scholarly journals Phasic Left Atrial Function in Cancer Patients Before Initiation of Anti-Cancer Therapy

2019 ◽  
Vol 8 (4) ◽  
pp. 421 ◽  
Author(s):  
Marijana Tadic ◽  
Martin Genger ◽  
Cesare Cuspidi ◽  
Evgeny Belyavskiy ◽  
Athanasios Frydas ◽  
...  

: We aimed to explore left atrial (LA) remodeling in the patients with solid cancer before initiation of chemo- or radiotherapy. This retrospective investigation included 92 chemo- and radiotherapy-naive cancer patients and 40 age- and gender-matched controls with a similar cardiovascular risk profile as the cancer group. All participants underwent comprehensive echocardiographic examination before the start of chemo- or radiotherapy. LA phasic function was evaluated in volumetric and strain method. Indexed minimal and pre-A LA volumes were significantly higher in the cancer patients. Total and passive LA emptying fraction (EF) were significantly lower, whereas active LAEF was significantly higher in the cancer patients. LA total longitudinal strain was significantly lower in the cancer patients. Strain rate analysis of LA phasic function showed that LA function during systole and early diastole was reduced in the cancer group, while it was increased during late diastole. These findings indicated that LA reservoir and conduit functions, assessed with LA volumetric and strain analysis, were deteriorated in the cancer group. On the other hand, LA booster pump function was elevated in the cancer group in comparison with the controls. In the whole population, cancer was associated with reduced LA total longitudinal strain independently of age, gender, BMI, LV hypertrophy, E/e’ ratio, diabetes, and hypertension. LA phasic function was impaired in the chemo- and radiotherapy-naive cancer patients in comparison with the control group. Cancer, LV hypertrophy, and hypertension were associated with reduced LA longitudinal strain independently of other important clinical parameters.

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Antonio Parlavecchio ◽  
Rodolfo Caminiti ◽  
Giampaolo Vetta ◽  
Giuseppe Pelaggi ◽  
Francesca Lofrumento ◽  
...  

Abstract Aims Worsening of cardiac function with increased arrhythmic risk is common in cancer patients undergoing chemotherapy. Impaired LV global longitudinal strain (GLS) in these patients despite preserved ejection fraction is a common issue. Recently, myocardial work by speckle-tracking echocardiography has been used to overcome GLS limitations in various conditions, but little is known about its usefulness in the detection of cardiac toxicity. Moreover, left atrial (LA) toxicity may occur early in the course of cancer therapy. The main aim of the study was to assess the cardiotoxic effects of tyrosine kinase inhibitors (TKIs) on patients with Philadelphia chromosome-positive chronic myeloid leukaemia (Ph+ CML) by using novel echocardiographic tools as myocardial work and atrial strain analysis. Methods and results We retrospectively enrolled Ph+ CML patients treated with TKIs followed at the cardio-oncology outpatient clinic of our hospital from December 2018 to March 2019 who underwent clinical evaluation with ECG and echocardiogram (TTE) before and after 1 year of treatment with TKIs. Healthy subjects were enrolled in the control group matched for gender, age and cardiovascular risk factors. Myocardial work was derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. LA longitudinal strain (reservoir, conduit, and booster) was obtained from an optimized apical 4-chamber view of the LA. The study recruited 32 patients in Ph+ CML group and 32 healthy controls. 39% of patients were treated with Imatinib, 29.3% with Nilotinib, 4.9% with Dasatinib and 4.9% with Ponatinib. Main results are detailed in Table 1. At 1-year follow-up there was a significant reduction compared to baseline in global constructive work (2555.22 ± 564.33 vs. 2119.31 ± 700.19; P = 0.0001), global work efficiency (96.13 ± 1.90 vs. 94.00 ± 2.96; P = 0.002), and global work index (2340.75 ± 579.57 vs. 1938.46 ± 680.23; P = 0.001), and a non-significant reduction in global wasted work (P = 0.393). Regarding left atrial strain analysis at the 1-year follow-up there was a statistically significant reduction in LA contractile strain (booster= 14.63 ± 1.408 vs. 12.38 ± 1.581; P = 0.018). LA contractile strain reduction was also observed in the comparison with controls (12.38 ± 2.99 vs. 14.91 ± 3.09; P = 0.009). Any other significant difference was detected between baseline and FU TTE data in the Ph+ CML group. Conclusions New imaging methods for the study of cardiotoxicity provide an additional tool for early prediction of potential adverse effects of antineoplastic drugs. TKIs therapy leads to an impairment of atrial contractility, which can be detected by atrial strain e myocardial work analysis.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12018-e12018
Author(s):  
Bruno Gustavo Muzzi Carvalho Carneiro ◽  
Andy Petroianu ◽  
Rafael Augusto Ribeiro Carvalho ◽  
Thiago Neto Ribeiro ◽  
Ana Maria Santos Rodrigues

