods: Patients undergoing anthracycline-containing combination CHEMO were evaluated at baseline with: history and physical; electrocardiogram; Echo; and BNP and Trop I. Biomarkers were repeated before and after up to 6 cycles of CHEMO. ECHO was repeated after 6 cycles or at 6 months from baseline. Cardiac events (heart failure, LVD, sudden death, or arrhythmia) were documented, if present. Results: To date, 111 (53M/58F) patients, age 56±14 (mean±SD), with either lymphoma (n=39, 35%), sarcoma (n=60, 54%), or breast cancer (n=12, 11%) were enrolled. At least one traditional cardiac risk factor was identified in 77 (69%) and 2 or more risk factors noted in 46 (41%). Baseline ECHO parameters including ejection fraction (EF) and biomarkers were normal. With CHEMO, the mean post CHEMO BNP value (pg/ml) for the group did not change significantly; however, in the 8 patients with cardiac events, the BNP post CHEMO was elevated. The Trop I values were not abnormal except in 2 patients with events. Conclusion: Preliminary data collected to date indicates that BNP values during CHEMO remain normal unless cardiac events occur. Additionally, elevated BNP levels appear to detect CVTx, but LVEF did not. Furthermore, patients receiving CHEMO frequently have cardiac risk factors that may promote CVTx. [Table: see text] No significant financial relationships to disclose.

The utility of routine pre-chemotherapy screening with cardiac gated blood pool scan for patients at low risk of anthracycline toxicity

2017 ◽  
Vol 24 (4) ◽  
pp. 264-271 ◽  
Author(s):  
Puey Ling Chia ◽  
K Chiang ◽  
R Snyder ◽  
A Dowling
Keyword(s):  
Risk Factors ◽  
Ejection Fraction ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Cardiac Monitoring ◽  
Left Ventricular Ejection ◽  
Cancer Type ◽  
Ventricular Ejection Fraction ◽  
Cardiac Risk Factors ◽  
Number Of Patients

Background Anthracycline-based chemotherapy is used in many malignancies. Current recommendations by several groups suggest cardiac monitoring prior to and during anthracycline therapy. We aim to review the usefulness of baseline cardiac screening for left ventricular ejection fraction to assess if it had any impact on chemotherapy decisions in patients to be treated with anthracycline-based regimens or any beneficial effect upon outcomes. Methods We conducted a retrospective three-year audit of cancer patients who underwent GBPS prior to anthracycline (doxorubicin) chemotherapy. Subjects were identified via records from the Department of Nuclear Medicine. Pharmacy dispensing records identified those who received doxorubicin. Patient demographics, cancer type, cardiac risk factors, GBPS ejection fraction (EF), and cumulative anthracycline dose were collected. Results From 1 August 2009 to 31 July 2012, 179 patients underwent GBPS pre-doxorubicin chemotherapy. The mean age was 59 years (range 21–89 years), with 51% being males. Only two patients (1.1%) had an abnormal EF < 50%, while 33 patients (18%) had an EF 51–59% and 144 patients (80%) had EF ≥ 60%. The two patients with reduced baseline EF still received anthracycline-based chemotherapy. All 135 patients without any known cardiovascular risk factors had normal EFs. The total number of patients who received anthracycline chemotherapy during the same period was 207. Thus 28 patients (13%) commenced anthracycline without a prior GBPS. Conclusion Only 1.1% of the screened patients had EF < 50%. These two patients still received doxorubicin chemotherapy despite a compromised EF, as their treating clinicians believed that the benefits of chemotherapy outweighed the risk of potential cardiac toxicity. Our audit questions the practice of routine cardiac evaluation pre-anthracycline screening with GBPS. We propose that routine screening only be requested if cardiac risk factors are present.

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