Advanced Heart Failure Therapies for Patients With Chemotherapy-Induced Cardiomyopathy

Oliveira, Guilherme H.; Qattan, Marwan; Al‐Kindi, Sadeer G.

doi:10.1161/circheartfailure.114.001292

Cited by 45 publications

(43 citation statements)

References 96 publications

(80 reference statements)

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“…132 Retrospective data shows that patients with chemotherapy-induced HF benefit from advanced HF therapies, including cardiac-resynchronization therapy, ventricular assist devices, and orthotropic heart transplant with similar outcomes to patient with other forms of HF. 133 Two studies demonstrate that cancer survivors who need OHT because of chemotherapyrelated cardiomyopathy have similar outcomes to other causes of cardiomyopathy both at short and long-term follow-up of 10-years. Interestingly, there is no increased risk of death because of recurrent malignancy in this population.…”

Section: Circulation Researchmentioning

confidence: 99%

Cardio-Oncology

Lenneman

Sawyer

2016

Circulation Research

335

138

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Through the success of basic and disease-specific research, cancer survivors are one of the largest growing subsets of individuals accessing the healthcare system. Interestingly, cardiovascular disease is the second leading cause of morbidity and mortality in cancer survivors after recurrent malignancy. This recognition has helped stimulate a collaboration between oncology and cardiology practitioners and researchers, and the portmanteau cardio-oncology (also known as onco-cardiology) can now be found in many medical centers. This collaboration promises new insights into how cancer therapies impact cardiovascular homeostasis and long-term effects on cancer survivors. In this review, we will discuss the most recent views on the cardiotoxicity related to various classes of chemotherapy agents and radiation. We will also discuss broadly the current strategies for treating and preventing cardiovascular effects of cancer therapy.

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Section: Circulation Researchmentioning

confidence: 99%

Cardio-Oncology

Lenneman

Sawyer

2016

Circulation Research

335

138

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“…The estimated prevalence of cardiomyopathy in 50‐year‐old survivors of childhood cancer exposed to cardiotoxic chemotherapy or radiation is 21% . Once AC‐induced cardiomyopathy develops, it is commonly progressive, with no definitive treatment other than implantation of a left ventricular assist device and/or heart transplantation . Currently, methods to detect subclinical cardiac injury early in the course of progressive cardiotoxicity are lacking.…”

Section: Introductionmentioning

confidence: 99%

Circulating microRNAs: Potential Markers of Cardiotoxicity in Children and Young Adults Treated With Anthracycline Chemotherapy

Leger

Léonard

Nielson

et al. 2017

JAHA

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BackgroundBiomarkers for early detection of anthracycline (AC)‐induced cardiotoxicity may allow cardioprotective intervention before irreversible damage. Circulating microRNAs (miRNAs) are promising biomarkers of cardiovascular disease, however, have not been studied in the setting of AC‐induced cardiotoxicity. This study aimed to identify AC‐induced alterations in plasma miRNA expression in children and correlate expression with markers of cardiac injury.Methods and ResultsCandidate plasma profiling of 24 miRNAs was performed in 33 children before and after a cycle of AC (n=24) or noncardiotoxic chemotherapy (n=9). Relative miRNA changes between the pre‐ and postcycle time points (6, 12, and 24 hours) were determined within each treatment group and compared across groups. Plasma miRNA expression patterns were further explored with respect to AC dose and high‐sensitivity troponin T. Greater chemotherapy‐induced dysregulation was observed in this panel of candidate, cardiac‐related plasma miRNAs in patients receiving anthracyclines compared with those receiving noncardiotoxic chemotherapy (24‐hour MANOVA; P=0.024). Specifically, plasma miRs‐29b and ‐499 were upregulated 6 to 24 hours post‐AC, and their postchemotherapy expression significantly correlated with AC dose. Patients with acute cardiomyocyte injury (high‐sensitivity troponin T increase ≥5 ng/L from baseline) demonstrated higher expression of miR‐29b and miR‐499 post‐AC compared with those without.ConclusionsIn this pilot study, cardiac‐related plasma miRNAs are dysregulated following ACs. Plasma miR‐29b and ‐499 are acutely elevated post‐AC, with dose response relationships observed with anthracycline dose and markers of cardiac injury. Further evaluation of miRNAs may provide mechanistic insight into AC‐induced cardiotoxicity and yield biomarkers to facilitate earlier intervention to mitigate cardiotoxicity.

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“…Among the different chemotherapy regimens associated with CCMP, anthracyclines in particular have been shown to cause end-stage American Heart Association (AHA) Stage C-D heart failure (HF). 4 A paucity of data exists regarding outcomes and response to traditional interventions in patients who develop end-stage CCMP. Analyses of the largest transplant registries of patients with advanced HF have suggested that prevalence of end-stage HF due to chemotherapy is up to 2.5%, 5 but the true incidence of CCMP in the advanced HF population in the United States is unknown owing to the lack of large-scale epidemiologic and outcomes studies encompassing CCMP.…”

mentioning

confidence: 99%

Heart Failure Therapies for End-Stage Chemotherapy–Induced Cardiomyopathy

Mukku

Fonarow

Watson

et al. 2016

Journal of Cardiac Failure

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With ongoing advancements in cancer-related treatments, the number of cancer survivors continues to grow globally, with numbers in the United States predicted to reach 18 million by 2020. As a result, it is expected that a greater number of patients will present with chemotherapy-related side effects. One entity in particular, chemotherapy-related cardiomyopathy (CCMP), is a known cardiotoxic manifestation associated with agents such as anthracyclines, trastuzumab, and tyrosine kinase inhibitors. Although such effects have been described in the medical literature for decades, concrete strategies for screening, prevention, and management of CCMP continue to be elusive owing to limited studies. Late recognition of CCMP is associated with a poorer prognosis, including a lack of clinical response to pharmacologic therapy, and end-stage heart failure. A number of advanced cardiac therapies, including cardiac resynchronization therapy, ventricular assist devices, and orthotopic cardiac transplantation, are available to for end-stage heart failure; however, the role of these therapies in CCMP is unclear. In this review, management of end-stage CCMP with the use of advanced therapies and their respective effectiveness are discussed, as well as clinical characteristics of patients undergoing these treatments. The relative paucity of data in this field highlights the importance and need for larger-scale longitudinal studies and long-term registries tracking the outcomes of cancer survivors who have received cardiotoxic cancer therapy to determine the overall incidence of end-stage CCMP, as well as prognostic factors that will ultimately guide such patients toward receiving appropriate end-stage care.

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Advanced Heart Failure Therapies for Patients With Chemotherapy-Induced Cardiomyopathy

Cited by 45 publications

References 96 publications

Cardio-Oncology

Cardio-Oncology

Circulating microRNAs: Potential Markers of Cardiotoxicity in Children and Young Adults Treated With Anthracycline Chemotherapy

Heart Failure Therapies for End-Stage Chemotherapy–Induced Cardiomyopathy

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