233 results found
Matthews AA, Hinton SP, Stanway S, et al., 2021, Endocrine therapy use and cardiovascular risk in postmenopausal breast cancer survivors, HEART, Vol: 107, Pages: 1327-1335, ISSN: 1355-6037
Tan L-L, Lyon AR, 2021, Cardio-oncology for the general cardiologist, HEART, Vol: 107, Pages: 1254-1266, ISSN: 1355-6037
Couch LS, Fiedler J, Chick G, et al., 2021, Circulating microRNAs predispose to takotsubo syndrome following high-dose adrenaline exposure, Cardiovascular Research, ISSN: 0008-6363
AIMS: Takotsubo syndrome (TTS) is an acute heart failure, typically triggered by high adrenaline during physical or emotional stress. It is distinguished from myocardial infarction (MI) by a characteristic pattern of ventricular basal hypercontractility with hypokinesis of apical segments, and absence of coronary occlusion. We aimed to understand whether recently discovered circulating biomarkers miR-16 and miR-26a, which differentiate TTS from MI at presentation, were mechanistically involved in the pathophysiology of TTS. METHODS AND RESULTS: miR-16 and miR-26a were co-overexpressed in rats with AAV and TTS induced with an adrenaline bolus. Untreated isolated rat cardiomyocytes were transfected with pre-/anti-miRs and functionally assessed. Ventricular basal hypercontraction and apical depression were accentuated in miR-transfected animals after induction of TTS. In vitro miR-16 and/or miR-26a overexpression in isolated apical (but not basal) cardiomyocytes produced strong depression of contraction, with loss of adrenaline sensitivity. They also enhanced the initial positive inotropic effect of adrenaline in basal cells. Decreased contractility after TTS-miRs was reproduced in non-failing human apical cardiomyocytes. Bioinformatic profiling of miR targets, followed by expression assays and functional experiments, identified reductions of CACNB1 (L-type calcium channel Cavβ subunit), RGS4 (regulator of G-protein signalling 4) and G-protein subunit Gβ (GNB1) as underlying these effects. CONCLUSION: miR-16 and miR-26a sensitise the heart to TTS-like changes produced by adrenaline. Since these miRs have been associated with anxiety and depression, they could provide a mechanism whereby priming of the heart by previous stress causes an increased likelihood of TTS in the future. TRANSLATIONAL PERSPECTIVE: TTS-associated miRs have the potential to be active players predisposing to TTS. Feasibly, their measurement in recovered TTS patients during subsequent peri
Boriani G, Lee G, Parrini I, et al., 2021, Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management., Eur J Prev Cardiol, Vol: 28, Pages: 611-621
BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF.
Sokolski M, Gajewski P, Zymlinski R, et al., 2021, Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Acute Admissions at the Emergency and Cardiology Departments Across Europe, AMERICAN JOURNAL OF MEDICINE, Vol: 134, Pages: 482-489, ISSN: 0002-9343
Sliwa K, van der Meer P, Petrie MC, et al., 2021, Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy, European Journal of Heart Failure, Vol: 23, Pages: 527-240, ISSN: 1388-9842
This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non‐classified cardiomyopathies, left ventricular non‐compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo‐/radiotherapy for cancer or haematological malignancies need specific pre‐, during and post‐pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.
Matthews AA, Hinton SP, Stanway S, et al., 2021, Risk of Cardiovascular Diseases Among Older Breast Cancer Survivors in the United States: A Matched Cohort Study, JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, Vol: 19, Pages: 275-+, ISSN: 1540-1405
Lyon AR, Citro R, Schneider B, et al., 2021, Pathophysiology of Takotsubo syndrome: JACC state-of-the-art review, Journal of the American College of Cardiology, Vol: 77, Pages: 902-921, ISSN: 0735-1097
Takotsubo syndrome (TTS) has been a recognized clinical entity for 31 years, since its first description in 1990. TTS is now routinely diagnosed in patients who present with acute chest pain, electrocardiographic changes, troponin elevation, unobstructed coronary arteries, and a typical pattern of circumferential left ventricular wall motion abnormalities that usually involve the apical and midventricular myocardium. Increasing understanding of this intriguing syndrome stems from wider recognition, possible increasing frequency, and a rising number of publications focused on the pathophysiology in clinical and laboratory studies. A comprehensive understanding of TTS pathophysiology and evidence-based treatments are lacking, and specific and effective treatments are urgently required. This paper reviews the pathophysiology of this fascinating syndrome; what is known from both clinical and preclinical studies, including review of the evidence for microvascular dysfunction, myocardial beta-adrenergic signaling, inflammation, and electrophysiology; and where focused research needs to fill gaps in understanding TTS.
