RESUMO
End-stage heart failure in cancer survivors may result from cardiotoxic chemotherapy and/or chest radiation and require advanced therapies, including left ventricular assist devices (LVADs) and transplantation. Traditionally, such therapies have been underutilized in cancer survivors owing to lack of experience and perceived risk of cancer recurrence. Recent data from large registries, however, have shown excellent outcomes of LVADs and transplantation in cancer survivors, albeit subject to careful selection and special considerations. This article summarizes all aspects of advanced heart failure therapies in patients with cancer therapy-related cardiac dysfunction and underscores the need for careful selection of these candidates.
Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Neoplasias/terapia , Terapia de Ressincronização Cardíaca , Feminino , Insuficiência Cardíaca/etiologia , Transplante de Coração , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Seleção de Pacientes , Sistema de Registros , Função Ventricular Esquerda/efeitos dos fármacos , Função Ventricular Esquerda/efeitos da radiação , Função Ventricular Direita/efeitos dos fármacos , Função Ventricular Direita/efeitos da radiaçãoRESUMO
Right ventricular (RV) impairment after cancer therapy-related cardiotoxicity and its prognostic implications in lung cancer have not been examined. The present research sought to evaluate RV structure, function, and mechanics in stage III non-small-cell lung cancer (NSCLC) before and after concurrent chemoradiotherapy (CCRT), and to explore the associations between RV impairments, radiation dose, and all-cause mortality. This prospective investigation included 128 inoperable NSCLC patients who were scheduled to receive CCRT. Echocardiographic examination and strain evaluation was performed at baseline and 6 months post-CCRT in all participants. Conventional RV dimensions revealed no significant changes post-CCRT. However, a reduction in RV free wall strain (RV-fwLS) was observed at 6 months post-CCRT (- 28.3 ± 4.6% vs. - 25.5 ± 4.8%, P < 0.001). The same was revealed for global RV longitudinal strain (RV-GLS) (- 23.4 ± 2.9% vs. - 20.2 ± 3.4%, P < 0.001). Pearson correlation showed that RV radiation mean dose was related with the percentage change in RV-fwLS (r = 0.303, P = 0.001) and RV-GLS (r = 0.284, P = 0.002). In multivariable analysis, the percentage change in RV-fwLS was an independent predictor of all-cause mortality (HR 1.296, 95% CI 1.202-1.428, P < 0.001). RV longitudinal strain is deteriorated at 6 months post-CCRT. The RV mechanics deterioration was associated with radiation dose and affected the long-term outcome of stage III NSCLC patients treated with CCRT.