Cardiovascular events (CVEs) associated with tyrosine kinase inhibitor (TKI) therapy in patients with metastatic renal cell carcinoma (mRCC) at a regional cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16040-e16040
Author(s):  
J. McGhie ◽  
M. J. Mackenzie ◽  
E. Winquist ◽  
S. Ernst ◽  
L. Sax ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Kinase Inhibitor ◽  
Cardiac Risk ◽  
Phase Iii ◽  
Cancer Center ◽  
True Rate ◽  
Cardiac Risk Factors ◽  
Coronary Syndrome ◽  
Phase Iii Trials

e16040 Background: Recent studies suggest the incidence of CVEs associated with TKIs has been underestimated. Phase III trials have reported low incidences of heart failure, cardiac ischemia and hypertension. A recent observational study reported that one third of patients taking sunitinib or sorafenib experienced a cardiovascular event often without symptoms. We assessed the incidence of CVEs in mRCC patients who received TKIs at our centre. Methods: Eligible mRCC patients were identified from a mRCC database between January 2006 and November 2008. Data was retrospectively extracted including age, sex, diagnosis, histology, past cardiac history, cardiac risk factors, number and type of TKI regimens, and CVEs. A CVE was defined as unexplained death, acute coronary syndrome (ACS), heart failure, or arrhythmia requiring intervention. We also identified any new or exacerbated cases of hypertension after the start of TKI therapy, as a CVE. Results: Eighty-five eligible patients were identified. Average age was 61 years (range, 23–78), 72% were male and 80% were clear cell in origin. A total of 31 CVEs occurred in 28 patients (33%). These events occurred at a median of 5 weeks of TKI therapy (range, 1 - 64 weeks). There were 8 cases of ACS, 2 of heart failure, 2 of arrhythmia, and 3 unknown causes of death. Only 2 of these particular CVEs were associated with new or increased hypertension. There were 16 cases of hypertension alone. Those who had CVEs had a higher mean number of cardiac risk factors. They were also more likely to have an echocardiogram during treatment, and less likely to receive sorafenib following sunitinib. Conclusions: Our study suggests a lower rate of CVEs than recent studies, but the true rate may be underestimated, as routine cardiac studies were not performed in all patients. Rational surveillance strategies for patients receiving TKI therapies should be developed. Prospective trials should address predictive and prognostic factors for CVEs. [Table: see text] [Table: see text]

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.

Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study

2020 ◽  
pp. postgradmedj-2020-138679
Author(s):  
Vedat Çiçek ◽  
Tufan Cinar ◽  
Mert Ilker Hayiroglu ◽  
Şahhan Kılıç ◽  
Nürgül Keser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Cardiac Risk ◽  
Cardiac Risk Factors ◽  
Hip Fracture Surgery ◽  
Single Centre Study ◽  
Fracture Surgery

IntroductionIn the present study, our aim was to ascertain the preoperative cardiac risk factors related to the in-hospital mortality in the elderly patients (aged over 65 years) who required preoperative cardiology consultation for hip fracture surgery.Material and MethodsThe present study was a retrospective, single-centre study, which enrolled consecutive elderly patients without heart failure scheduled for hip fracture surgery in our institution. In all patients, an anesthesiologist performed a detailed preoperative evaluation and decided the need for the cardiac consultation. Patients underwent preoperative cardiac evaluation by a trained cardiologist using the algorithms proposed in the recent preoperative guidelines. The in-hospital mortality was the main outcome of the study.ResultsIn total, 277 elderly patients undergoing hip fracture surgery were enrolled in this analysis. The overall in-hospital mortality rate was 12.1% (n=30 cases). In a multivariate analysis, we found that insulin dependency, cancer, urea, presence of atrial fibrillation (AF) (OR: 3.906; 95% CI 1.470 to 10.381; p=0.006) and pulmonary artery systolic pressure (PASP) (OR: 1.057; 95% CI 1.016 to 1.100; p=0.006) were the predictors of in-hospital mortality. The receiver operating characteristic curve analysis revealed that the optimal value of PASP in predicting the in-hospital mortality was 35 mm Hg (area under the curve=0.71; 95% CI 0.60 to 0.81, p<0.001) with sensitivity of 87.7% and specificity of 59.5%.ConclusionThe present research found that the preoperative cardiac risk factors, namely AF and PASP, might be associated with increased in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery.