e12018 Background: Many studies have suggested an inverse association between allergies and cancer, while others have found no relation between them, and still others have shown an increased risk of cancer in allergy patients. The conflicting findings from prior studies are partially due to the chosen research method, such as different definitions and measures for atopy, in addition to variations in the control of confusion factors, such as smoking and obesity. Objectives: Verify if there is a relation between certain types of cancer and allergies; investigate if there is a difference between individuals with and without cancer in relation to allergies. Methods: Case-control study carried out at the Alberto Cavalcanti Hospital of the Hospital Foundation of the State of Minas Gerais (FHEMIG), Brazil, from 2009 to 2011. The study included patients over 18 years of age, from both genders, who presented a diagnosis of cancer, as compared to healthy individuals, paired by gender and age. An anamnesis was gathered considering the medical history of the allergy, as diagnosed by a doctor, as well as the patients’ habits, associated illnesses, and the use of medications. For cancer patients, data concerning the tumor were recorded. Subsequently, an allergy percutaneous test was performed in each group to detect allergic hyperreactivity toward common inhalable, bacterial, and food antigens within our everyday environment. A blood sample was collected to quantitatively evaluate the eosinophils. Results: Both groups were paired according to interest variables, and eventual deviations were adjusted by means of multivariate analysis. Reports of allergies occurred in 30% of the patients in the cancer group, as compared to 53% in the control group (p<0.05), whereas in the cutaneous tests, a greater positivity occurred in the cancer group (69%) than in the control group (51%, p<0.05). No difference in the eosinophil values could be observed within the groups. Conclusions: Cancer patients present fewer allergies. By contrast, in cancer patients, positive cutaneous tests detected allergies which did not correspond to the clinical findings. Therefore, in cancer patients, the positive cutaneous test for allergies does not present a direct relation to the presence of clinically detectable allergies.


2019 ◽  
Author(s):  
Kenji Gonda ◽  
Kenji Yaginuma ◽  
Yuichi Rokkaku ◽  
Shoichiro Horita ◽  
Yuko Maejima ◽  
...  

Abstract Objectives In an aging population, an increase in the number of elderly cancer patients with cognitive impairment is expected. The possible association between cancer and cognitive impairment is important to elucidate, because it can have a serious impact on quality of life. Here, we focused on glucose metabolism as a factor that links cancer and cognitive impairment. Results Thirteen subjects with solid cancers and cognitive impairment were recruited. As a control group, 14 subjects with cognitive impairment alone and 8 subjects with cancer alone were recruited. A Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and that of β-cell function (HOMA-B) were used. In comparison with patients with solid cancer alone, those with cognitive impairment alone and those with both cancer and cognitive impairment had increased HOMA-IR values. Insulin resistance was increased in patients with cognitive impairment alone and those with both cognitive impairment and solid cancer than in patients without cognitive impairment; however, β-cell function was not affected. The present data indicated that elderly cancer patients with high HOMA-IR score may be at a relatively high risk for developing cognitive impairment. Furthermore, early treatment to reduce insulin sensitivity may prevent cognitive impairment.


