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Aarti Asnani - One of the best experts on this subject based on the ideXlab platform.
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5 fu Cardiotoxicity vasospasm myocarditis and sudden death
Current Cardiology Reports, 2021Co-Authors: Luis Alberto More, Aarti Asnani, Sarah LaneAbstract:PURPOSE OF REVIEW 5-fluorouracil (5-FU) is one of the most common causes of Cardiotoxicity associated with chemotherapy. The manifestations of 5-FU Cardiotoxicity are diverse, and there are no established clinical guidelines addressing the diagnosis and management of this condition. Here we summarize the mechanistic and clinical data available to guide clinicians in caring for patients with suspected 5-FU Cardiotoxicity. RECENT FINDINGS The decision to resume 5-FU treatment in patients with suspected cardiovascular toxicity remains challenging. Testing for predisposing genetic variants may be helpful, particularly in patients with other signs of 5-FU toxicity. Uridine triacetate is a recently approved antidote that can improve clinical outcomes in patients with life-threatening fluoropyrimidine Cardiotoxicity. 5-FU Cardiotoxicity remains poorly understood, with limited mechanistic or prospective clinical trial data available to define risk factors or effective management strategies. Risk stratification and therapeutic decisions should be individualized, based on the risk-benefit ratio of continuing 5-FU therapy for each patient.
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Doxorubicin Cardiotoxicity: Pathophysiology Updates
Current Treatment Options in Cardiovascular Medicine, 2020Co-Authors: Christopher W. Hoeger, Cole Turissini, Aarti AsnaniAbstract:Doxorubicin has long been known to cause Cardiotoxicity, yet our understanding of its pathophysiologic mechanisms remains incomplete. This review aims to update readers on the most recent evidence supporting candidate mechanisms and proposed treatments for doxorubicin Cardiotoxicity. Doxorubicin causes Cardiotoxicity via traditional mechanisms, such as oxidative stress, DNA and mitochondrial damage, and iron overload, as well as through novel pathways such as autophagy and CYP1 induction. The relative importance of each pathway and how these pathways interact with each other is not well-understood. Novel approaches to cardioprotection are needed. Novel mechanisms of doxorubicin Cardiotoxicity represent exciting opportunities for prevention and treatment of this entity. Further studies are needed to translate recent findings into clinical use.
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Changes in Citric Acid Cycle and Nucleoside Metabolism Are Associated with Anthracycline Cardiotoxicity in Patients with Breast Cancer
Journal of Cardiovascular Translational Research, 2019Co-Authors: Aarti Asnani, Laurie Farrell, Rahul Lall, Igal A. Sebag, Juan Carlos Plana, Robert E. Gerszten, Marielle Scherrer-crosbieAbstract:Anthracyclines and HER2-targeted antibodies are very effective for the treatment of breast cancer, but their use is limited by Cardiotoxicity. In this nested case-control study, we assessed the role of intermediary metabolism in 38 women with breast cancer treated with anthracyclines and trastuzumab. Using targeted mass spectrometry to measure 71 metabolites in the plasma, we identified changes in citric acid and aconitic acid that differentiated patients who developed Cardiotoxicity from those who did not. In patients with Cardiotoxicity, the magnitude of change in citric acid at three months correlated with the change in left ventricular ejection fraction (LVEF) and absolute LVEF at nine months. Patients with Cardiotoxicity also demonstrated more pronounced changes in purine and pyrimidine metabolism. Early metabolic changes may therefore provide insight into the mechanisms associated with the development of chemotherapy-associated Cardiotoxicity.
Qing H. Meng - One of the best experts on this subject based on the ideXlab platform.
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Biomarkers for monitoring chemotherapy-induced Cardiotoxicity.
Critical reviews in clinical laboratory sciences, 2016Co-Authors: Liyun Cao, Wuqiang Zhu, Elizabeth A. Wagar, Qing H. MengAbstract:Cardiotoxicity, including acute and late-onset Cardiotoxicity, is a well-known adverse effect of many types of antitumor agents. Early identification of patients with Cardiotoxicity is important to ensure prompt treatment and minimize toxic effects. The etiology of chemotherapy-induced Cardiotoxicity is multifactorial. Traditional methods for assessment of chemotherapy-induced Cardiotoxicity typically involve serial measurements of cardiac function via multi-modality imaging techniques. Typically, however, significant left ventricular dysfunction has already occurred when Cardiotoxicity is detected by imaging techniques. Biomarkers, most importantly cardiac natriuretic peptides and troponins, are promising markers for identifying patients potentially at risk for clinical heart failure symptoms. This review summarizes the recent progress in clinical utilization of biomarkers for early diagnosis of acute Cardiotoxicity and for prediction of late-onset Cardiotoxicity. We also discuss the conflicting results of different studies and the association of results with study design.