Baumgartner H, De Backer J, Babu-Narayan S, et al., 2021, The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC), EUROPEAN HEART JOURNAL, Vol: 42, Pages: 563-645, ISSN: 0195-668X
Ruiz-Garcia M, Bartra J, Alvarez O, et al., 2021, Cardiovascular changes during peanut-induced allergic reactions in human subjects, Journal of Allergy and Clinical Immunology, Vol: 147, Pages: 633-642, ISSN: 0091-6749
Background: Food allergy is the commonest cause of anaphylaxis. Changes in posture during acute reactions can trigger fatal outcomes, but the impact of allergic reactions on the cardiovascular system in non-fatal reactions remains poorly understood. Objective: To systematically evaluate changes in cardiovascular function during acute allergic reactions to peanut. Methods: Participants underwent double-blind placebo-controlled food challenge topeanut as part of a clinical trial. Changes in hemodynamic parameters (heart rate, stroke volume, blood pressure, peripheral blood flow) and electrocardiogram during food challenges were assessed using continuous monitoring. ClinicalTrials.gov Identifier: NCT02665793 Results: 57 adults (median age 24 (IQR 20-29) years, 53% female) participated; 22 (39%) had anaphylaxis. Acute reactions were associated with significant changes in stroke volume (mean decrease 4.2%, 95%CI 0.8 to 7.6; p=0.03), heart rate (mean increase 11.6%, 95%CI 8.4 to 14.8; p<0.0001) and peripheral blood flow (mean increase 19.7%, 95%CI 10.8 to 28.6; p<0.0001), irrespective of reaction severity. These changes were reproduced at subsequent repeat peanut challenge in 26 participants, and could be reversed with administration of intravenous fluids which resulted in faster resolution of abdominal symptoms. Conclusions: In this first detailed human study of cardiovascular changes during food-allergic reactions, we found evidence for significant fluid redistribution, independent of reaction severity. This provides a sound rationale for optimizing venous return during significant allergic reactions to food. Finally, these data provide a new paradigm for understanding severity in anaphylaxis, where poor outcomes occur due to a failure in compensatory mechanisms.Ruiz-Garcia et al 5 Clinical Implication: Significant changes in cardiovascular function, including decreased stroke volume, occur during peanut-induced allergic reactions in adults irrespective of severit
Čiburienė E, Čelutkienė J, Aidietienė S, et al., 2020, The prevalence of iron deficiency and anemia and their impact on survival in patients at a cardio-oncology clinic., Cardiooncology, Vol: 6
BACKGROUND: Iron deficiency (ID) and anemia are common in both heart failure (HF) and cancer patients and are associated with poor quality of life and survival. The aims of this study were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients. METHODS: We assessed iron, ferritin, hemoglobin concentrations, transferrin saturation (TSAT), cancer type, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), kidney function, cardiovascular risk factors and survival in 599 patients who were referred to cardio-oncology clinic from 2011 to 2017. ID was defined by a TSAT < 20%, absolute iron deficiency (AID) with a serum ferritin level < 100 μg/L while serum ferritin level of ≥ 100 μg/L was considered as functional iron deficiency (FID) and TSAT ≥ 20% was considered as no ID. RESULTS: The prevalence of ID, AID, and FID was 46, 31, and 15% of study patients, respectively. Anemia was present in approximately half (54%) of the patients with any ID. Multivariate Cox analyses showed that male gender (HR 1.704 [1.207-2.404] p = 0.002); previous cancer history (HR 1.879 [1.079-3.272] p = 0.026); elevated BNP (HR 2.126 [1.258-3.590] p = 0.005); TSAT< 20% (HR 1.721 [1.214-2.439] p = 0.002); ferritin ≥ 100 μg/L (HR 2.008 [1.088-3.706] p = 0.026); serum iron concentration < 12 μmol/L (HR 2.292 [1.614-3.255] p < 0.001); FID (HR 2.538 [1.1618-3.981] p < 0.001) and anemia (HR 2.462 [1.734-3.495] p < 0.001) were significantly associated with increased risk of all-cause death. CONCLUSIONS: About half of cardio-oncology patients had anemia and iron deficiency, with the ab
Broberg AM, Geisler J, Tuohinen S, et al., 2020, Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer., Curr Heart Fail Rep, Vol: 17, Pages: 397-408
PURPOSE OF REVIEW: Long-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment. RECENT FINDINGS: Baseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin antagonists. Early detection of cardiotoxicity with cardiac imaging and circulating cardiovascular biomarkers is currently evaluated in clinical trials. Chest wall irradiation accelerates atherosclerotic processes and induces fibrosis. Immune checkpoint inhibitors require consideration for surveillance due to a small risk of severe myocarditis. Cyclin-dependent kinases4/6 inhibitors, cyclophosphamide, taxanes, tyrosine kinase inhibitors, and endocrine therapy have a lower-risk profile for cardiotoxicity. Preventive and management strategies to counteract cancer treatment-related left ventricular dysfunction or heart failure in breast cancer patients should include a comprehensive cardiovascular risk assessment and individual clinical evaluation. This should include both patient and treatment-related factors. Further clinical trials especially on early detection, cardioprevention, and management are urgently needed.