2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Xuming Zhu ◽  
Huizhu Song ◽  
Yan Chen ◽  
Feifei Han ◽  
Qiong Wang ◽  
...  

Objective. Inflammation-driven markers play a crucial role in tumorigenesis and tumor progression. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in blood are systemic inflammatory response markers. Some reports have showed that NLR and PLR are related to a poor prognosis in patients with lung cancer. However, little studies have reported whether NLR and PLR can be diagnostic markers for lung cancer. The aim of the current study is to investigate the roles of NLR and PLR in diagnosing lung cancer. Methods. This study analyzed data from lung cancer patients and healthy individuals in Wuxi People’s Hospital Affiliated with Nanjing Medical University. The Mann–Whitney U test was performed to compare differences between the lung cancer group and the control group. Based on white blood cell (WBC) counts, both lung cancer patients and healthy individuals were divided into the low-level group, moderate-level group, and high-level group. The Kruskal-Wallis test was applied to compare differences of NLR and PLR among those groups with different WBC counts. Spearman correlation analysis was used to assess correlations. Receiver operating characteristic (ROC) curves were performed to determine diagnostic accuracy. Results. 210 patients diagnosed with lung cancer and 261 healthy subjects were enrolled in this study. Levels of NLR and PLR increased in the lung cancer group compared with the control group ( P < 0.001 ). For the lung cancer group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels had no significant variation with the increasing of WBC levels ( P = 0.206 ). For the control group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels would decline with the increasing of WBC levels ( P < 0.001 ). In the lung cancer group, both NLR and PLR had no significant correlations with aspartate transaminase, urea, and glucose. The area under the curve (AUC) with 95% confidence interval (95% CI) of NLR and PLR to distinguish lung cancer patients from healthy subjects was, respectively, 0.684 (0.634-0.735) and 0.623 (0.571-0.674). When NLR and PLR were combined, AUC (95% CI) increased to 0.691 (0.642-0.740). Conclusions. NLR and PLR alone have moderate ability to distinguish lung cancer patients from healthy subjects. Furthermore, combination forms of NLR and PLR can improve diagnostic ability.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Mansencal ◽  
S Utado ◽  
M Hauguelf-Moreau ◽  
S Mallet ◽  
P Charron ◽  
...  

Abstract Background In hypertrophic cardiomyopathy (HCM), longitudinal strain analysis allows to early detect left ventricular (LV) contraction abnormalities despite preserved LV ejection fraction. In current software, the width of the region of interest (ROI) is the same over the entire myocardial wall, and might analyze partially LV hypertrophic segments. Purpose The aim of this study is to evaluate a novel software for strain analysis with an adjustable ROI according to each segment thickness. Methods We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). All patients underwent echocardiography using a Vivid 9 GE system and measurements were performed using EchoPAC software. Global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for 2 groups) and with software adjusted to the myocardial wall thickness (for HCM group). Results GLS was significantly decreased in the HCM group as compared to the control group (−15.1±4.8% versus −20.5±4.3%, p<0.0001). In HCM group, GLS (standard method versus adjusted to thickness) were not significantly different (p=0.34). Interestingly, regional strain adjusted to thickness was significantly lower than standard strain in hypertrophic segments, especially in basal inferoseptal segment (p=0.0002), median inferoseptal segment (p<0.001) and median anteroseptal segment (p=0.02). Strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7±3%, versus −5.9±4.4%, p=0.049 in the basal inferoseptal segment and −5.7±3.5% versus −8.3±4.5%, p=0.0007 in the median inferoseptal segment). Analysis of strain adjusted to thickness had a better feasibility (97.5% versus 99%, p=0.01). Conclusion Analysis of longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Nabeshima ◽  
K Otani ◽  
T Kitano ◽  
M Takeuchi

