Evolução da Captação Miocárdica de 18F-FDG em Paciente com Diagnóstico de Cardiotoxicidade / Progression of Myocardial 18F-FDG Uptake in a Patient with Cardiotoxicity

Resumo O objetivo deste relato é mostrar a evolução da cardiotoxicidade (CTX) por quimioterápicos em paciente com linfoma por exames de imagens, destacando a importância da captação miocárdica de flúor-18 fluordeoxiglicose (18F-FDG) pela tomografia por emissão de pósitrons, acoplada à tomografia computadorizada (PET/CT). Feminino, 43 anos, com linfoma uterino, submetida a histerectomia, três esquemas de quimioterapia (QT), sucessivamente, e radioterapia. Apresentou episódios de insuficiência cardíaca aguda dois anos após QT. Ecocardiograma mostrou redução da fração de ejeção do ventrículo esquerdo (FEVE). Análise retrospectiva do 18F-FDG PET/CT observou elevação da captação miocárdica em todos os exames durante o seguimento oncológico. Apesar da remissão oncológica, a paciente desenvolveu IC com FEVE reduzida. Durante a QT, ocorreu aumento difuso e significativo da captação miocárdica de 18F-FDG, que precedeu a queda do desempenho cardíaco, e pareceu refletir alterações metabólicas nos cardiomiócitos relacionadas à CTX. A análise da captação miocárdica de 18F-FDG modificaria o desfecho cardiológico da paciente? Esse questionamento é relevante, visto que outros pacientes podem se beneficiar desse método como marcador precoce de CTX. Os exames de imagem são imprescindíveis no acompanhamento de pacientes com risco de CTX. O ecocardiograma permanece como principal auxílio diagnóstico, porém o 18F-FDG PET/CT pode estar surgindo como uma poderosa ferramenta para um diagnóstico mais precoce dessa condição clínica.

Abstract The objective of this case report was to present the progression of chemotherapy-induced cardiotoxicity in a patient with lymphoma, highlighting the importance of myocardial fluor-18-fluorodeoxyglucose (18F-FDG) uptake by positron emission tomography coupled with computed tomography (PET/CT). 43-year-old female patient with uterine lymphoma, who underwent hysterectomy followed by three chemotherapy regimens and radiotherapy. The patient had episodes of acute heart failure two years after chemotherapy. Echocardiogram revealed a reduction in left ventricular ejection fraction (LVEF). A retrospective analysis of 18F-FDG PET/CT showed an increase in myocardial uptake in all tests performed during oncologic treatment. Despite disease remission, the patient developed heart failure with reduced LVEF. During chemotherapy, there was a diffuse, significant increase in myocardial 18F-FDG uptake, which preceded the decrease in myocardial performance and seemed to reflect metabolic changes in cardiomyocytes, related to cardiotoxicity. Would an analysis of myocardial 18F-FDG uptake yield a different cardiac outcome in this patient? This question is relevant, considering that other patients may benefit from the use of PET as an early marker of cardiotoxicity. Imaging tests are essential in the follow-up of patients at risk of cardiotoxicity. Although echocardiography remains the main imaging test in the diagnosis of cardiotoxicity, 18F-FDG PET/CT may be a powerful tool for the early diagnosis of this condition.

Is dyslipidemia a risk factor for trastuzumab-induced cardiotoxicity in breast cancer patients? A systematic review and meta-analysis.

INTRODUCTION: Breast cancer patients undergoing trastuzumab therapy have greater risk of cardiovascular disease. Risk factors for this effect have been proposed. However, the role of dyslipidemia is not completely understood. This systematic review aimed to explore the role of dyslipidemia in trastuzumab-induced cardiotoxicity. METHODS: The investigators searched MEDLINE, Scopus, and Web of Science up to October 25, 2020. A random-effects model was used to determine pooled estimates of the results. The primary endpoint was trastuzumab-induced cardiotoxicity in patients with and without dyslipidemia. RESULTS: A total of 39 studies were selected for inclusion in our systematic review assessing 21079 patients. One study demonstrated a statistically significant association between dyslipidemia and cardiotoxicity (OR=2.28, 95% CI 1.22-4.26, p=0.01). In all other studies, no such association was observed. Twenty-one studies including 6135 patients were eligible for meta-analysis. In this meta-analysis of unadjusted data, dyslipidemia was significantly associated with cardiotoxicity (OR=1.25, 95% CI 1.01-1.53, p=0.04, I2=0%), however, a subgroup analysis of studies reporting adjusted measures did not demonstrate a significant association (OR=0.89, 95% CI 0.73-1.10, p=0.28, I2=0%). CONCLUSION: This systematic review and meta-analysis did not demonstrate a significant association between dyslipidemia alone and the development of cardiotoxicity. In the absence of other relevant cardiovascular risk factors, review of lipid profile may not be obligatory, and management of patients could be performed without referral for cardio-oncology assessment. Further investigation of risk factors for trastuzumab-induced cardiotoxicity is required to confirm these results.