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Biomarkers for monitoring chemotherapy-induced Cardiotoxicity
Critical Reviews in Clinical Laboratory Sciences, 2016Co-Authors: Elizabeth A. Wagar, Qing H. MengAbstract:AbstractCardiotoxicity, including acute and late-onset Cardiotoxicity, is a well-known adverse effect of many types of antitumor agents. Early identification of patients with Cardiotoxicity is important to ensure prompt treatment and minimize toxic effects. The etiology of chemotherapy-induced Cardiotoxicity is multifactorial. Traditional methods for assessment of chemotherapy-induced Cardiotoxicity typically involve serial measurements of cardiac function via multi-modality imaging techniques. Typically, however, significant left ventricular dysfunction has already occurred when Cardiotoxicity is detected by imaging techniques. Biomarkers, most importantly cardiac natriuretic peptides and troponins, are promising markers for identifying patients potentially at risk for clinical heart failure symptoms. This review summarizes the recent progress in clinical utilization of biomarkers for early diagnosis of acute Cardiotoxicity and for prediction of late-onset Cardiotoxicity. We also discuss the conflicting ...
Elizabeth A. Wagar - One of the best experts on this subject based on the ideXlab platform.
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Biomarkers for monitoring chemotherapy-induced Cardiotoxicity.
Critical reviews in clinical laboratory sciences, 2016Co-Authors: Liyun Cao, Wuqiang Zhu, Elizabeth A. Wagar, Qing H. MengAbstract:Cardiotoxicity, including acute and late-onset Cardiotoxicity, is a well-known adverse effect of many types of antitumor agents. Early identification of patients with Cardiotoxicity is important to ensure prompt treatment and minimize toxic effects. The etiology of chemotherapy-induced Cardiotoxicity is multifactorial. Traditional methods for assessment of chemotherapy-induced Cardiotoxicity typically involve serial measurements of cardiac function via multi-modality imaging techniques. Typically, however, significant left ventricular dysfunction has already occurred when Cardiotoxicity is detected by imaging techniques. Biomarkers, most importantly cardiac natriuretic peptides and troponins, are promising markers for identifying patients potentially at risk for clinical heart failure symptoms. This review summarizes the recent progress in clinical utilization of biomarkers for early diagnosis of acute Cardiotoxicity and for prediction of late-onset Cardiotoxicity. We also discuss the conflicting results of different studies and the association of results with study design.
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Biomarkers for monitoring chemotherapy-induced Cardiotoxicity
Critical Reviews in Clinical Laboratory Sciences, 2016Co-Authors: Elizabeth A. Wagar, Qing H. MengAbstract:AbstractCardiotoxicity, including acute and late-onset Cardiotoxicity, is a well-known adverse effect of many types of antitumor agents. Early identification of patients with Cardiotoxicity is important to ensure prompt treatment and minimize toxic effects. The etiology of chemotherapy-induced Cardiotoxicity is multifactorial. Traditional methods for assessment of chemotherapy-induced Cardiotoxicity typically involve serial measurements of cardiac function via multi-modality imaging techniques. Typically, however, significant left ventricular dysfunction has already occurred when Cardiotoxicity is detected by imaging techniques. Biomarkers, most importantly cardiac natriuretic peptides and troponins, are promising markers for identifying patients potentially at risk for clinical heart failure symptoms. This review summarizes the recent progress in clinical utilization of biomarkers for early diagnosis of acute Cardiotoxicity and for prediction of late-onset Cardiotoxicity. We also discuss the conflicting ...
M J Carreras - One of the best experts on this subject based on the ideXlab platform.
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trastuzumab related Cardiotoxicity in the elderly a role for cardiovascular risk factors
Annals of Oncology, 2012Co-Authors: Cesar Serrano, Javier Cortes, L De Mattosarruda, Meritxell Bellet, P Gomez, Cristina Saura, J Perez, Maria Vidal, Eva Munozcouselo, M J CarrerasAbstract:ABSTRACT Background Elderly breast cancer patients are usually excluded from clinical trials. Nevertheless, with the increasing use of trastuzumab, there is a need to address trastuzumab-related Cardiotoxicity in this population. Patients and methods Records for patients ≥70 years treated with trastuzumab since 2005 were reviewed. New York Heart Association classification was used to document symptomatic Cardiotoxicity. Asymptomatic Cardiotoxicity was defined as an absolute drop ≥10% with a final left ventricular ejection fraction 20%. Results Forty-five patients, median age 75.9 years (range 70–92), were identified. Three of 24 (12.5%) early breast cancer patients and 5 of 21 (23.8%) with advanced disease experienced asymptomatic Cardiotoxicity. Four of 45 patients (8.9%), all with advanced breast cancer, developed symptomatic congestive heart failure. All but one of them recovered in a median time of 5 weeks (range 3–21). Patients with trastuzumab-related Cardiotoxicity presented more often with cardiovascular risk factors, such as history of cardiac disease (33% versus 9.1%, P = 0.017) and diabetes (33.3% versus 6.1%, P = 0.010), compared with those without. Conclusions Elderly breast cancer patients with a history of cardiac disease and/or diabetes treated with trastuzumab have an increased incidence of Cardiotoxicity. Continuous cardiac monitoring is especially advised in this population.