Abstract Funding Acknowledgements Philips Medical Systems Background Continuous efforts of EACVI-ASE strain standardization task force make inter-vendor variability of left ventricular (LV) global longitudinal strain (GLS) lower. However, observer variability is still a major source of measurement inconsistency. The adoption of fully automated 2D strain software has a potential to eliminate this problem. Purpose We aimed to validate the usefulness of novel fully automated LV, left atrial (LA), and right ventricular (RV) 2D speckle tracking software packages. Methods We retrospectively selected 91 healthy subjects who had undergone 2D echocardiography using a specific ultrasound machine (EPIQ, Philips Medical Systems). Standard apical 4-chamber, 2-chamber, and long-axis views which encompassed whole part of both left ventricle and left atrium and RV focused view were acquired in all subjects. Novel fully automated speckle tracking software packages (AutoStrain, QLAB 13.0) were used for measuring GLS on the three apical views, LA longitudinal strain (LALS) on the apical-4-chamber view, and RV free wall longitudinal strain (RVfwLS) on the RV-focused view. Image quality was assessed by 3-point scales (good, fair, and poor). Endocardial border detection was also classified into 3 groups (adequate, poor, and no detection). Endocardial border was manually adjusted, when required. Results of fully automated analysis and results with fully automated analysis + manual editing were compared. Results Mean age was 37 ± 13 years, and 61 subjects were men. The image quality was categorized more than "fair" in 80% of subjects. The software did not recognize LA border in 3 cases and RV border in 4 cases. Thus, the feasibility of fully automated LV, LA, and RV analysis were 100%, 97%, and 96%, respectively. LVGLS, LALS, and RVfwLS using fully automated approach were 19.7 ± 2.3%, 45.5 ± 11.6%, and 25.7 ± 5.6%, respectively. Manual correction was required in all cases. LVGLS, LALS, and RVfwLS after the manual editing were 18.9 ± 2.1%, 44.0 ± 10.4%, and 26.6 ± 6.4%. The intraclass correlation coefficient (ICC) between the two methods were 0.86, 0.72, and 0.74. The fully automated analysis took 22 ± 2 sec, 11 ± 1 sec, and 10 ± 1 sec for the measurements of LVGLS, LALS, and RVfwLS. The corresponding values with manual editing were 98 ± 18 sec, 53 ± 12 sec, and 52 ± 12 sec, respectively. Inter-observer ICCs of LVGLS, LALS, and RVfwLS with fully automated approach were all 1.0, but corresponding values after the manual editing were 0.82, 0.74, and 0.79, respectively. Conclusions Novel fully automated 2D speckle tracking software packages provide LVGLS, LALS, and RVfwLS within one minute, and these values were well correlated with the corresponding values after the manual editing, especially for LVGLS. This is a time-saving approach for longitudinal strain analysis in the three cardiac chambers. Further studies should be required to validate their potential utility in clinical setting.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
G Claessen ◽  
L Stefani ◽  
D Flannery ◽  
P Brown ◽  
...  

Abstract Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon. Methods 36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis. Results All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients. Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls. Conclusions Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF. Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 &lt;0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 &lt;0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 &lt;0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 &lt;0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 &lt;0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 &lt;0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 &lt;0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial


2017 ◽  
Vol 42 (5) ◽  
Author(s):  
Soykan Arikan ◽  
Alper Gümüş ◽  
Özlem Küçükhüseyin ◽  
Cihan Coşkun ◽  
Saime Turan ◽  
...  

AbstractObjective:Gastric cancer is one of the most common malignancies worldwide. The risk factors for gastric cancer include environmental and genetic factors. Inflammation and the immune system are known to contribute to the development of the gastric cancer. We examined the influence of critical polymorphisms of CTLA-4 and CD28 genes and circulating protein levels on the etiology of gastric cancer.Methods:Genotyping of SNPs was performed in 55 gastric cancer patients and 105 healthy individuals using the PCR-RFLP method, and circulating levels of sCTLA-4 and sCD28 were measured.Results:There were no significant differences in the genotype and allele distributions of the evaluated SNPs [CTLA-4-318 C>T (rs5742909), CTLA-4+49 A>G (rs231775), CD28 C>T (rs3116496)] between gastric cancer patients and controls (p=0.36, p=0.78, and p=0.80, respectively). The circulating levels of sCTLA-4 and sCD28 were significantly different between the gastric cancer group and the control group (p<0.001 and p<0.001, respectively).Conclusion:The present results suggest that the CTLA-4 and CD28 gene polymorphisms that were evaluated do not play an important role in Turkish patients with gastric cancer. However, sCTLA4 and sCD28 levels were higher in cancer patients and may be useful as an auxiliary parameter in the diagnosis and monitoring of gastric cancer.


