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Cardio-oncology: what you need to know now for clinical practice and echocardiography

Abstract

Cardio-oncology is a rapidly growing field aimed at minimizing the effects of cardiovascular morbidity and mortality in cancer survivors. To meet this aim, patients are assessed at baseline to define their risk of cardiotoxicity and then followed closely during and after chemotherapy to assess for early signs or symptoms of cardiovascular disease. Cardiac imaging, and in particular, transthoracic echocardiography, plays an essential role in the baseline assessment and serial follow-up of cardio-oncology patients. The objectives of this paper are to review the mechanisms of cardiotoxicity of several common chemotherapeutic agents associated with an increased risk for left ventricular systolic dysfunction and to outline recommendations regarding the baseline assessment and serial follow-up of cardio-oncology patients with a focus on the role of echocardiography. cardio-oncology

References

  1. Yoon GJ, Telli ML, Kao DP, Matsuda KY, Carlson RW, Witteles RM 2010 Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally? Journal of the American College of Cardiology 56 1644–1650. (doi:10.1016/j.jacc.2010.07.023)

    Article  Google Scholar 

  2. Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM 2010 Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. Journal of the National Cancer Institute 102 14–25. (doi:10.1093/jnci/djp440)

    Article  CAS  Google Scholar 

  3. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A 2016 Cancer treatment and survivorship statistics. CA: A Cancer Journal for Clinicians 66 271–289. (doi:10.3322/caac.21349)

    Google Scholar 

  4. Maddams J, Brewster D, Gavin A, Steward J, Elliott J, Utley M, Moller H 2009 Cancer prevalence in the United Kingdom: estimates for 2008. British Journal of Cancer 101 541–547. (doi:10.1038/sj.bjc.6605148)

    Article  CAS  Google Scholar 

  5. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP etal 2014 Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal: Cardiovascular Imaging 15 1063–1093. (doi:10.1093/ehjci/jeu192)

    PubMed  PubMed Central  Google Scholar 

  6. Ewer MS, Ewer SM 2010 Cardiotoxicity of anticancer treatments: what the cardiologist needs to know. Nature Reviews Cardiology 7 564–575. (doi:10.1038/nrcardio.2010.121)

    Article  Google Scholar 

  7. Ewer MS, Lippman SM 2005 Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. Journal of Clinical Oncology 23 2900–2902. (http://dx.doi.org/doi:JCO.>doi:10.1200/JCO.2005.05.827)

    Article  CAS  Google Scholar 

  8. Vejpongsa P, Yeh ET 2014 Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. Journal of the American College of Cardiology 64 938–945. (doi:10.1016/j.jacc.2014.06.1167)

    Article  CAS  Google Scholar 

  9. Curigliano G, Cardinale D, Suter T, Plataniotis G, de Azambuja E, Sandri MT, Criscitiello C, Goldhirsch A, Cipolla C, Roila F etal 2012 Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Annals of Oncology 23 (Supplement 7) vii155–vii166. (doi:10.1093/annonc/mds293)

    Article  Google Scholar 

  10. Yeh JM, Nohria A, Diller L 2014 Routine echocardiography screening for asymptomatic left ventricular dysfunction in childhood cancer survivors: a model-based estimation of the clinical and economic effects. Annals of Internal Medicine 160 661–671. (doi:10.7326/M13-2266)

    Article  Google Scholar 

  11. Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M 2014 Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clinic Proceedings 89 1287–1306. (doi:10.1016/j.mayocp.2014.05.013)

    Article  Google Scholar 

  12. Negro A, Brar BK, Lee KF 2004 Essential roles of Her2/erbB2 in cardiac development and function. Recent Progress in Hormone Research 59 1–12. (doi:10.1210/rp.59.1.1)

    Article  CAS  Google Scholar 

  13. Bowles EJ, Wellman R, Feigelson HS, Onitilo AA, Freedman AN, Delate T, Allen LA, Nekhlyudov L, Goddard KA, Davis RL etal 2012 Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. Journal of the National Cancer Institute 104 1293–1305. (doi:10.1093/jnci/djs317)

    Article  CAS  Google Scholar 

  14. Herrmann J 2016 Tyrosine kinase inhibitors and vascular toxicity: impetus for a classification system? Current Oncology Reports 18 33.. (doi:10.1007/s11912-016-0514-0)

    Article  Google Scholar 

  15. Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K 2016 SCAI expert consensus statement: evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista). Catheterization and Cardiovascular Interventions 87 E202–E223. (doi:10.1002/ccd.26379)

    Article  Google Scholar 

  16. Herrmann J, Lerman A 2014 An update on cardio-oncology. Trends in Cardiovascular Medicine 24 285–295. (doi:10.1016/j. cm.2014.07.003)

    Article  CAS  Google Scholar 

  17. Volkova M, Russell R 3rd 2011 Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Current Cardiology Reviews 7 214–220. (doi:10.2174/157340311799960645)

    Article  CAS  Google Scholar 

  18. Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, Jones A 2010 Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer 10 337.. (doi:10.1186/1471-2407-10-337)

    Article  Google Scholar 

  19. Kalam K, Marwick TH 2013 Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: a systematic review and meta-analysis. European Journal of Cancer 49 2900–2909. (doi:10.1016/j.ejca.2013.04.030)

