Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril

The development of targeted drugs and immune checkpoint inhibitors (ICIs), as well as their implementation into clinical practice has allowed increasing the overall and event-free survival of oncohematological patients. Currently, assessment of the efficacy of a therapeutic strategy in each specific case includes the evaluation of an acceptable tolerability profile. The subject of discussion includes cardiovascular complications induced by target drugs and ICIs. The review mainly presents the issues of cardiovascular toxicity (CVT) in certain groups of oncohematological patients (with chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma). The spectrum of cardiovascular adverse effects associated with targeted and ICI therapy in oncohematological practice is quite wide — coronary artery disease, peripheral arterial disease, myocarditis, heart failure, arrhythmias, hypertension. The high importance of the problem of using targeted and immunosuppressive therapy dictates the need to predict adverse effects. The diagnosis of heart failure (one of CVT manifestations) is based on determining the decreased left ventricular ejection fraction during echocardiography, less often — during cardiac magnetic resonance imaging; global longitudinal myocardial strain is a significant parameter of preclinical heart failure, which is determined using the speckle tracking technique. To determine vascular toxicity, a special attention is paid to the vascular wall structure and microcirculation parameters — capillary density at rest, percentage of capillary recovery and perfused capillaries, stiffness index for large blood vessels, reflection index for small arteries, laboratory markers of inflammation and endothelial dysfunction (C-reactive protein, fibrinogen, homocysteine, endothelin 1, vascular endothelial growth factor). CVT prevention presumes the determination of the risk group, correction of risk factors, and administration of protective therapy to very high and high-risk patients. One of the promising directions for preventing vascular toxicity is the use of sodium-glucose linked transporter-2 inhibitors.

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Use of indicators of systolic and diastolic functions of the left ventricle in the diagnosis of early cardiotoxicity during chemotherapy with doxorubicin: An open, prospective, nonrandomized study

Karputs,

Snezhitskiy,

Kurbat

et al. 2024

CardioSomatics

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BACKGROUND: The search for new markers of early cardiotoxicity (CT) may help reduce the incidence of severe complications in the cardiovascular system during chemotherapy with doxorubicin. AIM: To determine echocardiography (EchoCG) parameters with the potential as CT markers in patients with primary breast cancer (BC) 12 months after the end of chemotherapy with doxorubicin. MATERIAL AND METHODS: An open, prospective, nonrandomized study included 100 patients with verified BC who were treated at the Grodno University Clinic (Grodno, Belarus). Twelve months after the end of chemotherapy, 10 patients were excluded from the general group (7 women refused inclusion, the global longitudinal deformation of the myocardium could not be measured in 3 because of a poor acoustic window). All patients underwent transthoracic echocardiography with the assessment of systolic and diastolic myocardial function before and 12 months after the end of chemotherapy. RESULTS: In 24/90 (26.6%) patients, a relative (before / after 12 months) decrease in global longitudinal myocardial deformity 12% (cardiotoxicity manifestation, CT+ subgroup) was detected. The cutoff point of the absolute decrease in global longitudinal myocardial deformation after 12 months was 18.0% (sensitivity, 87.9%; specificity, 83.7%). Significant differences were found between the absolute values of echocardiography in the CT+ and CT− (without CT manifestations) subgroups 12 months after the end of chemotherapy: the indexed final diastolic volume (FDV) was in 54 (49; 61) CT+ and 61 (53; 65) in CT− (p=0.034), the indexed final systolic volume (FSV) was 17 (15; 20) in CT+ and 20 (17; 23) in CT− (p=0.031), and the ratio of the rates of peaks of early and late filling of the left ventricle (E/A) in was 1.13 (1.10; 1.27) in CT+ and 1.29 (1.15; 1.45) in CT− (p=0.031). The specificity, sensitivity, and cutoff points for these parameters were established. The cutoff, sensitivity, and specificity were 57.7 62.1%, and 66.7% for FDV; 18.8, 60.6%, and 62.5% for FSV; and 1.18, 68.2%, and 66.7% for E/A, respectively. CONCLUSION: The E/A, FDV, and FSV are candidate markers of CT 12 months after the end of chemotherapy with doxorubicin in patients with BC.

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Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril

Cited by 3 publications

References 9 publications

Cyclophosphamide/fludarabine/rituximab

Cyclophosphamide/fludarabine/rituximab

Approaches to early diagnosis and prevention of cardiovascular toxicity induced by targeted drugs and immune checkpoint inhibitors in oncohematology: a literature review

Use of indicators of systolic and diastolic functions of the left ventricle in the diagnosis of early cardiotoxicity during chemotherapy with doxorubicin: An open, prospective, nonrandomized study

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