Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies

Abstract

Objectives The purpose of this study was to examine treatment practices for cancer therapy-associated decreased left ventricular ejection fraction (LVEF) detected on echocardiography and whether management was consistent with American College of Cardiology/American Heart Association guidelines. Background Patients treated with anthracyclines or trastuzumab are at risk of cardiotoxicity. Decreased LVEF represents a Class I indication for drug intervention according to American College of Cardiology/American Heart Association guidelines. Methods Patients receiving anthracycline or trastuzumab at Stanford University from October 2005 to October 2007 and who had undergone echocardiography before and after receiving an anthracycline or trastuzumab were identified. Chart review examined chemotherapy regimens, cardiac risk factors, imaging results, concomitant medications, and cardiology consultations. Results Eighty-eight patients received therapy with an anthracycline or trastuzumab and had a pre-treatment and follow-up echocardiogram. Ninety-two percent were treated with anthracyclines, 17% with trastuzumab after an anthracycline, and 8% with trastuzumab without previous treatment with anthracycline. Mean baseline LVEF was 60%, with 14% having a baseline <55%. Forty percent had decreased LVEF (<55%) after anthracycline and/or trastuzumab treatment. Of these patients, 40% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy, and 54% cardiology consultation. Of patients with asymptomatic decreased LVEF, 31% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 35% beta-blocker therapy, and 42% cardiology consultation. Of those with symptomatic decreased LVEF, 67% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 100% beta-blocker therapy, and 89% cardiology consultation. Conclusions Many cancer survivors are not receiving treatment consistent with heart failure guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving cardiotoxic therapy.

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…It is important for oncologists to collaborate with cardiologists to evaluate cardiac function, prevent induced cardiomyopathy, monitor the patient during treatment, and treat HF if it develops. 573 Similarly, rheumatologic or infiltrative cardiomyopathies can involve more than one system; for that reason, coordination of care among subspecialties such as rheumatology, internal medicine, or other relevant subspecialties is imperative. For management of women with peripartum cardiomyopathy, perinatologists and high-risk obstetricians should coordinate care with HF e624 cardiologists, intensive care specialists, and cardiac and obstetric anesthesiologists to optimize outcomes for the mother and fetus.…”

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…Z kolei podejście oparte na łącznym wykorzystywaniu oznaczeń biomarkerów i badań obrazowych także ma pewne ograniczenia [101]. Pomiar kilku krążących biomarkerów (troponina I i BNP lub NT-proBNP) okazał się przydatny we wczesnym wykrywaniu dysfunkcji mięśnia sercowego i jawnej HF związanej z leczeniem onkologicznym [88,89,113,315]. Potrzebne są jednak jednoznaczne dane, które rozstrzygną, czy biomarkery pozwalają wiarygodnie przewidywać istotne klinicznie późne konsekwencje leczenia onkologicznego.…”

Cardioprotective Effect of β-Adrenoceptor Blockade in Patients With Breast Cancer Undergoing Chemotherapy

“…10 An asymptomatic decrease in EF is an indication for therapy with β-blockers (BBs) in the management of HF in adults according to current guidelines, 11 but this approach is not yet generally accepted for primary prevention of cardiotoxicity. Indeed, although use of cardioprotective agents has been suggested, 12,13 neither intentional nor coincidental continuous use of BBs during trastuzumab and chemotherapy treatment has yet been studied. Accordingly, we hypothesized that coincidental continuous use of BBs during chemotherapy with trastuzumab and anthracycline could reduce new HF events in patients who survive breast cancer without established structural heart disease.…”