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Review Article epIdemIologyAlthough the prevalent cardiologic complication in oncologic patients is represented by systolic dysfunction and heart failure, valvular heart disease (VHD) occurs in many cases, especially as a late cardiotoxic effect of radiation therapy, which incidence is estimated near to 10% of treated patients. [1] Hemodynamically significant (> moderate) valve disease is more common >10 years' following radiation. [2] It has been known since the 1960s that valve dysfunction can be caused by cancer therapy. VHD incidence is increased following cardiac irradiation, [3] but recent studies suggest that radiation-induced heart disease (RIHD) is decreasing, probably due to changes in radiation techniques. [4] Regarding chemotherapy, it has recently been reported that patients treated with anthracycline and aromatase inhibitors are at higher risk of developing cardiovascular diseases other than heart failure, such as VHD. [5] Valvular disease induced by cancer therapy is still the subject of research to fully understand its pathogenesis and its ideal management. Its main characteristics are shown in Table 1. [6] Due to the latency of the presentation of valvular dysfunction, the diagnosis is delayed and more often incidental, and most of the studies that explore radio and VHD chemotherapy have been retrospective and observational. etIopathogenesIsVHD may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to the left ventricle (LV) dysfunction. [1] Radiation-induced valvular heart diseasesRadiotherapy has helped reduce the mortality rate of some cancers over the past 60 years. In patients with Hodgkin's lymphoma (HL), when combined with chemotherapy, radiotherapy improved survival by almost 60%. [7] In patients with breast cancer, relapse rates decreased by about half, resulting in a 15-year survival of 60%. [8] Radiotherapy is Valvular heart diseases (VHD) may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to the left ventricle dysfunction. The incidence of VHD is especially in younger survivors treated with thoracic radiation therapy for certain malignancies, such as Hodgkin's lymphoma and breast cancer. The mechanism of radiation-induced damage to heart valves is not clear and includes diffuse fibrocalcific thickening of the valve. VHD is commonly diagnosed after a long latent period, in the context of clinical symptoms, or suspected on the basis of a new murmur. The evaluation includes identification of anatomical valve abnormalities, valve dysfunction, and assessing the functional consequences of valve dysfunction on the ventricles. Echocardiography is the optimal imaging technique for diagnostic and therapeutic management. Cardiovascular magnetic resonance and computed tomography (CT) may be used to assess the severity of VHD, but cardiac CT is mainly useful for detecting extensive calcifications of the as...
The aim of the study was to evaluate the application of global longitudinal strain (GLS) and myocardial work (MW) at rest and during exercise in healthy sedentary or trained participants, to test their ability to improve echocardiographic information and to complement prescribing exercise, cardiac screening, or rehabilitation programs. Methods: Thirty healthy males were divided into three groups of 10, sedentary (G1), resistance (G2) and power (G3) athletes, underwent a standard clinical evaluation protocol and exercise stress testing echocardiography. Results: During stress, all showed increased left ventricular ejection fraction and mitral annulus tissue Doppler (E'). G1 showed a decrease in left atrial volume (LAVi) as opposed to an increase in G3. E/E 'a decrease in G2, unlike the increase in G3. All groups showed increase of Strain (GLS average AV, Longitudinal LS, Medio-Basal MB Apical AP), global constructive work (GCW), and Global wasted work. G1 showed increase for global work efficiency, G2 and G3 for global work index (GWI). G3 showed a greater variation of E/E', LAVi, GWI and GCW compared to G1 and G2, greater of GLS AV, LS-AP compared to G2. Only G3 showed differences for GLS AV versus LS-AP. The relative regional strain ratio showed a greater value in G3 versus G1 at the end of stress compared to rest. Conclusions: The new echocardiographic applications to study the physiological adaptation could open new perspectives for the diagnostic and therapeutic development through the prescription of personalized exercises and screening and follow-up of the early pathological changes of the athlete's heart.
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