How to Diagnose and Manage QT Prolongation in Cancer Patients

Kim, Peter Y.; Irizarry-Caro, Jorge A.; Ramesh, Tushar; Iliescu, Cezar; Lopez‐Mattei, Juan

doi:10.1016/j.jaccao.2021.01.002

Cited by 21 publications

(17 citation statements)

References 6 publications

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“…Aber auch der u. a. beim Schilddrüsenkarzinom verwendete Tyrosinkinase-Hemmer (TKI) Vandetanib verursacht in einem relevanten Prozentsatz von bis zu 18 % eine Verlängerung der QTc-Zeit. Letztere sollte bei onkologischen Therapien aufgrund der geringeren Überkorrektur bei höheren Herzfrequenzen eher mit der Fridericia-als mit der Bazett-Formel bestimmt werden, weil dadurch ein geringeres Risiko für nicht gerechtfertigte, prognostisch relevante Therapieunterbrechungen besteht [11]. Sobald die so kontrollierte QT-Zeit 500 ms übersteigt (oder die Differenz zur Ausgangs-QTc-Zeit > 60 ms liegt), sollten die Therapie pausiert, Elektrolytstörungen ausgeglichen und mögliche konkurrierende Ursachen identifiziert werden.…”

Section: Arrhythmieunclassified

Krebstherapien und Herzerkrankungen – ein komplexes Wechselspiel

Birner

2022

Aktuelle Kardiologie

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ZusammenfassungMit der zunehmenden Entwicklung hoch effektiver onkologischer Therapien sind nun zahlreiche Krebserkrankungen mit einer deutlich besseren Langzeitprognose assoziiert. Aus diesem Grund ist es zwingend erforderlich, potenzielle kardiotoxische Nebenwirkungen dieser Therapien möglichst frühzeitig zu identifizieren, um das Langzeitüberleben von Krebspatienten nicht durch schwerwiegende, schlimmstenfalls sogar letale kardiovaskuläre Ereignisse zu belasten. Eine wichtige Rolle spielen dabei insbesondere medikamentös induzierte Kardiomyopathien, aber auch Arrhythmien, eine verschlechterte arterielle Hypertonie und arterielle bzw. venöse Thrombosen müssen berücksichtigt werden. Durch adaptierte Ausgangs- und Verlaufsuntersuchungen lassen sich Patienten identifizieren, die ein erhöhtes Risiko für derartige kardiotoxische Ereignisse haben. Auch wenn die Datenlage inkonklusiv ist, scheint es doch kardioprotektive Medikamente zu geben, die in dieser Situation angewandt werden können.

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Section: Arrhythmieunclassified

Krebstherapien und Herzerkrankungen – ein komplexes Wechselspiel

Birner

2022

Aktuelle Kardiologie

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“…An important limitation of this study is its retrospective design, which limits the acquisition of some data, such as the presence of comorbidities. It is known that ventricular repolarization rates may change with heart diseases (Brüler et al 2018;Vila et al 2021), with non-cardiac diseases (Armstrong et al 2017;Kim et al 2021), as well as with antiarrhythmic drugs administration (Shantsila et al 2007). In addition, information such as systemic blood pressure, blood gases, and 24 hours Holter recording to thoroughly investigate the presence of arrhythmias could enrich the understanding of the pathophysiological mechanisms involved in the development of cardiovascular complications in dogs with hyperadrenocorticism.…”

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confidence: 99%

QT Interval Instability and Variability in Dogs with Hyperadrenocorticism

Vila

Vanhoni

Sousa

2021

Preprint

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Hyperadrenocorticism is one of the most common endocrine diseases in dogs. In humans, it is clearly associated with a higher risk of cardiovascular events, but studies in dogs are scarce. To investigate the arrhythmogenic risk of dogs with hyperadrenocorticism, indices of variability and instability of the QT interval were studied in 38 dogs with hyperadrenocorticism and in 12 healthy dogs: variance (QTv), total instability (TI), short-term (STI) and long-term (LTI), and mean (QTm). Except for QTm, all parameters studied were higher in the hyperadrenocorticism group than in the control group. In addition, STI and QTv showed moderate positive correlation with left ventricle wall thickness. To a better understanding on the effect of the hypothalamus-pituitary-adrenal axis on ventricular repolarization, the hyperadrenocorticism group was subdivided according to the percentage of variation in plasma cortisol concentration (<30.1%; 30.1-60%; >60%) 8 hours after low-dose administration of dexamethasone. There was statistical difference in QTv, TI and LTI indices between the control group and the <30.1% and >60% groups, and in STI index between the control group and the >60% group. There was no statistical difference between sex groups in any of the electrocardiographic parameters studied. This result may indicate that the etiology of hyperadrenocorticism, and its consequent influence on hypothalamus-pituitary-adrenal axis could interfere on the heterogeneity of ventricular repolarization parameters in different ways, especially in the short-term stability; however further studies are necessary to understand the role of cortisol on electrical instability in dogs.

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“…2,3 More than 200 marketed cardiovascular and noncardiovascular drugs prolong QTc and are listed in the reference site Crediblemeds.org 4 as associated with a known or possible risk of torsade de pointes. Clinical practice, guidelines, as well as the label of many of these drugs recommend measuring QTc before drug administration [5][6][7] because exposure to a drug that prolongs QTc in a patient with high baseline QTc value is more likely to make QTc reach the limit of 500 ms, considered as a major risk factor for torsade. [8][9][10] While it is mathematically evident that reaching a QTc of 500 ms with a QTprolonging drug is more likely to occur if baseline QTc is at 460 ms than if it is at 400 ms, it is relevant to determine if the amplitude of drug-induced QTc prolongation is amplified when baseline QTc is longer.…”

Section: Introductionmentioning

confidence: 99%

Influence of baseline QTc on sotalol‐induced prolongation of ventricular repolarization in men and women

Funck‐Brentano

Salem

2022

Brit J Clinical Pharma

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The extent of sotalol‐induced QTc prolongation on the electrocardiogram, is variable among subjects and influenced by sex. However, the influence of baseline QTc on the extent of drug‐induced QTc prolongation remains unclear. This was studied around peak plasma concentration in a large cohort of 376 healthy male and 614 healthy female subjects who received 80 mg of sotalol orally. Baseline QTc was 379 ± 16 ms in men and 393 ± 15 ms in women (P < .0001). The change in QTc from baseline was highly variable among both sexes and was greater in women than in men (26.5 ± 13.2 vs.13.0 ± 10.8 ms; P < .0001). The slope of the regression line between QTc on sotalol and baseline QTc did not significantly differ from unity in men and in women, indicating that the extent of QTc prolongation with sotalol was not influenced by baseline QTc. Assessing QTc after administration of an IKr blocker may be more important than measuring a baseline QTc.

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How to Diagnose and Manage QT Prolongation in Cancer Patients

Cited by 21 publications

References 6 publications

Krebstherapien und Herzerkrankungen – ein komplexes Wechselspiel

Krebstherapien und Herzerkrankungen – ein komplexes Wechselspiel

QT Interval Instability and Variability in Dogs with Hyperadrenocorticism

Influence of baseline QTc on sotalol‐induced prolongation of ventricular repolarization in men and women

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