Dobutamine stress echocardiography: A sensitive indicator of diminished myocardial function in asymptomatic doxorubicin-treated long-term survivors of childhood cancer

Klewer, Scott E.; Goldberg, Stanley J.; Donnerstein, Richard L.; Berg, Robert A.; Hutter, John J.

doi:10.1016/0735-1097(92)90497-b

Cited by 123 publications

(53 citation statements)

References 30 publications

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“…94 Thus, measurements of diastolic function by Doppler echocardiography may be a sensitive method for early detection of toxicity. 94,95 Provocative testing with exercise 96 or dobutamine echocardiography 97 has also been used to assess early anthracycline cardiotoxicity. Thus, these provocative-testing modalities may be sensitive for the early detection of subclinical cardiomyopathy and may provide an opportunity for therapeutic intervention before the development of overt LV dysfunction.…”

Section: Monitoring Cardiovascular Toxicitymentioning

confidence: 99%

Cardiovascular Complications of Cancer Therapy

et al. 2004

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Abstract-The cardiotoxicity of anticancer agents can lead to significant complications that can affect patients being treated for various malignancies. The severity of such toxicity depends on many factors such as the molecular site of action, the immediate and cumulative dose, the method of administration, the presence of any underlying cardiac condition, and the demographics of the patient. Moreover, toxicity can be affected by current or previous treatment with other antineoplastic agents. Cardiotoxic effects can occur immediately during administration of the drug, or they may not manifest themselves until months or years after the patient has been treated. In this article we review commonly used chemotherapy agents, including several recently approved medications, for their propensity to cause cardiotoxicity. Further research will be required to more accurately predict which patients are at risk for developing cardiotoxicity. In addition, management plans, as well as strategies to reduce cardiotoxicity, need to be developed.

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Section: Monitoring Cardiovascular Toxicitymentioning

confidence: 99%

Cardiovascular Complications of Cancer Therapy

et al. 2004

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“…Subklinik karditoksisite erken tanısında birçok ekokardiyografik parametreler kullanılmıştır. Sol ventrikül sistol sonu duvar gerginliği (LVESS)'de artma, sistolde ventrikül duvar kalınlığında incelme ve ventrikül kavitesinde genişleme, izovolümik relaksasyon zamanı (IRT)'nda ve dekselerasyon zamanı (DT)'nda uzama gibi değişiklikler bildirilmiştir (8)(9)(10)(11).…”

Section: Introductionunclassified

“…Stres EKO çalışmalarında egzersiz ile sol atriyum ve sol ventrikül sistolik çaplarında genişleme, EF'de azalma, ESS'de artma, dobutamin infüzyonu ile; FK'da azalma, sol ventrikül (LV) sistol sonu duvar gerginliği (ESS)'de artma, IRT'de uzama, mitral erken ve geç doluş doruk hızlarının oranı (E/A)'nda azalma gibi değişiklikler açığa çıkarılmıştır (10,15,16). Ayrıca istirahatta var olan değişik-liklerin dobutamin infüzyonu ile belirginleştiği gösterilmiştir: ESS'de artma ve sol ventrikül arka duvar kalınlığı yüzdesi (LVADK)'nde azalma (10,16). Şimdiye kadar yapılan subklinik kardiyotoksisite değerlendirme çalışmalarında, çeşitli ekokardiyografik ölçüm yöntemleri kullanılmıştır.…”

Section: Introductionunclassified

“…Dinlenme sırasında belirgin olmayan kardiyak bozukluklar, egzersiz ile açığa çıkarılabilmekte ve stres ekokardiyografisi (EKO) ile egzersize verilen fizyolojik yanıtın, bozulma derecesi saptanabilmektedir (12). Stres EKO çalışmalarında egzersiz ile sol atriyum ve sol ventrikül sistolik çaplarında genişleme, EF'de azalma, ESS'de artma, dobutamin infüzyonu ile; FK'da azalma, sol ventrikül (LV) sistol sonu duvar gerginliği (ESS)'de artma, IRT'de uzama, mitral erken ve geç doluş doruk hızlarının oranı (E/A)'nda azalma gibi değişiklikler açığa çıkarılmıştır (10,15,16). Ayrıca istirahatta var olan değişik-liklerin dobutamin infüzyonu ile belirginleştiği gösterilmiştir: ESS'de artma ve sol ventrikül arka duvar kalınlığı yüzdesi (LVADK)'nde azalma (10, 16).…”

