Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity

Civelli, Maurizio; Cardinale, Daniela; Martinoni, Alessandro; Lamantia, Giuseppina; Colombo, N.; Colombo, Alessandro; Gandini, Sara; Martinelli, Giovanni; Fiorentini, Cesare; Cipolla, Carlo M.

doi:10.1016/j.ijcard.2005.07.029

Cited by 83 publications

(54 citation statements)

References 35 publications

(23 reference statements)

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“…There are also conflicting results regarding the effectiveness of dobutamine stress echocardiography in the detection of chemotherapy cardiotoxicity. One study in 49 patients with breast cancer revealed a very subtle alteration of myocardial contractile reserve during low dose dobutamine stress echocardiography 7 months after completion of a third cycle of high dose chemotherapy and predicted a subsequent decline in their LVEF (25). In contrast, other studies did not report any incremental value of dobutamine echocardiography in the early detection of cardiotoxicity (12,100).…”

Section: Stress Imagingmentioning

confidence: 99%

Anthracycline‐Induced Cardiomyopathy in Adults

Tan

Neilan

Francis

et al. 2015

Comprehensive Physiology

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Anthracyclines are one of the most commonly used antineoplastic agent classes, and a core part of the treatment in breast cancers, hematological malignancies, and sarcomas. Their benefit is decreased by their well-recognized cardiotoxicity. The purpose of this review is to outline the presentation, mechanisms, diagnosis, and treatment of anthracyclines-induced cardiotoxicity. Symptomatic heart failure occurs in 2% to 5% of patients treated with anthrayclines and may be higher in older patients or patients with cardiovascular risk factors. The mechanisms involved in anthracycline-induced cardiotoxicity involve myocyte loss by apoptosis in the presence of a limited regenerative capacity. Once symptomatic, anthracycline-induced cardiotoxicity is associated with markedly decreased survival. Left ventricular ejection fraction (LVEF), mostly determined using echocardiography, is used to monitor patients treated with anthracyclines. As more than 1/3 of patients treated with anthracyclines do not recover their baseline LVEF once it is decreased, more sensitive echocardiographic indices of LV function such as myocardial deformation or biomarkers have been studied in patients monitoring. Cardioprotective treatments such as angiotensin-converting enzyme inhibitors, beta-blockers, iron chelators, statins, and metformin are also the topic of research efforts.

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Section: Stress Imagingmentioning

confidence: 99%

Anthracycline‐Induced Cardiomyopathy in Adults

Tan

Neilan

Francis

et al. 2015

Comprehensive Physiology

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“…However, the predictive value of reduced contractile reserve for optimizing chemotherapy management and preventing or limiting CHF is unknown. 44 …”

Section: Echocardiography For Assessment Of Lvef Lvesvi and Risk Of Chfmentioning

confidence: 99%

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

Schwartz

Jain

Storozynsky

2013

Journal of Nuclear Cardiology

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The field of cardio-oncology is challenged to address an ever greater spectrum of cardiotoxicity associated with combination chemotherapy, greater dose intensity, extremes of age, and enhanced patient survival which exposes more protracted risk of developing congestive heart failure (CHF). Recent reports of chemotherapy-induced hypertension as a common adverse effect of angiogenesis inhibitors and immunosuppressants clarify the need for routine blood pressure (BP) monitoring and guideline-based management of hypertension as an integral strategy to preserve LV function. Serial monitoring of radionuclide left ventricular ejection fraction (LVEF) in adults and echocardiography in children continues to provide outcome based, cost-effective prevention of CHF in high risk patients receiving chemotherapy. To optimize treatment and monitoring strategies to eliminate late-onset LV dysfunction and CHF, traditional and novel candidate methods for assessment of chemotherapy-induced LV dysfunction are reviewed. These include serial assessment of LV volume indices by gated SPECT ERNA and gated SPECT MPI, 3D echocardiography and contrast 2D echocardiography; longitudinal strain imaging, diastolic functional parameters, 123 I-MIBG, 111 In-Antimyosin antibody imaging, and 99m Tc-Annexin V apoptosis imaging, biomarkers including troponins and BNP; genetic markers, and both functional and tissue characterization techniques with T1 weighted and T2 weighted images with cardiac magnetic resonance imaging (CMR). In our quest to optimize strategies for long-term cancer survival and prevention of CHF for patients receiving chemotherapy, rigorous modality and guideline-specific clinical outcome trials are required. A new multi-modality monitoring approach is proposed, which integrates evidencebased strengths of CMR, echocardiography, ERNA, biomarkers, and BP management for surveillance and validation of cardiotoxicity and prevention of clinical heart failure in patients receiving a broad spectrum of cancer therapies.

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“…Although both exercise 27 and dobutamine stress echocardiography 27,112,[133][134][135][136][137][138][139][140] have been applied to patients with cancer for the identification of anthracycline-induced CTRCD, the results of these studies appear to be inconclusive and contradictory. One of these studies prospectively assessed LV contractile reserve by low-dose dobutamine stress echocardiography in 49 women with breast cancer before each chemotherapy cycle and 1, 4, and 7…”

mentioning

confidence: 99%