2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano, José Luís; Lancellotti, Patrizio; Muñoz, Daniel; Aboyans, Victor; Asteggiano, Riccardo; Galderisi, Maurizio; Habib, Gilbert; Lenihan, Daniel J.; Lip, Gregory Y.H.; Lyon, Alexander R.; Fernández, Teresa López; Mohty, Dania; Piepoli, Massimo F; Tamargo, Juan; Torbicki, Adam; Suter, Thomas M.

doi:10.5603/kp.2016.0156

Cited by 79 publications

(111 citation statements)

References 275 publications

(391 reference statements)

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“…Cardiac toxicity was defined as a decrease of more than 10% in LVEF compared to the lower limit of the specified normal value without any heart failure‐associated symptoms. Additionally, cardiac toxicity was also defined as a >5% decrease in LVEF along with the presence of heart failure symptoms …”

Section: Methodsmentioning

confidence: 99%

“…Echocardiography is a common cardiac toxicity monitoring method, since it enables the identification of LV dysfunction, valve, and pericardial diseases, especially LV systolic dysfunction, but the traditional ultrasound indexes, such as left ventricular ejection fraction (LVEF), are not sufficiently sensitive for the detection of early changes in cardiac function . Anthracycline dosage is relatively low for the treatment of breast cancer in China.…”

Section: Introductionmentioning

confidence: 99%

“…Two‐dimensional strain parameters, especially left ventricular longitudinal strain, have been shown to precede a decrease in LVEF during anthracycline chemotherapy. ASE/EACVI and ESC guidelines both strongly recommend a GLS‐based follow‐up during the course of chemotherapy …”

Section: Introductionmentioning

confidence: 99%

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Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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Background Anthracycline‐related cardiotoxicity has a poor prognosis; therefore, early detection of any change in LV function is critical. Objective The aim of this study was to evaluate the two‐dimensional speckle tracking technique for the early detection of cardiac toxicity after low‐dose anthracycline chemotherapy in the Chinese population. Methods Forty breast cancer patients were treated by chemotherapy using anthracycline for 4–6 cycles. Patients were examined by echocardiography before chemotherapy (T0) and after the second (T2), fourth (T4), and sixth (T6) cycle. LV ejection fraction (LVEF), LV global longitudinal strain (GLS) and endocardium, mid‐myocardium, and epicardium global longitudinal strain (GLS‐Endo, GLS‐Mid, and GLS‐Epi). Additionally, global circumferential strain (GCS), RV global longitudinal strain (RVGLS), and LA global longitudinal strain (LAGLS) were evaluated. Results Left ventricular ejection fraction was significantly reduced at T4 (P < 0.05). Compared with T0, GLS, GLS‐Endo, GLS‐Mid, and GLS‐Epi were significantly reduced at T2, T4, and T6 (P < 0.05 for all), the apical septum wall (AS) was also reduced significantly at T2 (P < 0.05), and the apical anterior wall (AA) and the basal anterior wall (BA) longitudinal strains were significantly reduced at T4 (P < 0.05). GCS, RVGLS, and LAGLS were not significantly changed after treatment (P > 0.05). Conclusions LV stratified strains and strain of the segments supplied by the left anterior descending coronary artery are more sensitive to the cardiac toxicity of anthracycline.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anqi

Zhang

et al. 2019

Echocardiography

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“…A recent consensus paper from the ESC proposed a definition of chemotherapy-related cardiotoxicity as an LVEF decrease of >10 percentage points from baseline to a value <53% on repeat confirmatory echocardiographic imaging 25. Current protocols are guided by expert consensus and typically recommend quantification of LVEF prior to starting anthracycline and following completion of chemotherapy with additional on-therapy measurement for patients receiving cumulative doses >200 mg/m 2 of doxorubicin 4. Baseline LV dysfunction is a strong marker for developing heart failure complications with anthracycline and may be detected more commonly in elderly comorbid patients and those who have received previous cardiotoxic regimes.…”

Section: Monitoring For Cardiotoxicitymentioning

confidence: 99%

“…Patients who develop asymptomatic decline in LVEF reaching criteria for cardiotoxicity should be considered for guideline-based heart failure treatment either with ACEi/angiotensin receptor blockade (ARB) alone or in combination with β-blockade 4. Of 226 patients who developed cardiotoxicity following anthracycline-based chemotherapy and received treatment with enalapril or enalapril and β-blocker in combination, 11% exhibited complete recovery of LVEF, 18% had no recovery and the remainder exhibited partial LVEF recovery to baseline over a period of 5-year echocardiographic follow-up 11.…”

Section: Prevention and Treatment Of Cardiotoxicitymentioning

confidence: 99%

Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention

Henriksen

2017

Heart

359

260

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Anthracycline chemotherapy causes dose-related cardiomyocyte injury and death leading to left ventricular dysfunction. Clinical heart failure may ensue in up to 5% of high-risk patients. Improved cancer survival together with better awareness of the late effects of cardiotoxicity has led to growing recognition of the need for surveillance of anthracycline-treated cancer survivors with early intervention to treat or prevent heart failure. The main mechanism of anthracycline cardiotoxicity is now thought to be through inhibition of topoisomerase 2β resulting in activation of cell death pathways and inhibition of mitochondrial biogenesis. In addition to cumulative anthracycline dose, age and pre-existing cardiac disease are risk markers for cardiotoxicity. Genetic susceptibility factors will help identify susceptible patients in the future. Cardiac imaging with echocardiographic measurement of global longitudinal strain and cardiac troponin detect early myocardial injury prior to the development of left ventricular dysfunction. There is no consensus on how best to monitor anthracycline cardiotoxicity although guidelines advocate quantification of left ventricular ejection fraction before and after chemotherapy with additional scanning being justified in high-risk patients. Patients developing significant left ventricular dysfunction with or without clinical heart failure should be treated according to established guidelines. Liposomal encapsulation reduces anthracycline cardiotoxicity. Dexrazoxane administration with anthracycline interferes with binding to topoisomerase 2β and reduces both cardiotoxicity and subsequent heart failure in high-risk patients. Angiotensin inhibition and β-blockade are also protective and appear to prevent the development of left ventricular dysfunction when given prior or during chemotherapy in patients exhibiting early signs of cardiotoxicity.

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Cardiovascular disease burden in patients with urological cancers: The new discipline of uro‐cardio‐oncology

Zheng,

Liu,

Chen

et al. 2024

Cancer Innovation

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Cancer remains a major cause of mortality worldwide, and urological cancers are the most common cancers among men. Several therapeutic agents have been used to treat urological cancer, leading to improved survival for patients. However, this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications. Here, we propose the novel discipline of uro‐cardio‐oncology, an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer. In this comprehensive review, we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers, including androgen deprivation therapy, vascular endothelial growth factor receptor tyrosine kinase inhibitors, immune checkpoint inhibitors, and chemotherapeutics. In addition, we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance, diagnosis, and effective management of cardiovascular complications. Finally, we provide an analysis of future perspectives in this emerging specialty, identifying areas in need of further research.

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2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Cited by 79 publications

References 275 publications

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy

Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention

Cardiovascular disease burden in patients with urological cancers: The new discipline of uro‐cardio‐oncology

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