Trastuzumab-mediated cardiotoxicity in the nontrial setting: Evaluation of patients receiving adjuvant trastuzumab at an academic centre

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11550-e11550
Author(s):  
D. Withrow ◽  
S. Verma ◽  
R. Dent ◽  
S. Ahmed ◽  
J. Fralick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Adjuvant Trastuzumab ◽  
Patient Age ◽  
Ventricular Ejection Fraction ◽  
Patient Âgé ◽  
The Relationship

e11550 Background: Trastuzumab is effective in the treatment of HER-2 positive breast cancer. Although clinical trials have shown an increased risk of cardiotoxicity associated with trastuzumab, this risk has not been well studied in the non-trial setting. This study aims to examine (1) the incidence of cardiotoxicity associated with trastuzumab in the clinical setting (2) the relationship, if any, between risk factors and incidence of cardiotoxicity and (3) cardiac monitoring practices. Methods: A retrospective chart review was conducted of all patients receiving adjuvant trastuzumab therapy between August 2005 and May 2008, at a Canadian academic centre. The incidence of cardiotoxicity, defined as a significant reduction in left ventricular ejection fraction (drop of >10% leading to an ejection fraction of <50%) and/or New York Heart Association class III-IV CHF symptoms requiring trastuzumab delay or discontinuation was evaluated. Medical charts and patient surveys provided demographics, risk factors and cardiac toxicity for each patient. Results: 183 patients were included in the study. The average age of participating patients was 54.8 years and 51% of participants had node positive cancer. 72% were treated sequentially with Trastuzumab and 88% received anthracyclines. The incidence of cardiotoxicity was 6.0% (n=11). Upon univariate analysis, patient age was found to be the only variable significantly associated with the occurrence of cardiotoxicity (OR: 3.55, 95% CI 1.76–90.0). Left ventricular function was monitored by serial MUGA scan every 3.35 ±1.89 months as compared to the 3 month gold standard in clinical trials. Conclusions: In this study the incidence of cardiotoxicity was 6.0%. Patient age was the only significant variable associated with cardiotoxicity, as expected from previous studies. Clinically, this suggests that older patients may need more frequent monitoring for cardiac dysfunction via MUGA and/or ECHO scans. Future research needs to address the relationship between treatment regimens and the incidence of cardiotoxicity. Furthermore, we need to better define cardiotoxicity and the clinical significance of cardiac related symptoms. No significant financial relationships to disclose.

Strong risk factors for depression and anxiety in heart failure patients

2021 ◽  
Author(s):  
Naila Niaz ◽  
Syed Muhammad Faraz Ali ◽  
Attaullah Younas ◽  
Tallat Anwar Faridi ◽  
Asif Hanif
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anxiety And Depression ◽  
Team Approach ◽  
Depression And Anxiety ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients

Despite advancing medical technology, Heart Failure (HF) is still a prevalent disease with high mortality and high health expenditure. To improve patient outcome and prognosis, it is important to identify the association of risk factors which leads to the co-morbid depression and anxiety in heart failure patients. Objectives: To determine the association of depression and/or anxiety with age, gender and ejection fraction in heart failure patients. Methods: It is an analytical cross sectional study including 323 CHF patients who visited the to the Faisalabad Institute of Cardiology hospital Out-Patient Department, 250 were males and 73 were females, mean age was 54.1 ± 9.2 years having 70 years as maximum and 25 years as minimum.  Data collection was done using Hospital Anxiety and Depression Scale (HADS) questionnaire to assess depression and anxiety. Data was analyzed using SPSS version 24. For quantitative data, mean and standard deviation was calculated and for qualitative data frequency and percentages was calculated. To measure the association of anxiety and depression with age categories, ejection fraction and gender, chi square test was used. P values less than and equal to 0.05 were taken as significant. Results: No association of depression and anxiety with gender and Left Ventricular Ejection Fraction (LVEF) was observed. However, depression and anxiety were found to be significantly associated with age Conclusions: The study concluded that age is a strong risk factor of depression and anxiety in congestive heart failure patients. Multidisciplinary health care team approach and interventions are required to cater chronic heart failure (CHF) patients to address the psychological burden.