scholarly journals HOUT-15. IDENTIFICATION AND CHARACTERIZATION OF CARDIAC EVENT ABNORMALITIES IN PATIENTS WITH CRANIOPHARYNGIOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi115-vi115
Author(s):  
Christa Seligman ◽  
Rebecca Harrison ◽  
Saamir Hassan ◽  
Jimin Wu ◽  
John DeGroot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Cancer Center ◽  
Qtc Interval ◽  
Cardiac Health ◽  
Cardiac Risk Factors ◽  
Related Information ◽  
Abnormal Rate ◽  
Md Anderson

Abstract BACKGROUND Craniopharyngiomas (CP) are frequently associated with a malignant clinical trajectory despite their benign histology. This population frequently has endocrinopathies and autonomic dysfunction due to tumour location, which may influence cardiac function and long term health outcome. In this study, we evaluated for clinical and paraclinical cardiac abnormalities in adult and pediatric patients with craniopharyngioma. METHODS We retrospectively identified patients in our neurosurgery database with a diagnosis of craniopharyngioma that received neurosurgery at MD Anderson Cancer Center. We queried the medical record for demographic and disease-related information, as well as clinical information regarding cardiac risk factors. Perioperative electrocardiograms (EKGs) were analyzed where available. RESULTS We identified 56 patients with craniopharyngioma, 27 (48.2%) of which were female. Average age was 39 years, and all patients had undergone subtotal (49.1%), gross total (32.7%), or near gross total (18.2%) resection. Over half (53.6%) had undergone radiation, none had received systemic therapy, and 1 (1.8%) intra-cystic chemotherapy. The majority had adamantanomatous-type histology (83%) and the remainder papillary (17%). At diagnosis, average BMI was elevated at 30.98. Hypertension (30.4%), diabetes mellitus (32.1%), and thyroid dysfunction (80%), were found in this cohort. Nearly a quarter (23.2%) were on statin therapy for dyslipidemia. Stimulant (14.3%) and neuropleptic (3.6%) use were also identified. Of patients with perioperative EKG performed (N= 39), 30 were available for review. Of these, patients were identified with abnormal rate (N=9, 30.0%), PR interval (N=2, 6.7%), QRS interval (N=4, 13.3%), and QTc interval (N=1, 3.3%). Some patients presented with a history of heart palpitations (1.8%) and syncopal episodes (3.6%), but not chest pain. CONCLUSION This analysis demonstrates frequent vascular and cardiac risk factors in patients with craniopharyngioma. We advocate for increased awareness of cardiac health in this young population. Further prospective evaluation is warranted to better understand cardiac health in this patient group.

Clinical Significance of Cardiac Co-Morbidities and Risk Factors for Patients Treated with Imatinib.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4490-4490
Author(s):  
Asifa Malik ◽  
Jorge E. Cortes ◽  
Hagop Kantarjian ◽  
Gloria Mattiuzzi ◽  
Gloria Iliescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Research Funding ◽  
Cardiac Risk ◽  
Imatinib Treatment ◽  
Cardiac Events ◽  
Cardiac Risk Factors ◽  
History Of