Daniela Cardinale - One of the best experts on this subject based on the ideXlab platform.
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Cardiotoxicity of Anthracyclines.
Frontiers in cardiovascular medicine, 2020Co-Authors: Daniela Cardinale, Fabiani Iacopo, Carlo M. CipollaAbstract:Cardiotoxicity is a feared side effect that may limit the clinical use of anthracyclines. It may indeed affect the quality of life and survival of patients with cancer, regardless of oncological prognosis. This paper provides an overview of anthracycline-induced Cardiotoxicity in terms of definition, classification, incidence, risk factors, possible mechanisms, diagnosis, and treatment. We also report effective strategies for preventing Cardiotoxicity. In addition, we discuss limiting current approaches, the need for a new classification, and early Cardiotoxicity detection and treatment. Probably, anthracycline-induced Cardiotoxicity is a continuous phenomenon that starts from myocardial cell injury; it is followed by left ventricular ejection fraction (LVEF) and, if not diagnosed and cured early, progressively leads to symptomatic heart failure. Anthracycline-induced Cardiotoxicity can be detected at a preclinical phase. The role of biomarkers, in particular troponins, in identifying subclinical Cardiotoxicity and its therapy with angiotensin-converting enzyme inhibitors (mainly enalapril) to prevent LVEF reduction is a recognized and effective strategy. If cardiac dysfunction has already occurred, partial or complete LVEF recovery may still be obtained in case of early detection of Cardiotoxicity and prompt heart failure treatment.
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early detection of anthracycline Cardiotoxicity and improvement with heart failure therapy
Circulation, 2015Co-Authors: Daniela Cardinale, Alessandro Colombo, Giulia Bacchiani, Ines Tedeschi, Carlo Ambrogio Meroni, Fabrizio Veglia, Maurizio Civelli, Giuseppina Lamantia, Nicola Colombo, Giuseppe CuriglianoAbstract:Background— Three types of anthracycline-induced cardiotoxicities are currently recognized: acute, early-onset chronic, and late-onset chronic. However, data supporting this classification are lacking. We prospectively evaluated incidence, time of occurrence, clinical correlates, and response to heart failure therapy of Cardiotoxicity. Methods and Results— We assessed left ventricular ejection fraction (LVEF), at baseline, every 3 months during chemotherapy and for the following year, every 6 months over the following 4 years, and yearly afterward in a heterogeneous cohort of 2625 patients receiving anthracycline-containing therapy. In case of Cardiotoxicity (LVEF decrease >10 absolute points, and 5 absolute points and >50%) or full (LVEF increase to the baseline value). The median follow-up was 5.2 (quartile 1 to quartile 3, 2.6–8.0) years. The overall incidence of Cardiotoxicity was 9% (n=226). The median time elapsed between the end of chemotherapy and Cardiotoxicity development was 3.5 (quartile 1 to quartile 3, 3–6) months. In 98% of cases (n=221), Cardiotoxicity occurred within the first year. Twenty-five (11%) patients had full recovery, and 160 (71%) patients had partial recovery. At multivariable analysis, end-chemotherapy LVEF (hazard ratio, 1.37; 95% confidence interval, 1.33–1.42 for each percent unit decrement) and cumulative doxorubicin dose (hazard ratio, 1.09; 95% confidence interval, 1.04–1.15 for each 50 mg/m 2 increment) were independent correlates of Cardiotoxicity. Conclusions— Most Cardiotoxicity after anthracycline-containing therapy occurs within the first year and is associated with anthracycline dose and LVEF at the end of treatment. Early detection and prompt therapy of Cardiotoxicity appear crucial for substantial recovery of cardiac function.
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Role of Biomarkers in Chemotherapy-Induced Cardiotoxicity
Progress in Cardiovascular Diseases, 2010Co-Authors: Daniela Cardinale, Maria Teresa SandriAbstract:Chemotherapy-induced Cardiotoxicity remains an unresolved problem strongly impacting the quality of life and the overall survival of cancer patients. The main strategy for minimizing Cardiotoxicity is early detection of high-risk patients and prompt prophylactic treatment. The current standard for monitoring cardiac function detects Cardiotoxicity only when a functional impairment has already occurred, not allowing for any early preventive strategies. Measurement of cardiospecific biomarkers can be a valid diagnostic tool for early identification, assessment, and monitoring of Cardiotoxicity. In particular, the role of troponin in identifying patients at risk of Cardiotoxicity and of angiotensin-converting enzyme inhibitors in preventing cardiac dysfunction and cardiac events is clearly emerging as a new effective approach. Therefore, we propose troponin as a criterion standard marker for the assessment of cardiac risk of both old and new antineoplastic treatments, and its evaluation should be included among the criteria utilized to define Cardiotoxicity.