scholarly journals The continuous heart failure spectrum: moving beyond an ejection fraction classification

2019 ◽  
Vol 40 (26) ◽  
pp. 2155-2163 ◽  
Author(s):  
Filippos Triposkiadis ◽  
Javed Butler ◽  
Francois M Abboud ◽  
Paul W Armstrong ◽  
Stamatis Adamopoulos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
Statistical Power ◽  
Structural Changes ◽  
Randomized Clinical Trials ◽  
New Technologies ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Randomized clinical trials initially used heart failure (HF) patients with low left ventricular ejection fraction (LVEF) to select study populations with high risk to enhance statistical power. However, this use of LVEF in clinical trials has led to oversimplification of the scientific view of a complex syndrome. Descriptive terms such as ‘HFrEF’ (HF with reduced LVEF), ‘HFpEF’ (HF with preserved LVEF), and more recently ‘HFmrEF’ (HF with mid-range LVEF), assigned on arbitrary LVEF cut-off points, have gradually arisen as separate diseases, implying distinct pathophysiologies. In this article, based on pathophysiological reasoning, we challenge the paradigm of classifying HF according to LVEF. Instead, we propose that HF is a heterogeneous syndrome in which disease progression is associated with a dynamic evolution of functional and structural changes leading to unique disease trajectories creating a spectrum of phenotypes with overlapping and distinct characteristics. Moreover, we argue that by recognizing the spectral nature of the disease a novel stratification will arise from new technologies and scientific insights that will shape the design of future trials based on deeper understanding beyond the LVEF construct alone.

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.

scholarly journals The Relationship Between Cardio-Ankle Vascular Index and Left Atrial Phasic Function in Hypertensive Patients With Preserved Ejection Fraction

2021 ◽  
Vol 3 ◽  
Author(s):  
Tsuyoshi Tabata ◽  
Kazuhiro Shimizu ◽  
Yukihiro Morinaga ◽  
Naoaki Tanji ◽  
Ruiko Yoshida ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Hypertensive Patients ◽  
The Relationship

Background: To investigate the relationship between arterial stiffness, reflected by cardio-ankle vascular index (CAVI) value, and left atrial (LA) phasic function in hypertensive patients with preserved left ventricular ejection fraction (LVEF).Methods: We retrospectively studied 165 consecutive patients (mean age, 66.5 ± 11.7 years) diagnosed with hypertension with preserved LVEF who had undergone CAVI measurement and echocardiography on the same day. The latter included speckle-tracking echocardiography to assess LA phasic function (reservoir, conduit, and pump strain) and left ventricular global longitudinal strain (LVGLS).Results: The results of univariate analysis showed CAVI value to be correlated with LA reservoir strain and LA conduit strain (r = −0.387 and −0.448, respectively; both P &lt; 0.0001). The results of multiple linear regression analysis showed CAVI value to be independently related to age (β = 0.241, P = 0.002) and LA conduit strain (β = −0.386, P = 0.021) but not LV mass index, LA volume index, or LV systolic function (including LVGLS).Conclusion: In hypertensive patients with preserved LVEF, increased CAVI value appears to be independently associated with impaired LA phasic function (particularly LA conduit function) before LA and LV remodeling. CAVI determination to assess arterial stiffness may be useful in the early detection of interactions between cardiovascular abnormalities in hypertensive patients.

