scholarly journals Management of Advanced Heart Failure in Children with Cancer Therapy-Related Cardiac Dysfunction

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 872
Author(s):  
Hari P. Tunuguntla ◽  
Kriti Puri ◽  
Susan W. Denfield
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Late Onset ◽  
Advanced Heart Failure ◽  
Cancer Therapies ◽  
Children With Cancer ◽  
Pericardial Disease ◽  
Symptomatic Heart Failure ◽  
Childhood Malignancies

The evolution of cancer therapies has led to marked improvement in survival of those affected by childhood malignancies, while also increasing the recognition of early and late toxicities associated with cancer therapies. Cardiotoxicity can include cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction as a result of exposure to chemotherapy and/or radiation. Anthracyclines remain the most common cause of chemotherapy-induced cardiomyopathy (CCM) with varying clinical presentations including: acute, early onset, and late-onset. Many individuals develop cardiac dysfunction over the long-term, ranging from subclinical cardiac dysfunction to end-stage symptomatic heart failure. The focus of this review is on characterization of symptomatic heart failure in children with cancer therapy-related cardiac dysfunction (CTRCD) primarily due to CCM and utilization of advanced heart failure therapies, including ventricular assist device (VAD) support and heart transplantation, with consideration of unique patient-related factors.

Very early detection of low dose anti-cancer therapy-related cardiotoxicity in lymphoma patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.W Liu ◽  
H.Y Chang ◽  
C.H Lee ◽  
W.C Tsai ◽  
P.Y Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Systolic Dysfunction ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Funding Source ◽  
Anti Cancer ◽  
All Cause Mortality

Abstract Background and purpose Left ventricular (LV) global peak systolic longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive modality for the detection of subclinical LV systolic dysfunction and a powerful prognostic predictor. However, the clinical implication of LV GLS in lymphoma patients receiving anti-cancer therapy remains unknown. Methods We prospectively enrolled 74 patients (57.9±17.0 years old, 57% male) with lymphoma who underwent echocardiography prior to chemotherapy, post 3rd and 6th cycle and 1 year after chemotherapy. Cancer therapy-related cardiac dysfunction (CTRCD) is defined as the reduction of absolute GLS value from baseline of ≥15%. All the eligible patients underwent a cardiopulmonary exercise test (CPET) upon completion of 3 cycles of anti-cancer therapy. The primary outcome was defined as a composite of all-cause mortality and heart failure events. Results Among 36 (49%) patients with CTRCD, LV GLS was significantly decreased after the 3rd cycle of chemotherapy (20.1±2.6% vs. 17.5±2.3%, p<0.001). In the multivariable analysis, male sex and anemia (hemoglobin <11 g/dL) were found to be independent risk factors of CTRCD. Objectively, patients with CTRCD had lower minute oxygen consumption/kg (VO2/kg) and lower VO2/kg value at anaerobic threshold in the CPET. The incidence of the primary composite outcome was higher in the CTRCD group than in the non-CTRCD group (hazard ratio 3.21; 95% CI, 1.04–9.97; p=0.03). Conclusion LV GLS is capable of detecting early cardiac dysfunction in lymphoma patients receiving anti-cancer therapy. Patients with CTRCD not only had a reduced exercise capacity but also a higher risk of all-cause mortality and heart failure events. Change of LVEF and GLS after cancer Tx Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Ministry of Science and Technology (MOST), Taiwan

scholarly journals DIURETIC RESISTANCE IN ADVANCED HEART FAILURE: A Literature Review

2021 ◽  
Vol 2 (1) ◽  
pp. 8-15
Author(s):  
Anita Surya Santoso ◽  
Mohammad Saifur Rohman ◽  
Indra Prasetya ◽  
Budi Satrijo
Keyword(s):  
Heart Failure ◽  
Prognostic Factor ◽  
Literature Review ◽  
Cardiac Dysfunction ◽  
Signs And Symptoms ◽  
Underlying Mechanism ◽  
Advanced Heart Failure ◽  
Diuretic Resistance

Advanced heart failure (HF) is used to characterized patients in HF with severe symptoms, recurrent decompensation and severe cardiac dysfunction. The prevalencekof HFkis approximatelyg1-2% of thecadult population inhdeveloped countries and it will be rising more than 10%pamongapeoplec>70ayears of age, whereas estimated theoprevalence ofcpatients with advanced HF is about 1% until 10%cof thekoverallkHFopopulation. Most ofkthe HF hospitalizationssare due to signs and symptoms of fluidcoverload.Recurrent congestionccould worsen patientssoutcomes.Loopdiureticssare recommended for thectreatmentcofkcongestionqinprHF patient. cHowever,cdiureticvresistanceeispavcommon problem issueiinpacuteqdecompensationtofcadvancedochronicrheartwfailureq(ACHF) patients and established prognostic factor. Some early reports estimated the prevalence of diuretic resistance about 20%-30% in HF population. In this review, we will be discuss how to diagnose the advancedvheartufailurepand the underlying mechanism of diuretic resistancebin HF patients. We also describe pharmacologicalvand non-pharmacologicalstrategies to overcome this issue.

Cancer therapy-related cardiac dysfunction: is endothelial dysfunction at the heart of the matter?

