Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally?

OBJECTIVES: The purpose of this study was to examine treatment practices for cancer therapy-associated decreased left ventricular ejection fraction (LVEF) detected on echocardiography and whether management was consistent with American College of Cardiology/American Heart Association guidelines. BACKGROUND: Patients treated with anthracyclines or trastuzumab are at risk of cardiotoxicity. Decreased LVEF represents a Class I indication for drug intervention according to American College of Cardiology/American Heart Association guidelines. METHODS: Patients receiving anthracycline or trastuzumab at Stanford University from October 2005 to October 2007 and who had undergone echocardiography before and after receiving an anthracycline or trastuzumab were identified. Chart review examined chemotherapy regimens, cardiac risk factors, imaging results, concomitant medications, and cardiology consultations. RESULTS: Eighty-eight patients received therapy with an anthracycline or trastuzumab and had a pre-treatment and follow-up echocardiogram. Ninety-two percent were treated with anthracyclines, 17% with trastuzumab after an anthracycline, and 8% with trastuzumab without previous treatment with anthracycline. Mean baseline LVEF was 60%, with 14% having a baseline <55%. Forty percent had decreased LVEF (<55%) after anthracycline and/or trastuzumab treatment. Of these patients, 40% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy, and 54% cardiology consultation. Of patients with asymptomatic decreased LVEF, 31% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 35% beta-blocker therapy, and 42% cardiology consultation. Of those with symptomatic decreased LVEF, 67% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 100% beta-blocker therapy, and 89% cardiology consultation. CONCLUSIONS: Many cancer survivors are not receiving treatment consistent with heart failure guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving cardiotoxic therapy.

Neuronal network morphology and electrophysiologyof hippocampal neurons cultured on surface-treated multielectrode arrays.

Toward the development of biocompatible surfaces for implantable electrode arrays and the creation of patterned neuronal networks, the impact of select biochemical substrates [poly-D-lysine (PDL), polyornithine (PO), polyethylenimine (PEI), and a basement membrane extract (BM)] on network morphology and spontaneous electrophysiological activity of dissociated hippocampal neurons was investigated. Cultured in serum-free Neurobasal medium at 100 000 cells/cm(2), neurons attached to each substrate. PDL, PO, and PEI induced little or no neuronal clustering and process fasciculation, whereas the addition of BM promoted these features. The ratios of somas to processes, and axons to dendrites, as determined by immunohistochemical staining and image analysis were comparable across all substrates. Spontaneous firing was recorded using planar multielectrode arrays (MEAs) at the third week in vitro for the two most divergent morphologies according to Euclidian cluster analysis, namely those induced by PO + BM and PEI. Mean spike amplitude, mean firing rate, median interspike interval (ISI), mean burst rate, and correlation index were analyzed and compared to morphological features. Synchronized bursting was highly correlated with neuronal clustering and process fasciculation. Spike amplitude was negatively correlated with thin branching which was most evident in neurons grown on PEI. These data indicate that factors, which influence adherence of neurons to surfaces, can profoundly impact both neuronal network morphology and electrophysiological activity in vitro.