Descriptive evaluation of frequent patient referrals to our cardio-oncology clinic: The Mayo experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14018-e14018
Author(s):  
Anza Zahid ◽  
Prema P. Peethambaram ◽  
Carrie A. Thompson ◽  
Minetta C. Liu ◽  
Kathryn Jean Ruddy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
B Cell Lymphoma ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cancer Type ◽  
Ventricular Ejection Fraction

e14018 Background: Cancer survival rates are improving. Therefore, management of cardiovascular complications has now become a crucial clinical concern. Cardio-oncology is the sub-specialty that assists in the overall management of cancer patients in a multi-disciplinary manner. Mayo Clinic cardio-oncology practice was initiated to work closely with our oncology colleagues for early detection of cardiovascular complications in response to cancer-therapy. Majority of the patients visit our cardio-oncology clinic once, we thought it is important to study the group of patients that visited frequently due to cardiovascular complications. Aim: To evaluate the most common cardiovascular complication in patients with 2 or more visits to our cardio-oncology clinic. Methods: From 2012-2017, there were > 2500 patients visits to our clinic, with 24 patients having 2 or more visits. Data including patients’ demographics, ethnicity, chemotherapeutic medications, primary cancer type, cardiovascular risk factors, echocardiography and clinical outcomes were collected. Cardiotoxicity was defined as the decrease in left ventricular ejection fraction (LVEF) of > 10% to a value of < 53%. Heart failure was diagnosed based on Framingham’s criteria or by a cardiologist. Results: There were 19 women (80%) and 5 men (20%). Median age at the time of diagnosis was 56 years [19-76]. The most common malignancy was breast cancer (70%), followed by B-cell lymphoma (12%) and acute myeloid leukemia (8%). Thirty percent had > 2 risk factors for cardiovascular disease. 75% of the patients had an LVEF of < 53, of these 67% developed heart failure with 58% preserved and 42% reduced ejection fraction. Those with heart failure had received a mean anthracycline dose of 305 ± 91.8mg/m2. With initiation of ACEI, B-Blockers, and diuretics (GDMT) 79% showed recovery of LVEF to ≥53 during the follow up. Conclusions: In our experience, most patients who were seen at least twice in the cardio-oncology clinic for heart failure had received a dose of > 300mg/m2 anthracycline. With GDMT over 75% of the patients recovered. Care in the cardio-oncology clinic plays a key role in optimizing these clinical outcomes.

Abstract 13370: The Relationship Between Longitudinal Changes in Left Ventricular Ejection Fraction and Survival From 57,823 Patients in a Large Regional Health System

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Linyuan Jing ◽  
Samuel Fielden ◽  
Gregory J Wehner ◽  
Joseph Leader ◽  
Christopher M Haggerty ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Linear Relationship ◽  
Mortality Risk ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality ◽  
Non Linear ◽  
The Relationship

Introduction: An intriguing U-shape relationship between left ventricular ejection fraction (LVEF) and survival has recently been reported, with LVEFs of 60-65% associated with the lowest mortality risk. In heart failure, LVEF recovery has been linked to improved outcomes; however, the relationship between changes in LVEF (ΔLVEF) and survival in a general clinical population has not been studied. We hypothesized that ΔLVEF would have a non-linear relationship with all-cause mortality. Methods: A total of 194,599 echocardiograms from 57,823 patients with physician-reported LVEF were identified from Geisinger health records, along with dates of death or last living encounter, age, sex, smoking status, height, weight, and active diagnoses. ΔLVEF for a given echocardiogram was calculated for 136,776 studies as the difference between the most recent previous and current LVEF. Cox Proportional Hazards Regression was used to relate interaction between ΔLVEF and current LVEF to all-cause mortality while adjusting for confounders. Results: Death occurred in 15,419 patients who underwent 39,562 (29%) echocardiograms. Median follow up duration was 3.6 years (IQR, 1.3-7.2), and median time between tests was 1.0 year (IQR, 0.2-2.3). The interaction between LVEF and ΔLVEF ( P < 0.001) demonstrated that a stable LVEF of 60-65% was associated with the best survival (Figure). A decreased LVEF was universally associated with increased mortality, while LVEFs that had increased showed non-linear interactions. In general, an LVEF of 35-55% that had increased from the previous test was associated with a similar or slightly lower mortality than the same LVEF that was unchanged or had decreased, while an LVEF >55% that had increased was associated with an increase in mortality risk compared to those with a stable LVEF. Conclusions: Changes in LVEF have a non-linear relationship with all-cause mortality. In general, a constant, stable LVEF associates with the lowest risk of mortality.

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