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The role of dobutamine stress echocardiography in early diagnosis of cardiac toxicity in long-term survivors of asymptomatic children treated with anthracycline

Yıldırım¹,

Tunaoğlu²,

Pınarlı³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Long-term survivors of asymptomatic children treated with anthracycline may have cardiac toxicity without clinical findings. The subclinical cardiac toxicity could be evaluated by dobutamine stress echocardiography (DSE) with exploring effective and safe doses of dobutamine. Methods: Twenty asymptomatic survivors (mean age: 19.2±4.0 years) treated with cumulative dose of 282.1±125.9 mg/m 2 of anthracycline were compared with 18 age-matched healthy volunteers. Total time completed this treatment was 10.2±2.2 years. This was a cross-sectional casecontrolled study and patient and control groups were evaluated at the time of routine appointments. Echocardiographic studies were performed before and after each dobutamine infusion of 5, 10, 15, 20μg/kg/min. Statistical analysis: Mann-Whitney U test was used to evaluate the difference between the groups. ANOVA for repeated measurements test was used to compare each measurement of control and patients groups and Bonferroni posthoc test was used for correction. Results: Hemodynamic changes are observed at the dobutamine doses of 15μg/kg/min in the patient group. Before dobutamine infusion in the patient group only isovolumic relaxation and contraction times values were prolonged comparing to the control group. After the infusion of dobutamine ejection fraction, shortening fraction, left ventricular posterior wall thickening (%LVPWt), end-systolic wall stress (ESS), ÖZETAmaç: Çocukluk çağında antrasiklin tedavisi almış asemptomatik hastalarda, geç dönemde çıkma olasılığı kardiyotoksisiteyi, klinik olarak bulgu vermeden; dobutamin stres ekokardiyografi (DSE) ile açığa çıkarmak, etkili ve güvenilir dobutamin dozunu saptamaktır. Yöntemler: Bu çalışmada antrasiklin tedavisi almış, yakınması olmayan yaş ortalaması 18.4±3.2 yıl, kümülatif antrasiklin dozu 282.1±125.9mg/m 2 ve en son antrasiklin dozundan sonra geçen süre ortalama 10.2±2.2 yıl olan 20 asemptomatik hasta (14 erkek, 6 kız) ve yaş ortalaması 19.2±4.0 yıl olan 18 sağlıklı gönüllü olgu incelenmiştir. Bu çalışma kesitsel vaka-kontrollü olarak yapılmış, hasta ve kontrol grup randevuları sırasında değerlendiril-miştir. Hasta ve kontrol grubu başlangıçta ve 5, 10, 15, 20μ/kg/dk dobutamin infüzyonları sırasında, ekokardiyografi (EKO) ile değerlendirilmiştir. İstatistiksel değerlendirme, gruplar arası fark analizi için Mann-Whitney U testi, her grupta tekrarlayan ölçümler için varyans analizi ve Bonferroni posthoc düzeltmeleri yapılmıştır. Bulgular: Hasta grubunda kontrol grubuna göre, anlamlı hemodinamik değişiklikler 15 μ/kg/dk dobutamin dozunda ortaya çıkmıştır. Hasta grupta, başlangıçta kontrol grubuna göre sadece izovolümik relaksasyon ve kontraksiyon zamanı değerlerinde uzama saptanmasına karşın, dobutamin infüzyonu ile ejeksiyon fraksiyonu, fraksiyonel kısalma , sol ventrikül arka duvar kalınlığı yüzdesi (LVADK%), sol ventrikül sistol sonu duvar gerginliği (ESS), interventriküler septum sistolik kalınlık, sol ventrikül diyastolik çap, sol ventrikül sistolik çap, mitral akselerasyon (AT) ve deselerasyon zama...

