Long-Term Risk of Cardiovascular Disease in 10-Year Survivors of Breast Cancer

Hooning, Maartje J.; Botma, Akke; Aleman, Berthe M.P.; Baaijens, Margreet H.A.; Bartelink, Harry; Klijn, Jan G.M.; Taylor, Carolyn; Leeuwen, Flora E. van

doi:10.1093/jnci/djk064

Cited by 744 publications

(564 citation statements)

References 25 publications

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“…Most of the patients with cardiac ischemia did not have anginal complaints. These findings are in agreement with the study of Marks et al [9], Heidenreich et al [13,14] and the Dutch Late Effects Breast Cancer Cohort, which studied the effects of cardiovascular toxicity of radiation therapy in women with breast cancer during a period of 10 years [15,16] and the SEER database [17]. The latter was a large study of women, who survived breast cancer treated with radiation therapy.…”

supporting

confidence: 89%

Cardiac perfusion screening in patients to be treated with radiation therapy in the chest, is it a must?

Baur

2009

Int J Cardiovasc Imaging

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supporting

confidence: 89%

Cardiac perfusion screening in patients to be treated with radiation therapy in the chest, is it a must?

Baur

2009

Int J Cardiovasc Imaging

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“…Clinical importance of radiation‐induced heart disease is well known, and there is growing evidence of a relation between radiotherapy (RT) and cardiovascular events 1, 2, 3, 4. Increased morbidity and mortality rates from cardiovascular damage may lower the survival rates 5.…”

Section: Introductionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

J Applied Clin Med Phys

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Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.

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“…1,2 However, it was soon recognized that these drugs can lead to left ventricular (LV) systolic dysfunction as assessed by LV ejection fraction (LVEF) and to heart failure. 3 ---5 Chemotherapyinduced cardiotoxicity (CIC) is one of the main determinants of prognosis in breast cancer survivors, 6,7 but only a small subgroup of patients exposed to chemotherapy agents will develop CIC, which has a reported incidence of 3-12% for anthracycline therapy alone and up to 28% when combined with trastuzumab.…”

Section: Introductionmentioning

confidence: 99%

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

Portugal

Branco

Galrinho

et al. 2017

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) is the gold standard in screening for chemotherapy-induced cardiotoxicity (CIC). Measurement of myocardial deformation using speckle tracking enables more detailed assessment of myocardial contractility. The aim of this study was to determine the relationship between global and regional longitudinal strain and CIC. Methods: This was a prospective study of 158 breast cancer patients undergoing chemotherapy with anthracyclines with or without adjuvant trastuzumab who underwent serial monitoring by transthoracic echocardiography with assessment of myocardial deformation. CIC was defined as a decrease in LVEF to <53%. Global longitudinal strain (GLS) was estimated using EchoPAC BT12 software on a GE Vivid E9 cardiac ultrasound system. Patients were classified according to the 2015 ASE/EACVI criteria as having impaired myocardial deformation when GLS was reduced (less negative), with a cutoff of -18%. Results: During a mean follow-up of 5.4 months (1-48 months), the incidence of CIC was 18.9%. A decrease in GLS was observed during follow-up for the entire cohort (baseline GLS -20.1±3.5% vs. -18.7±3.4% at last follow-up assessment, p=0.001). A total of 97 patients (61.4%) were observed to have impaired myocardial deformation (GLS ≥18%) at some point during follow-up. This decrease was more significant in patients who eventually developed CIC (GLS -17.2±2.5%, ଝ Please cite this article as: Portugal G, Moura Branco L, Galrinho A, et al. Importância da deformação longitudinal na deteção da cardiotoxicidade induzida por quimioterapia e na identificação de padrões específicos de afetação segmentar. Rev Port Cardiol. 2017;36:9---15. Resultados: Durante um período de seguimento médio de 5,4 meses (1-48 meses), a incidên-cia de CIT foi de 18,9%. Na população global observou-se uma deterioração significativa do GLS durante o tratamento com quimioterapia (-20,1 ± 3,5% versus 18,7 ± 3,4%, p = 0,001), com compromisso do GLS detetado durante em algum período do seguimento em 61,4% dos doentes. Esta deterioração foi mais marcada no subgrupo de doentes com CIT (GLS: -17,2 ± 2,5%, p = 0,02). Na análise regional da deformação longitudinal, verificou-se compromisso da contractilidade envolvendo preferencialmente os segmentos septais (seis em seis) e parede anterior (dois em três). Por regressão logística multivariada, o compromisso do GLS esteve independentemente associado ao desenvolvimento de CIT (odds ratio 4,88, IC 1,32-18,0, p = 0,017). Conclusões: O compromisso da deformação longitudinal é frequente em doentes submetidos a quimioterapia e mostrou um padrão de distribuição predominante a nível septal e anterior. A degradação da GLS foi um preditor independente de CIT. PALAVRAS-CHAVE

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Long-Term Risk of Cardiovascular Disease in 10-Year Survivors of Breast Cancer

Abstract: Radiotherapy as administered from the 1980s onward is associated with an increased risk of cardiovascular disease. Irradiated breast cancer patients should be advised to refrain from smoking to reduce their risk for cardiovascular disease.

Cited by 744 publications

References 25 publications

Cardiac perfusion screening in patients to be treated with radiation therapy in the chest, is it a must?

Cardiac perfusion screening in patients to be treated with radiation therapy in the chest, is it a must?

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

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