Reversibility of Left Ventricular Dysfunction Resulting from Chemotherapy: Can This Be Expected?

Wells, Quinn S.; Lenihan, Daniel J.

doi:10.1016/j.pcad.2010.06.005

Cited by 32 publications

(28 citation statements)

References 57 publications

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“…9 Anthracycline use has been shown to result in LVD with an incidence of 1-5 %, ranging from acute to late onset. 10 Anthracycline-induced HF is thought to be cumulative and dose-dependent, with an incidence reaching 5 % at a total doxorubicin dose of 450 mg/m 2 . 11 However, examination of endomyocardial biopsies reveals histopathological changes with doses as low as 240 mg/m 2 , suggesting that subclinical cardiotoxity may be present as early as the first dose.…”

Section: Definitions Of Cancer Therapy-related Cardiac Toxicitymentioning

confidence: 99%

“…Under normal circumstances, in cardiac myocytes, the HER2 signalling pathway is responsible for adaptation to stress. 8 The incidence of LVD with trastuzumab ranges from 2 % to 28 %, 10 with a 1.7-4.1 % incidence of HF. 13 Other HER2-targeted agents, such as lapatinib and pertuzumab, used in combination with trastuzumab have not shown additive cardiotoxicity.…”

Section: Her2-targeted Agentsmentioning

confidence: 99%

“…10 Imatinib, an inhibitor of the fusion protein breakpoint cluster region (BCR)/Abelson (ABL) has been instrumental in the treatment of chronic myelogenous leukaemia; however, there has been a reported 0.5-1.7 % incidence of LVD, thought to be caused by mitochondrial abnormalities within cardiac myocytes following treatment with imatinib.…”

Section: Small Tyrosine Kinase Inhibitorsmentioning

confidence: 99%

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Cancer and Heart Failure: Understanding the Intersection

Hamo

Bloom

2017

Cardiac Failure Review

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Heart disease and cancer are the two leading causes of death, together accounting for almost 50 % of deaths in the US.1 Unfortunately, the tremendous success in improving cancer survival is often attenuated by downstream cardiovascular complications from cancer therapy.Acute cardiac toxicity may limit the ability to use life-saving cancer therapy and chronic toxicity limits overall survival. As novel agents with more specific targets become available, unanticipated cardiac complications arise. The spectrum of cardiac toxicities is broad, ranging from ischaemia and arrhythmias to hypertension, left ventricular dysfunction (LVD) and the development of clinical heart failure (HF).Notably, there is increasing evidence that suggests an underlying relationship between cancer and the heart, independent of cancer therapies' effect on left ventricular ejection fraction (LVEF) and heart rate. 2,3 HF caused by chemotherapy portends a worse prognosis compared with idiopathic and ischaemic cardiomyopathy, 4 highlighting the need for enhanced understanding and management. Definitions of Cancer Therapy-related Cardiac ToxicityThere is currently no universally accepted definition of cancer therapyrelated cardiac toxicity; however, several definitions pertaining to specific agents have been proposed. A recent consensus defines cancer therapy-related cardiac dysfunction (CTRCD) as a decrease in LVEF of >10 % to a value of <53 %. 5 The Cardiac Review and EvaluationCommittee involved in trials with trastuzumab defines cardiotoxicity as a decrease in LVEF that is either global or more severe in the septum and decline in LVEF of at least 5 % to <55 % with signs or symptoms of HF, or a decline of at least 10 % to <55 % without HF signs or symptoms. 6According to the Food and Drug Administration, anthracycline cardiotoxicity is defined as a >20 % decrease in LVEF when the baseline LVEF is normal, or >10 % decrease when baseline LVEF is abnormal. In contrast to topoisomerase II-alpha, which is located on rapidly dividing cells, topoisomerase II-beta, located on cardiac myocytes is the proposed mechanism behind the cardiotoxicity. 9 Anthracycline use has been shown to result in LVD with an incidence of 1-5 %, ranging from acute to late onset. 10 Anthracycline-induced HF is thought to be cumulative and dose-dependent, with an incidence reaching 5 % at a total doxorubicin dose of 450 mg/m 2 . 11 However, examination of endomyocardial biopsies reveals histopathological changes with doses as low as 240 mg/m 2 , suggesting that subclinical cardiotoxity may be present as early as the first dose. 12 HER2-targeted AgentsTrastuzumab, a monoclonal antibody targeted against humanised epidermal growth factor receptor 2 (HER2) has played a pivotal role in breast cancer patients whose tumours overexpress HER2. Under normal circumstances, in cardiac myocytes, the HER2 signalling pathway is responsible for adaptation to stress. 8 The incidence of LVD with trastuzumab ranges from 2 % to 28 %, 10 with a 1.7-4.1 % incidence of HF. 13 Other HER2-targeted a...

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Section: Definitions Of Cancer Therapy-related Cardiac Toxicitymentioning

confidence: 99%

Section: Her2-targeted Agentsmentioning

confidence: 99%

Section: Small Tyrosine Kinase Inhibitorsmentioning

confidence: 99%

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Cancer and Heart Failure: Understanding the Intersection

Hamo

Bloom

2017

Cardiac Failure Review

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“…O trastuzumabe causa disfunção ventricular em até 28% dos casos. Nessa, ocorre disfunção transitória reversível dos miócitos, sem que haja relação com a dose, resultando em melhor prognóstico 12,13 . O sunitinibe e o bevacizumabe determinam cardiotoxicidade em 3% a 12% dos casos 14 .…”

Section: Insuficiência Cardíaca 31 -Incidência E Agentes Mais Envolvunclassified

“…A monitorização da função ventricular esquerda após o uso de trastuzumabe merece considerações especiais, uma vez que a disfunção cardíaca é na maioria das vezes reversível com o uso desse quimioterápico 13 . As Tabelas intensivo, incluindo rastreamento ativo de disfunção ventricular.…”

Section: N a Ta B E L A 5 S U G E R I M O S M O N I T O R A M E N Tunclassified

I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia

Filho¹,

Hajjar²,

Bacal³

et al. 2011

Arq. Bras. Cardiol.

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Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

Blechman

Arad

Nussbaum

et al. 2014

Clinical Cardiology

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BackgroundImprovement in the left ventricular ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM).HypothesisThere are different implications of persistent versus transient improvement in LVEF among DCM patients receiving contemporary therapy.MethodsWe studied 188 patients with nonischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo‐Doppler exams performed at least 12 months apart. Increased LVEF in echo 2, which was not sustained in echo 3, was defined as transient improvement in LVEF (TIEF).ResultsOver an average follow‐up of 6.8 years, PIEF occurred in 61 (33%) patients, predicting a better long‐term outcome (P < 0.001) in a combined end‐point comprising death, heart transplantation, or the need for a ventricular assist device. The TIEF group had an intermediate course and were closer to nonimprovers (P = 0.003 vs PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy‐associated disease, left ventricular hypertrophy, and baseline LVEF ≤25%. A score to predict PIEF assigned 1 point to each of the following: disease duration <3 years and no familial cardiomyopathy; pregnancy‐associated presentation; basal LVEF ≤25%; and left ventricular wall thickness ≥12. A score of ≥3 was present in 44% of the patients, reliably predicting PIEF in 91% (P = 0.01).ConclusionsPersistent improvement in LVEF is associated with improved long‐term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.

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Reversibility of Left Ventricular Dysfunction Resulting from Chemotherapy: Can This Be Expected?

Cited by 32 publications

References 57 publications

Cancer and Heart Failure: Understanding the Intersection

Cancer and Heart Failure: Understanding the Intersection

I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia

Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

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