2021 ◽  
Vol 135 (12) ◽  
pp. 1487-1503
Author(s):  
Crizza Ching ◽  
Dakota Gustafson ◽  
Paaladinesh Thavendiranathan ◽  
Jason E. Fish
Keyword(s):  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Inflammatory Markers ◽  
Cancer Survival ◽  
Growth Factor Receptor ◽  
Cardiovascular Effects ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cancer Therapies ◽  
The Impact

Abstract Significant improvements in cancer survival have brought to light unintended long-term adverse cardiovascular effects associated with cancer treatment. Although capable of manifesting a broad range of cardiovascular complications, cancer therapy-related cardiac dysfunction (CTRCD) remains particularly common among the mainstay anthracycline-based and human epidermal growth factor receptor-targeted therapies. Unfortunately, the early asymptomatic stages of CTRCD are difficult to detect by cardiac imaging alone, and the initiating mechanisms remain incompletely understood. More recently, circulating inflammatory markers, cardiac biomarkers, microRNAs, and extracellular vesicles (EVs) have been considered as early markers of cardiovascular injury. Concomitantly, the role of the endothelium in regulating cardiac function in the context of CTRCD is starting to be understood. In this review, we highlight the impact of breast cancer therapies on the cardiovascular system with a focus on the endothelium, and examine the status of circulating biomarkers, including inflammatory markers, cardiac biomarkers, microRNAs, and endothelial cell-derived EVs. Investigation of these emerging biomarkers may uncover mechanisms of injury, detect early stages of cardiovascular damage, and elucidate novel therapeutic approaches.

scholarly journals Cancer Therapy–Related Cardiac Dysfunction and Heart Failure

2016 ◽  
Vol 9 (2) ◽  
Author(s):  
Carine E. Hamo ◽  
Michelle W. Bloom ◽  
Daniela Cardinale ◽  
Bonnie Ky ◽  
Anju Nohria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction

scholarly journals Cancer Therapy–Related Cardiac Dysfunction and Heart Failure

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Michelle W. Bloom ◽  
Carine E. Hamo ◽  
Daniela Cardinale ◽  
Bonnie Ky ◽  
Anju Nohria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction

A Review of the Cardiovascular Effects of Oncology Agents

2008 ◽  
Vol 21 (2) ◽  
pp. 146-158 ◽  
Author(s):  
Bradi L. Frei ◽  
Scott A. Soefje
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Adverse Effect ◽  
Cancer Therapy ◽  
Cardiovascular Effects ◽  
Cancer Therapies ◽  
Cardiovascular Toxicity ◽  
Action Monitoring ◽  
Increased Risk ◽  
Chemotherapy Agents

Cardiovascular toxicity is an important adverse effect of several classes of oncology drugs. Because cancer survivors are living longer, the late effects of cancer therapy must be addressed. Many patients diagnosed with cancer are already at an increased risk for cardiovascular disease before drug treatment. Select chemotherapy agents further complicate the issue because of their own ability to induce cardiovascular toxicities or exacerbate preexisting conditions. Hypertension, dyslipidemia, heart failure, and arrhythmia are known consequences of some cancer therapies. This review provides an overview of the epidemiology, mechanism of action, monitoring, and management of these cardiovascular effects.

The use of levosimendan in children with cancer with severe acute cardiac dysfunction: case series and a review of the literature

2013 ◽  
Vol 24 (3) ◽  
pp. 524-527 ◽  
Author(s):  
Alvise Tosoni ◽  
Anne I. Dipchand ◽  
Hadi Mohseni-Bod
Keyword(s):  
Heart Failure ◽  
Bone Marrow ◽  
Cardiac Dysfunction ◽  
Case Series ◽  
Marrow Transplant ◽  
Loading Dose ◽  
Review Of The Literature ◽  
Heart Failure Therapy ◽  
Children With Cancer ◽  
Initial Management

AbstractWe report the use of levosimendan in two febrile, neutropenic children with cancer – one post bone marrow transplant – with acute heart failure following chemotherapy. Initial management with epinephrine, milrinone, and diuresis was unsuccessful. Infusion of levosimendan without a loading dose was added to the ongoing heart failure therapy, which resulted in persistent symptomatic and echocardiographic improvement without major side effects.

scholarly journals Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Part I

2017 ◽  
Vol 14 (3) ◽  
pp. 6-20
Author(s):  
I Ye Chazova ◽  
S A Tyulyandin ◽  
M V Vitsenia ◽  
A G Ovchinnikov ◽  
M G Poltavskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Side Effects ◽  
Cancer Therapy ◽  
Myocardial Dysfunction ◽  
Cardiovascular Complications ◽  
Cancer Therapies ◽  
Patients With Cancer ◽  
Prevention And Treatment ◽  
Actual Survival

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this first part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related cardiac dysfunction and heart failure.

scholarly journals Time to switch angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to sacubitril/valsartan in patients with cancer therapy-related cardiac dysfunction

2022 ◽  
Vol 50 (1) ◽  
pp. 030006052110679
Author(s):  
Qianlan Xi ◽  
Zijun Chen ◽  
Tingming Li ◽  
Liya Wang
Keyword(s):  
Heart Failure ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Efficacy And Safety ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Advances in cancer therapy have resulted in more cancer therapy-related cardiac dysfunction (CTRCD), which is the main cause of death in older female survivors of breast cancer. Traditionally, guideline-recommended medications for heart failure, such as beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), are commonly used to prevent or attenuate CTRCD. However, sometimes their effectiveness is not satisfactory. Recently, the drug combination of sacubitril plus valsartan has been proven to be more beneficial for heart failure with reduced ejection fraction in the long term compared with an ACEI/ARB alone. However, there is a lack of evidence of the efficacy and safety of this drug combination in CTRCD. We report a case of worsening CTRCD, despite treatment with traditional medications, in which the patient improved after changing perindopril to sacubitril/valsartan. The patient’s heart function greatly improved after changing this ACEI to sacubitril/valsartan. Changing an ACEI/ARB to sacubitril/valsartan in patients with worsening chemotherapy-induced heart failure is appropriate. Further studies with a high level of evidence are required to assess the efficacy and safety of sacubitril/valsartan for CTRCD.

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