Nursing interventions for adult patients undergoing cancer cardiotoxic therapy: Scoping review.

PURPOSE: To identify nursing interventions for the management of adult patients undergoing cardiotoxic oncologic therapy. METHODS: This scoping review was performed in accordance with the JBI guidelines. The literature search took place between July and August 2022. Studies examining interventions for the management of adult cancer patients undergoing cardiotoxic therapy were included. The characteristics and results of the studies were synthesized and analyzed in a narrative way. FINDINGS: In the nine included studies, it was verified that the interventions were implemented to guide the actions of the health team in general rather than specifically nursing staff. Nine nursing interventions related to the Classification of Nursing Interventions were included. CONCLUSIONS: The nursing interventions identified focused on rigorous cardiovascular surveillance, risk assessment, and actions to identify and mitigate cardiotoxicity. IMPLICATIONS FOR NURSING PRACTICE: It is believed that the implementation of the identified nursing interventions will lead to evidence-based nursing practice and will contribute to the development of care products and processes that assess the cardiological risks and cardiotoxicity.

OBJETIVO: Identificar as intervenções de enfermagem no manejo de pacientes adultos submetidos à terapia oncológica cardiotóxica. MÉTODOS: Revisão de escopo seguindo a JBI. A busca da literatura ocorreu entre julho e agosto de 2022. Foram incluídos estudos que abordam intervenções para o manejo de pacientes adultos oncológicos submetidos à terapia cardiotóxica. As características e resultados foram sintetizados e analisados de forma narrativa. RESULTADOS: Nos nove estudos incluídos, verificou-se que as intervenções foram direcionadas às ações da equipe de saúde, em geral, e não àquelas específicas da enfermagem. A partir da literatura, foram identificadas nove intervenções de enfermagem relacionadas à Classificação das Intervenções de Enfermagem. CONCLUSÕES: As intervenções de enfermagem identificadas direcionaram-se para vigilância cardiovascular rigorosa, avaliação de risco e ações para identificar e mitigar a cardiotoxicidade. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Acredita-se que a implementação das intervenções identificadas proporcionará uma prática de enfermagem baseada em evidências e contribuirá para o desenvolvimento de produtos e processos assistenciais que avaliem os riscos cardiológicos e a cardiotoxicidade.

Irbesartan has a curative effect on lipopolysaccharide-induced cardiotoxicity by antioxidant and antiapoptotic pathways.

INTRODUCTION AND OBJECTIVE: Lipopolysaccharide (LPS) has been associated with myocardial inflammation, oxidative stress, apoptosis, and cardiac dysfunction, as well as death by causing sepsis. In this study, we investigated the effect of irbesartan (IRB), an angiotensin receptor antagonist, on cardiotoxicity caused by LPS. METHODS: The experiment involved 24 Wistar albino rats divided into three groups of eight: control, LPS (5 mg/kg), and LPS (5 mg/kg)+IRB (3 mg/kg). Parameters including total oxidative status, total antioxidant status, oxidative stress index, and ischemia-modified albumin were measured to assess oxidative stress in heart tissues and serum. Serum CK, CK-MB, and LDH levels were measured spectrophotometrically. RT-qPCR was used to detect the mRNA expression levels of Bcl-2, BAX, p53, caspase-3, and sirtuin 1. Tissues taken from the heart and aorta were examined by immunohistochemistry and histopathology. RESULTS: While there was an increase in the parameters indicating heart damage, oxidative stress, and apoptosis in the group given LPS, there was an improvement in all parameters and heart damage in the group treated with IRB. CONCLUSION: As a result of our study, we determined that IRB has an ameliorating effect on myocardial damage caused by oxidative stress and apoptosis developed by the LPS-induced sepsis model.