Abstract Abstract 4490 Background: Imatinib is currently standard therapy for patients with success in Chronic Myeloid Leukemia (CML). Several instances of cardiac adverse events have been reported for patients while on therapy with imatinib. In many instances, these events occur in patients with pre-existing cardiac conditions. The aim of our study was to determine the occurrence of cardiac events in patients with CML treated with Imatinib, and the impact that cardiac risk factors and pre-existing cardiac conditions had on the risk of developing cardiac adverse effects. Methods: We reviewed the medical records of 51 patients with chronic phase CML who were treated with imatinib after failing prior therapies. For each patient we collected cardiac risk factors, pre-existing cardiac disease, pre-treatment EKG and echocardiogram (ECHO) readings, as well as post-treatment changes in EKG and ECHO findings. Results: Pre-existing cardiac conditions were found in 14 (27%) patients, including congestive heart failure in 2 (4%), myocardial infarction in 4 (8%), atrial fibrillation in 1 (2%), benign arrhythmias in 1(2%), aortic regurgitation in 1(2%), mitral valve prolapse in 1 (2%), mitral regurgitation in 1(2%), pericarditis in 1(2%), bradycardia in1(2%) and benign arrhythmia in 1(2%). Cardiac risk factors were present in 26 patients (51%), including smoking in 10 patients (20%), hypertension in 17 (33%), diabetes mellitus in 9 (18%), obesity in 2 (4%), hyperlipidemia in 5 (10%), stress (self-reported by patient or on anxiolytic therapy) in 5 (10%), alcohol in 11 (22%), atherosclerosis in 3 (6%), and positive family history for cardiac disease in 5 patients (9.8%). Cardiac events were noted in 19 patients (37%) of whom 11 (58%) had pre-existing cardiac conditions prior to initiating imatinib treatment and 14 patients (27%) had at least one cardiac risk factor. Congestive heart failure with clinical manifestations was seen in 9 patients (18%) with documentation of decreased ejection fraction on echocardiogram seen in 3 patients (6%) who had a decrease in LVEF from a median of 55% (range 50% to 72%) to a median of 45% (range 25% to 60%). Out of the patients who developed CHF while on treatment with imitanib, 3 patients (6%) had history of cardiac conditions (atrial fibrillation in 1 (2%), congestive heart failure in 2 (4%)). Myocardial infarction was documented in 3 patients (6%), one of which had prior myocardial infarction and pacemaker, another had history of mitral valve prolapse and hypertension; one patient had hypertension, diabetes mellitus and positive family history but no prior history of heart disease. Arrhythmia was seen in 3 patients (6%). Post-treatment EKG changes occurred in 14 patients (27%) including bradycardia, PAC's, PVC's, ST-T wave changes, tachycardia and other rhythm abnormalities. These changes were usually asymptomatic. Gated cardiac study done after a median of 63 months (range 29 to 83 months) after initiation of imatinib treatment showed EF below 60% in 9 patients (18%) with a median of 55% (range 36% to 59%). None of the patients died of cardiac conditions and none discontinued imatinib therapy because of cardiac events. Conclusion: Although cardiac events occur in some patients treated with imatinib, these are much more common among patients with pre-existing cardiac conditions and/or cardiac risk factors. These patients need to be monitored closely to minimize their risk and intervene early when new cardiac events arise. Disclosures: Cortes: novartis: Research Funding; BMS: Research Funding; Pfizer: Consultancy, Research Funding. Kantarjian:novartis: Research Funding; BMS: Research Funding. O'Brien:Novartis: Research Funding.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

Conventional cardiac risk factors associated with trastuzumab-induced cardiotoxicity in breast cancer: Systematic review and meta-analysis

2021 ◽  
pp. 100723
Author(s):  
George Koulaouzidis ◽  
Amanda E. Yung ◽  
Diana E. Yung ◽  
Karolina Skonieczna-Żydecka ◽  
Wojciech Marlicz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Cardiac Risk ◽  
Factors Associated ◽  
Cardiac Risk Factors

Sexual Assault While in the Military: Violence as a Predictor of Cardiac Risk?

2003 ◽  
Vol 18 (2) ◽  
pp. 219-225 ◽  
Author(s):  
Susan M. Frayne ◽  
Katherine M. Skinner ◽  
Lisa M. Sullivan ◽  
Karen M. Freund
Keyword(s):  
Risk Factors ◽  
Sexual Assault ◽  
Women Veterans ◽  
Cardiac Risk ◽  
Veterans Administration ◽  
Cardiac Risk Factors ◽  
Military Violence ◽  
Problem Alcohol Use ◽  
History Of ◽  
The Military

The purpose of this article is to determine whether known cardiac risk factors are more prevalent among women veterans who report having sustained sexual assault while in the military. We surveyed a random sample of 3,632 women veterans using Veterans Administration (VA) ambulatory care nationally. Obesity, smoking, problem alcohol use, sedentary lifestyle, and hysterectomy before age 40 were found to be more common in women reporting a history of sexual assault while in the military than in women without such history. An association between myocardial infarction and prior sexual assault history may be mediated in part by known cardiac risk factors.

Cardioprotection with ICRF-187 (Cardioxane) in patients with advanced breast cancer having cardiac risk factors for doxorubicin cardiotoxicity, treated with the FDC regimen

1995 ◽  
Vol 3 (3) ◽  
pp. 176-182 ◽  
Author(s):  
Svetislav Jelić ◽  
Siniša Radulović ◽  
Zora Nešković-Konstantinović ◽  
Miroslav Kreačić ◽  
Zorana Ristović ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Advanced Breast Cancer ◽  
Cardiac Risk ◽  
Advanced Breast ◽  
Cardiac Risk Factors ◽  
Doxorubicin Cardiotoxicity
Sign in / Sign up

Export Citation Format

Share Document