    Article  CAS  Google Scholar 

  20. Gulati G, Heck SL, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, Gravdehaug B, von Knobelsdorff-Brenkenhoff F, Bratland A, Storas TH etal 2016 Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2?×?2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. European Heart Journal 37 1671–1680. (doi:10.1093/eurheartj/ehw022)

    Article  CAS  Google Scholar 

  21. Chotenimitkhun R, D’Agostino R Jr, Lawrence JA, Hamilton CA, Jordan JH, Vasu S, Lash TL, Yeboah J, Herrington DM, Hundley WG 2015 Chronic statin administration may attenuate early anthracycline-associated declines in left ventricular ejection function. Canadian Journal of Cardiology 31 302–307. (doi:10.1016/j.cjca.2014.11.020)

    Article  Google Scholar 

  22. Liu L, Liu ZZ, Liu YY, Zheng ZD, Liang XF, Han YL, Xie XD 2013 Preventive effect of low-dose carvedilol combined with candesartan on the cardiotoxicity of anthracycline drugs in the adjuvant chemotherapy of breast cancer. Zhonghua Zhong Liu Za Zhi 35 936–940.

    CAS  PubMed  Google Scholar 

  23. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE etal 2014 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129 S76–S99. (doi:10.1161/01.cir.0000437740.48606.dl)

    Article  Google Scholar 

  24. Bosch X, Rovira M, Sitges M, Domenech A, Ortiz-Perez JT, de Caralt TM, Morales-Ruiz M, Perea RJ, Monzo M, Esteve J 2013 Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). Journal of the American College of Cardiology 61 2355–2362. (doi:10.1016/j.jacc.2013.02.072)

    Article  CAS  Google Scholar 

  25. Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, Rubino M, Veglia F, Fiorentini C, Cipolla CM 2010 Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. Journal of the American College of Cardiology 55 213–220. (doi:10.1016/j.jacc.2009.03.095)

    Article  CAS  Google Scholar 

  26. Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH 2014 Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. Journal of the American College of Cardiology 63 2751–2768. (doi:10.1016/j.jacc.2014.01.073)

    Article  Google Scholar 

  27. Narayan HK, French B, Khan AM, Plappert T, Hyman D, Bajulaiye A, Domchek S, DeMichele A, Clark A, Matro J etal 2016 Noninvasive measures of ventricular-arterial coupling and circumferential strain predict cancer therapeutics-related cardiac dysfunction. JACC: Cardiovascular Imaging 9 1131–1141. (doi:10.1016/j. cmg.2015.11.024)

    PubMed  Google Scholar 

  28. Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, Civelli M, Peccatori F, Martinelli G, Fiorentini C etal 2004 Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 109 2749–2754. (doi:10.1161/01.CIR.0000130926.51766.CC)

    Article  CAS  Google Scholar 

  29. Weesner KM, Bledsoe M, Chauvenet A, Wofford M 1991 Exercise echocardiography in the detection of anthracycline cardiotoxicity. Cancer 68 435–438. (doi:10.1002/1097-0142(19910715)68:2<435::aid-cncr2820680237>3.0.co;2-#)

    Article  CAS  Google Scholar 

  30. Khouri MG, Hornsby WE, Risum N, Velazquez EJ, Thomas S, Lane A, Scott JM, Koelwyn GJ, Herndon JE, Mackey JR etal 2014 Utility of 3-dimensional echocardiography, global longitudinal strain, and exercise stress echocardiography to detect cardiac dysfunction in breast cancer patients treated with doxorubicin-containing adjuvant therapy. Breast Cancer Research and Treatment 143 531–539. (doi:10.1007/s10549-013-2818-1)

    Article  CAS  Google Scholar 

  31. Ryerson AB, Border WL, Wasilewski-Masker K, Goodman M, Meacham L, Austin H, Mertens AC 2015 Assessing anthracycline-treated childhood cancer survivors with advanced stress echocardiography. Pediatric Blood and Cancer 62 502–508. (http://dx.doi.org/doi:pbc.25328">doi:10.1002/pbc.25328)

    Article  CAS  Google Scholar 

  32. Hamada H, Ohkubo T, Maeda M, Ogawa S 2006 Evaluation of cardiac reserved function by high-dose dobutamine-stress echocardiography in asymptomatic anthracycline-treated survivors of childhood cancer. Pediatrics International 48 313–320. (doi:10.1111/j.1442-200X.2006.02210.x)

    Article  CAS  Google Scholar 

  33. Civelli M, Cardinale D, Martinoni A, Lamantia G, Colombo N, Colombo A, Gandini S, Martinelli G, Fiorentini C, Cipolla CM 2006 Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity. International Journal of Cardiology 111 120–126. (doi:10.1016/j.ijcard.2005.07.029)

    Article  Google Scholar 

  34. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL etal 2013 20136 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 62 e147–e239. (doi:10.1016/j.jacc.2013.05.019)

    Article  Google Scholar 

  35. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA etal 2016 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal 37 2129–2200. (doi:10.1093/eurheartj/ehw128)

    Article  Google Scholar 

  36. Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T etal 2013 Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Journal of the American Society of Echocardiography 26 1013–1032. (doi:10.1016/j.echo.2013.07.005)

    Article  Google Scholar 

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Correspondence to Sharon L. Mulvagh MD.

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Larsen, C.M., Mulvagh, S.L. Cardio-oncology: what you need to know now for clinical practice and echocardiography. Echo Res Pract 4, R33–R41 (2017). https://doi.org/10.1530/ERP-17-0013

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