BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab

Dobson, Rebecca; Ghosh, Ashoke Kumar; Ky, Bonnie; Marwick, T. H.; Stout, Martin; Harkness, Allan; Steeds, Richard P.; Robinson, Shaun; Oxborough, David; Adlam, David; Stanway, Susannah; Rana, Bushra S.; Ingram, Thomas E.; Ring, Liam; Rosen, Stuart D.; Plummer, Chris; Manisty, Charlotte; Harbinson, Mark; Sharma, Vishal; Pearce, Keith; Lyon, Alexander R.; Augustine, Daniel

doi:10.1016/j.jaccao.2021.01.011

Cited by 46 publications

(42 citation statements)

References 74 publications

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“…Conversely, echocardiography with its wider availability and cost-effectiveness is highly suited for serial surveillance. Consequently, given that definitions of cardiotoxicity in many oncology trials are based on a reduction of LVEF, TTE-derived LVEF remains the first-line method for the detection of CTRCD according to consensus guidelines [1,[16][17][18][19] (Figure 1). One of the key limitations of 2D TTE is its significant inter-and intraobserver variation, often quoted at 10% [16,20].…”

Section: Volumetric Assessment and Cmrmentioning

confidence: 99%

“…In the absence of randomized prospective studies directly comparing patient outcomes from CMR and TTE derived LVEF, guidance from the British Society for Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) recognises the addition of recent pilot data on the safe use of trastuzumab in patients with asymptomatic reductions in TTE-derived LVEF down to 40% [17,29,30].…”

Section: Volumetric Assessment and Cmrmentioning

confidence: 99%

“…Consequently, a distinct multidisciplinary clinical subspecialty, cardio-oncology, has emerged with the aim of preventing, monitoring, and treating cancer therapeuticsrelated cardiac dysfunction (CTRCD) [15]. In current cardio-oncology practice, transthoracic echocardiography (TTE) remains the first line for cardiac surveillance among oncology patients due to its widespread availability and lack of radiation exposure [16][17][18][19]. However, with a reported temporal inter-and intra-observer variability of 10% in the assessment of left ventricular ejection fraction (LVEF) by 2D TTE [20], cardiac magnetic resonance (CMR) is gaining an increasingly prominent role in cardio-oncology.…”

Section: Introductionmentioning

confidence: 99%

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Herceptin-Mediated Cardiotoxicity: Assessment by Cardiovascular Magnetic Resonance

Jin

Liu

Hothi

2022

Cardiology Research and Practice

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Herceptin (trastuzumab) is a recombinant, humanized, monoclonal antibody that targets the human epidermal growth factor receptor 2 (HER2) and is used in the treatment of HER2-positive breast and gastric cancers. However, it carries a risk of cardiotoxicity, manifesting as left ventricular (LV) systolic dysfunction, conventionally assessed for by transthoracic echocardiography. Clinical surveillance of cardiac function and discontinuation of trastuzumab at an early stage of LV systolic dysfunction allow for the timely initiation of heart failure drug therapies that can result in the rapid recovery of cardiac function in most patients. Often considered the reference standard for the noninvasive assessment of cardiac volume and function, cardiac magnetic resonance (CMR) imaging has superior reproducibility and accuracy compared to other noninvasive imaging modalities. However, due to limited availability, it is not routinely used in the serial assessment of cardiac function in patients receiving trastuzumab. In this article, we review the diagnostic and prognostic role of CMR in trastuzumab-mediated cardiotoxicity.

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Section: Volumetric Assessment and Cmrmentioning

confidence: 99%

Section: Volumetric Assessment and Cmrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Herceptin-Mediated Cardiotoxicity: Assessment by Cardiovascular Magnetic Resonance

Jin

Liu

Hothi

2022

Cardiology Research and Practice

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“…The risk profile of the patients. The risk of cardiotoxicity of the cytostatic drugs is more elevated in women, patients aged under 15 or over 65 years, with more than two risk factors: arterial hypertension with values more than 140/90 mmHg (160/90 mmHg if over 80 years old), diabetes mellitus with HbA1c more than 7.5%, dyslipidaemia, smoking, obesity (body mass index more than 25 kg/m 2 ), sedentary lifestyle (less than 2.5 hours/week moderate to intense physical activity), thyroid dysfunction, electrolyte abnormalities, stage ≥ 2 chronic kidney disease, history of heart disease (heart failure, cardiomyopathies, borderline LVEF between 50 -59%, atrial fibrillation, supraventricular tachycardia, prolonged Q-T interval, ventricular tachycardia), moderate to severe valvular heart disease [31]; elevated baseline or during cancer therapy of troponin and/or NTproBNP [11]. The risk profile of the treatment.…”

Section: Risk Factors For Cardiac Toxicity In Oncological Patients Under Chemotherapymentioning

confidence: 99%

Cardiotoxicity of Anticancer Therapies: Focus on the Role of the Cardio-Oncological Team. A Practical Review