2020 ◽  
Author(s):  
Arisara Kiatsilapanan ◽  
Sirilak Surachetpong

Abstract Background : Left atrial (LA) function plays an important role in diastolic dysfunction in cats with hypertrophic cardiomyopathy (HCM). Two-dimensional speckle tracking echocardiography (2D-STE) is a novel technique for assessing LA function. This study aimedto evaluate changes in the LA function inHCM cats compared to normal cats, using 2D-STE. Results: Seventeen client-owned cats affected with HCM and twenty healthy control cats. Conventional echocardiographic and 2D-STE variables were measured and compared between groups (the normal and HCM groups). The difference between two groups was compared by using the independent Student’s t-test. A p -value less than 0.05 was considered significant. Variability from the 2D-STE variables tests displayed good reproducibility (coefficient of variation ≤15%). The mean value of peak atrial longitudinal strain (PALS) in the HCM group (13.16 ± 8.64) was lower in the control group (28.54 ±10.31) ( p < 0.001). PALS was lowest at the LA roof region. The atrial longitudinal strain of septal and lateral regions was significantly lower in the HCM group than the normal group. PALS correlated with the percentage of the LA fractional shortening (LA-FS) (r=0.538, p =0.001), the percentage of the LA ejection fraction (LA-EF) (r =0.797, p <0.001), and the LA fractional area change (FAC) (r =0.746, p <0.001). Conclusions: PALS can be used to evaluate changes in theLA function in HCM cats. It is a reproducible method for assessing the LA function in cats affected with HCM. Keywords cats; heart; left atrium; strain


2021 ◽  
Vol 29 (1) ◽  
pp. 68-76
Author(s):  
Andrew Robinson ◽  
Andrew Mazurek ◽  
Minqi Xu ◽  
Yanping Gong

(1) Background: To date, data addressing the antibody response of cancer patients to SARS-CoV-2 vaccines are limited. To our knowledge, this is the first report to evaluate humoral immunity. responses in Canadian cancer patients. (2) Methods: 116 cancer patients and 35 healthy participants were enrolled in this cross-sectional study. The interval between the first and second doses were closely matched during analysis. IgG antibodies against the SARS-CoV-2 spike receptor–binding domain were determined using an enzyme-linked immunosorbent assay (ELISA). (3) Results: Following two doses of SARS-CoV-2 vaccine (including BNT162b2, AZD1222, and mRNA-1273), the mean serum anti-spike protein antibody level was 382.4 BAU/mL (binding antibody unit, SD ± 9.4) in the control group, 265.8 BAU/mL (±145.7) in solid cancer patients, and 168.2 BAU/mL (±172.9) in hematological cancer patients. Observed differences were significantly lower in both solid and hematological groups when comparing to the control group (p ≤ 0.0001). In solid cancer group, patients with cytotoxic chemotherapy demonstrated significantly lower antibody levels (p < 0.01), whereas the rest of the patients showed similar antibody levels as the healthy control. Antibody levels were lower in those on treatment than those off treatment in patients with hematological malignancies (p < 0.0001) but not for those with solid cancers (p = 0.4553). (4) Conclusions: After two doses of the SARS-CoV-2 vaccination, patients with solid and hematological malignancies demonstrated impaired serological responses. This was particularly prominent if there was cytotoxic chemotherapy or systemic therapy in solid and hematological cancer, respectively.


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