de Boer RA, Hulot J-S, Tocchetti CG, et al., 2020, Common mechanistic pathways in cancer and heart failure. A scientific roadmap on behalf of the Translational Research Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC), EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 2272-2289, ISSN: 1388-9842
Holland J, Nicol E, Nazir S, et al., 2020, The added value of combined cardiopulmonary assessment with CT in distinguishing between cardiac tumours and thrombus, JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, Vol: 14, Pages: E149-E150, ISSN: 1934-5925
Seferovic PM, Fragasso G, Petrie M, et al., 2020, Heart Failure Association of the European Society of Cardiology update on sodium-glucose co-transporter 2 inhibitors in heart failure (an update on the sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology), EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1984-1986, ISSN: 1388-9842
Pudil R, Mueller C, Celutkiene J, et al., 2020, Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from theCardio-Oncology Study Groupof theHeart Failure Associationand theCardio-Oncology Council of the European Society of Cardiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1966-1983, ISSN: 1388-9842
Youn J-C, Chung W-B, Ezekowitz JA, et al., 2020, Cardiovascular disease burden in adult patients with cancer: An 11-year nationwide population-based cohort study, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 317, Pages: 167-173, ISSN: 0167-5273
Talukder S, Murphy MO, Lyon A, et al., 2020, Metastasectomy of left atrial mesenchymal chondrosarcoma, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 58, Pages: 861-863, ISSN: 1010-7940
Yakupoglu HY, Wechalekar K, Baksi AJ, et al., 2020, Exercise-Induced Reversible Apical Ballooning in a Patient With Previous Takotsubo Syndrome and Ongoing Symptoms, CIRCULATION-CARDIOVASCULAR IMAGING, Vol: 13, ISSN: 1941-9651
Tocchetti CG, Ameri P, de Boer RA, et al., 2020, Cardiac dysfunction in cancer patients: beyond direct cardiomyocyte damage of anticancer drugs: novel cardio-oncology insights from the joint 2019 meeting of the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart, CARDIOVASCULAR RESEARCH, Vol: 116, Pages: 1820-1834, ISSN: 0008-6363
Seferovic PM, Fragasso G, Petrie M, et al., 2020, Sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1495-1503, ISSN: 1388-9842
Celutkiene J, Pudil R, Lopez-Fernandez T, et al., 2020, Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC), EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1504-1524, ISSN: 1388-9842
Lyon AR, Dent S, Stanway S, et al., 2020, Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from theCardio-OncologyStudyGroup of theHeartFailureAssociation of theEuropeanSociety ofCardiology in collaboration with theInternationalCardio-OncologySociety, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1945-1960, ISSN: 1388-9842
Chioncel O, Parissis J, Mebazaa A, et al., 2020, Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 22, Pages: 1315-1341, ISSN: 1388-9842
Lyon A, Babalis D, Morley-Smith AC, et al., 2020, Investigation of the safety and feasibility of AAV1/SERCA2a gene transfer in patients with chronic heart failure supported with a left ventricular assist device – the SERCA-LVAD TRIAL, Gene Therapy, Vol: 27, Pages: 579-590, ISSN: 0969-7128
The SERCA-LVAD trial was a phase 2a trial assessing the safety and feasibility of delivering an adeno-associated vector 1 carrying the cardiac isoform of the sarcoplasmic reticulum calcium ATPase (AAV1/SERCA2a) to adult chronic heart failure patients implanted with a left ventricular assist device. Enrolled subjects were randomised to receive a single intracoronary infusion of 1x1013 DNase-resistant AAV1/SERCA2a particles or a placebo solution in a double-blinded design, stratified by presence of neutralising antibodies to AAV. Elective endomyocardial biopsy was performed at 6 months unless the subject had undergone cardiac transplantation, with myocardial samples assessed for the presence of exogenous viral DNA from the treatment vector. Safety assessments including ELISPOT were serially performed. Although designed as a 24 subject trial, recruitment was stopped after five subjects had been randomised and received infusion due to the neutral result from the CUPID 2 trial. Here we describe the results from the 5 patients, which confirmed that viral DNA was delivered to the failing human heart in 2 patients receiving gene therapy with vector detectable at follow up endomyocardial biopsy or cardiac transplantation. Absolute levels of detectable transgene DNA were low, and no functional benefit was observed. There were no safety concerns in this small cohort. This trial identified some of the challenges of performing gene therapy trials in this LVAD patient cohort, which may help guide future trial design.
Ananthan K, Lyon AR, 2020, The Role of Biomarkers in Cardio-Oncology, JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH, Vol: 13, Pages: 431-450, ISSN: 1937-5387
Zhang L, Awadalla M, Mahmood SS, et al., 2020, Cardiovascular megnetic resonance in immune checkpoint Inhibitor-associated myocarditis, EUROPEAN HEART JOURNAL, Vol: 41, Pages: 1733-+, ISSN: 0195-668X
López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, et al., 2020, Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry, European Heart Journal, Vol: 41, Pages: 1720-1729, ISSN: 0195-668X
AIM: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. METHODS AND RESULTS: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). CONCLUSIONS: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.
Reed N, Glen H, Gerrard G, et al., 2020, Expert Consensus on the Management of Adverse Events During Treatment with Lenvatinib for Thyroid Cancer, CLINICAL ONCOLOGY, Vol: 32, Pages: E145-E153, ISSN: 0936-6555
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