Long-Term Cardiac Safety of Dose-Dense Anthracycline Therapy Cannot Be Predicted From Early Ejection Fraction Data

Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2009; 27(36):6073-5. DOI: 10.1200/JCO.2009.25.5091
Source: PubMed
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    • "The contribution of personal susceptibility factors and pre-existing cardiac risk factors for women who are to receive cardiotoxic cancer therapy has yet to be fully elucidated but an increased vulnerability for adverse cardiac outcomes has been suggested [18, 20, 24]. It is a critical time for cardiology and oncology to collaborate to identify and develop interventions for women newly diagnosed with breast cancer in the presence of cardiac risk factors if our goal is to enhance the quality of life for cancer survivors and decrease morbidity and mortality [43-46] Fig. (1). "
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    ABSTRACT: The purpose of this paper is to identify risk factors for cardiovascular disease in women with breast cancer and review healthy lifestyle behaviors as essential risk reduction strategies. Women with breast cancer account for 22% of the 12 million cancer survivors. Women diagnosed with breast cancer often present with modifiable and non-modifiable cardiovascular risk factors and/or pre-existing co-morbid illness. Any one or a combination of these factors may increase the risk of cardiovascular disease. There is strong evidence that healthy eating and routine physical activity can reduce cardiovascular disease. Exercise improves cardiovascular fitness, body composition and quality of life in breast cancer survivors and observational studies suggest a survival benefit. Lifestyle interventions including a healthy diet, regular physical activity, weight management and smoking cessation should be integrated into a survivorship care plan to reduce cardiovascular disease risk and promote better health for women with breast cancer.
    Current Cardiology Reviews 11/2011; 7(4):250-7. DOI:10.2174/157340311799960627
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    ABSTRACT: Anthracycline has been shown to degrade titin that plays a role in myocardial twisting and untwisting. This study aimed to test the hypothesis that left ventricular (LV) twisting and untwisting motion may be altered in children after anthracycline therapy. Thirty-six childhood leukemia survivors aged 15.6 ± 5.5 years and 20 healthy controls aged 16.8 ± 7.7 years (P = 0.54) were studied. LV twisting and untwisting motion was determined using speckle tracking imaging, whereas LV ejection fraction and systolic and diastolic mitral annular velocities were determined respectively by three-dimensional and tissue-Doppler echocardiography. Compared with controls, patients had significantly lower LV ejection fraction (P = 0.01) but similar systolic and diastolic mitral annular velocities (all P > 0.05). Their peak LV torsion (P = 0.003), systolic twisting velocity (P < 0.001), and diastolic untwisting velocity (P = 0.04) were significantly lower than controls, which could be attributable to their reduced apical rotation (P = 0.03) and apical untwisting rate (P = 0.002). For the whole cohort, LV systolic torsion and twisting velocity correlated significantly with apical untwisting rate (P < 0.001) and LV diastolic untwisting velocity (P < 0.001). In patients, none of the twisting or untwisting parameters were found to correlate with cumulative anthracycline dose (all P > 0.05). Twenty-eight (78%) patients had LV ejection fractions ≥50%. Although their systolic and diastolic mitral annular velocities were similar to those of controls, their peak LV torsion (P = 0.005), apical untwisting rate (P = 0.01), and LV systolic twisting velocity (P = 0.001) remained significantly lower. Impairment of LV twisting and untwisting motion is evident in children after anthracycline therapy, even in those with "normal" LV ejection fractions.
    Echocardiography 05/2011; 28(7):738-45. DOI:10.1111/j.1540-8175.2011.01429.x · 1.25 Impact Factor
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    ABSTRACT: Early recognition of cardiotoxicity from oncologic treatments is essential to set-up a strategy to prevent irreversible damage and heart failure. The left ventricular ejection fraction, regardless of the technique used for its calculation, is today recognized as inadequate to detect early cardiotoxicity and should not be used anymore as the sole index to assess left ventricular function. In the last years, a number of other parameters derived from cardiovascular imaging techniques have been proposed for cardiotoxicity recognition and many of them have shown a greater diagnostic accuracy in predicting acute and chronic cardiac damage or functional impairment caused by oncology treatments compared to the left ventricular ejection fraction. In addition, data are available that show the opportunity to evaluate also heart valves, pericardium and arterial and venous vasculature. However, because all current information on the role of cardiovascular imaging techniques in cardioncology are derived from monocenter, small, non randomized, observational studies, there is the need for large multicenter trials in this field. This is a challenge for both cardiologists and oncologists, who should work together to achieve this goal.
    06/2011; 21(2):60–72. DOI:10.1016/j.jcecho.2011.05.006
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