Gheorghe¹

2021

FARMACIA

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In the last decades there were important improvements in oncological therapies which increased the survival of patients. However, patients and doctors are confronted with the side effects of the oncological therapy especially at the level of cardiovascular system. The occurrence of the deleterious effects depends on the class of chemotherapy used and on the history of cardiac risk factors of the patients. Anthracyclines have the highest dose dependent cardiac toxicity and induce acute or longterm heart failure but fluoropyrimidines, cytokines, checkpoint inhibitors can induce myocardial ischemia, arrhythmia, pericardial effusion, vasculitis. Patients should be monitored by a cardio-oncological team. The cardio-vascular protection may be achieved by treating oncological patients who present a high cardiac risk with angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), beta blockers, and statins. The oncologist must select the class of medication that offers the best risk-benefit ratio and must sometimes decide alongside the cardiologist to temporary stop chemotherapy. RezumatUltimele decade au înregistrat progrese importante ale tratamentelor oncologice care au dus la creșterea speranței de viață a pacienților. Pe de altă parte, doctorii și pacienții s-au confruntat cu efectele secundare ale tratamentelor, mai ales cele cardiovasculare. Apariția efectelor secundare depinde de clasa de citostatice utilizate și de profilul de risc cardio-vascular al pacientului. Antraciclinele au cea mai mare toxicitate cardiacă dependentă de doză și pot induce insuficiență cardiacă acută sau cronică, dar și fluoroprimidinele, citokinele, inhibitorii checkpoint pot induce ischemie miocardică, aritmii, revărsat pericardic, vasculită. Pacienții trebuie monitorizați de o echipă cardio-oncologică. Protecția cardiacă la pacienții oncologici cu risc cardiovascular crescut se poate realiza prin administrarea de inhibitori ai enzimei de conversie a angiotensinei (ACEI)/blocanți de receptori de angiotensină (ARB), beta-blocante, statine. Oncologul trebuie sa aleagă clasa de medicamente care oferă balanța risc-beneficiu cea mai favorabilă, iar împreună cu cardiologul trebuie uneori să ia decizia importantă de oprire temporară a chimioterapiei.

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“…Baseline CV risk assessments including serum cardiac biomarkers, electrocardiographic (ECG) and echocardiography or alternative cardiac imaging modalities are recommended for patients receiving potentially cardiotoxic cancer therapies by the European Society for Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) (9,10). In addition, the British Society of Echocardiography and British Cardio-Oncology Society have published a protocol for baseline and surveillance echocardiography for cancer patients undergoing anthracycline treatment and/or anti-HER2 therapy (11). This protocol suggests for patients to have echocardiography before treatment, every 3 months during treatment, and 3-12 months after completing cancer therapy.…”

Section: Introductionmentioning

confidence: 99%

Initial experience of the implementation of a cardio-oncology program for breast cancer patients receiving modern radiotherapy in a tertiary institution

Hou¹,

Wu²,

Wu³

et al. 2021

Ther Radiol Oncol

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Background: The modern era of multimodality cancer treatment strategies has contributed to a much longer survival time of breast cancer patients. Accordingly, cardiovascular toxicity related to anticancer therapy including radiation-induced heart disease has become an issue of concern. To address this issue, it is important to develop cardio-oncology programs to provide cardiovascular assessment, surveillance and management for patients receiving cancer therapy with potential heart impairment.Methods: A multidisciplinary cardio-oncology combined care team and clinical protocol were established.Cardiac assessments of patients at risk before radiation, and surveillance and management of cardiotoxicity after completing cancer therapy were performed. A novel radiotherapy planning technique with completedirectional-complete block in helical tomotherapy was used to reduce cardiac exposure dose and limit heart damage. We analyzed the effect in the patients receiving this modern technique and cardio-oncology care. Results:The number of breast cancer patients receiving cardio-oncology care increased annually, from 64 (71.9%) in 2013 to 177 (81%) in 2019. A series of cardiac assessments were performed, including cardiac biomarkers, electrocardiogram, echocardiogram, and/or myocardial perfusion imaging to evaluate the patient's cardiac risk or development of subsequent cardiotoxicity after cancer therapy. Among the 303 patients who were treated with the modern radiotherapy technique, 15 (5%) were diagnosed with cardiovascular disease by the combined care program.Conclusions: For the breast cancer patients receiving multimodality cancer treatment with modern radiotherapy in this study, the multidisciplinary cardio-oncology program of screening, prevention, management and follow-up protocols reduced cancer therapy-related cardiovascular toxicity, and improved the clinical outcomes and quality of life for long-term survivors.

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BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab

Cited by 46 publications

References 74 publications

Herceptin-Mediated Cardiotoxicity: Assessment by Cardiovascular Magnetic Resonance

Herceptin-Mediated Cardiotoxicity: Assessment by Cardiovascular Magnetic Resonance

Cardiotoxicity of Anticancer Therapies: Focus on the Role of the Cardio-Oncological Team. A Practical Review

Initial experience of the implementation of a cardio-oncology program for breast cancer patients receiving modern radiotherapy in a tertiary institution

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