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“…Civelli et al [95] measured LVCR (defined as the difference between peak and resting LVEF) with low-dose dobutamine during and after high-dose chemotherapy in women with advanced breast cancer; an asymptomatic decline in LVCR of ≥5 units from baseline predicted LVEF decline to <50%. By comparison, multiple exercise and pharmacologic stress studies have been performed in anthracycline-treated adult survivors of pediatric malignancies with mixed results regarding the incremental sensitivity of exercise [96][97][98][99] or pharmacologic [100,101] stress echocardiography to detect subclinical therapy-induced cardiotoxicity over resting echocardiography alone.…”

Section: Stress-related Functional Testingmentioning

confidence: 99%

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

et al. 2015

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Advancements in diagnostic tools and curative-intent therapies have improved cancerspecific survival. With prolonged survival, patients are now subject to increased aging and development of cardiovascular risk factors such that further improvements in cancerspecific mortality are at risk of being offset by increased cardiovascular mortality. Moreover, established and novel adjuvant therapies used in cancer treatment are associated with unique and varying degrees of direct as well as indirect myocardial and cardiovascular injury (i.e., cardiotoxicity). Current approaches for evaluating anticancer therapy-induced injury have limitations, particularly lack of sensitivity for early detection of subclinical cardiac and cardiovascular dysfunction. With emerging evidence suggesting early prevention and treatment can mitigate the degree of cardiotoxicity and limit interruption of life-saving cancer therapy, the importance of early detection is increasingly paramount. Newer imaging modalities, functional capacity testing and blood biomarkers have the potential to improve early detection of cardiotoxicity and reduce cardiovascular morbidity and mortality. KeywordsMortality rates from cancer have declined over the past 30 years as more effective methods of early detection, pharmacologic treatments and surgical approaches have resulted in significant cancerrelated survival gains [1][2][3]. Long-term survivors with cancer are expected to increase by approximately 30% in the next decade to an estimated 18 million by 2022 in the USA alone [4]. With prolonged survival, cancer patients are now subject to the effects of aging and to the development of other risk factors that determine the long-term risk of cardiovascular disease (CVD) [5][6][7]. In this setting, CVD may limit the survival gains of oncology and is already the predominant cause of mortality in breast cancer patients over 50 years of age [5,6,8] and a more common contributor than cancer to mortality among older survivors [9,10].The cardiovascular effects of a prolonged survival are also compounded by those of standard modern cancer therapy. Current anticancer therapies are associated with unique and varying degrees of direct (e.g., myocardial toxicity, ischemia, hypertension, arrhythmias) [11][12][13][14] as well as indirect (e.g., unfavorable lifestyle changes) sequential and progressive cardiovascular insults [11]. The most well known direct cardiotoxic effects of cancer therapy historically occur with anthracyclinecontaining regimens (i.e., doxorubicin, epirubicin). Anthracyclines are still widely used in solid tumors (i.e., breast cancer, osteosarcoma etc.) and hematologic malignancies (Hodgkin's/nonHodgkin's lymphoma, acute lymphoblastic leukemia etc.) and are well recognized to trigger dosedependent, cumulative, progressive cardiac dysfunction [15,16] manifest as decreased left ventricular ejection fraction (LVEF) [17][18][19], and ultimately, symptomatic heart failure (HF) in up to 5% of patients [20]. Newer, targeted agents have dramatically improved the a...

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Dobutamine stress echocardiography: A sensitive indicator of diminished myocardial function in asymptomatic doxorubicin-treated long-term survivors of childhood cancer

Cited by 123 publications

References 30 publications

Cardiovascular Complications of Cancer Therapy

Cardiovascular Complications of Cancer Therapy

The role of dobutamine stress echocardiography in early diagnosis of cardiac toxicity in long-term survivors of asymptomatic children treated with anthracycline

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

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