Valor Diagnóstico de Parâmetros Tridimensionais de Strain de Imagem de Speckle Tracking para Detecção de Disfunção Cardíaca Relacionada à Quimioterapia do Câncer: Uma Metanálise / Diagnostic Value of Three-Dimensional Speckle Tracking Imaging Strain Parameters for Detection of Cancer Chemotherapy-Related Cardiac Dysfunction: A Meta-Analysis

Resumo Fundamento Agentes quimioterápicos (por exemplo, antraciclinas, trastuzumabe) comumente usados para o tratamento de tumores malignos demonstraram ter efeitos cardiotóxicos, que estão associados a um prognóstico ruim. A ecocardiografia tridimensional tem sido usada para prever a disfunção cardíaca induzida pela quimioterapia do câncer. Objetivos Avaliação do desempenho diagnóstico de parâmetros de strain, área global de strain (AGS), strain longitudinal (SLG), strain circunferencial (SCG) e strain radial (SRG) por metanálise. Métodos Estudos relevantes foram pesquisados nas bases de dados Embase, PubMed e Web of Science. A análise estatística foi realizada usando Stata 12. O resumo da curva característica operacional do receptor, sensibilidade, especificidade, razão de verossimilhança positiva (RVP), razão de verossimilhança negativa (RVN), e o correspondente intervalo de confiança de 95% para os quatro parâmetros de strain foram combinados. P<0,05 foi considerado estatisticamente significativo. Resultados Nove estudos envolvendo 650 participantes foram incluídos. AGS e SLG mostraram vantagens diagnósticas significativas sobre SCG e SRG. Para AGS, a sensibilidade foi de 0,85 (0,70, 0,93) e a especificidade foi de 0,82 (0,78, 0,86) com RVP de 4,76 (3,55, 6,39) e RVN de 0,18 (0,09, 0,39) e uma área sob a curva (AUC) de 0,85 (0,82, 0,88). Para SLG, a sensibilidade foi de 0,81 (0,74, 0,86) e a especificidade foi de 0,81 (0,68, 0,90) com RVP de 4,35 (2,42, 7,80) e RVN de 0,23 (0,17, 0,33) e uma AUC de 0,85 (0,82, 0,88).OGCS mostrou uma sensibilidade de 0,63 e uma especificidade de 0,79 com uma AUC de 0,77.O SRG mostrou uma sensibilidade de 0,74e uma especificidade de 0,66 com umAUC de 0,73. Conclusão Parâmetros 3D-STI de strain AGS e SLG mostraram bom desempenho na detecção precoce de disfunção cardíaca em pacientes com tumores recebendo quimioterapia.

Abstract Background Chemotherapeutic agents (e.g., anthracyclines, trastuzumab) commonly used for treating malignant tumors have been demonstrated to have cardiotoxic effects, which is associated with poor prognosis. Three-dimensional echocardiography has been used to predict cancer chemotherapy-induced cardiac dysfunction. Objectives Evaluation of the diagnostic performance of strain parameters, global area strain (GAS), longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) by meta-analysis. Methods Relevant studies were searched from the Embase, PubMed, and Web of Science databases. Statistical analysis was performed using Stata 12. The summary receiver operating characteristic curve, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and corresponding 95% confidence interval for the four strain parameters were pooled. P<0.05 was considered statistically significant. Results Nine studies involving 650 participants were included. GAS and GLS showed significant diagnostic advantages over GCS and GRS. For GAS, the sensitivity was 0.85 (0.70, 0.93) and specificity was 0.82(0.78, 0.86) with PLR of 4.76 (3.55, 6.39) and NLR of 0.18 (0.09, 0.39) and an area under the curve (AUC) of 0.85 (0.82, 0.88). For GLS, the sensitivity was 0.81 (0.74, 0.86) and specificity was 0.81(0.68, 0.90) with PLR of 4.35(2.42, 7.80) and NLR of 0.23 (0.17, 0.33) and an AUC of 0.85 (0.82, 0.88). The GCS showed a sensitivity of 0.63 and a specificity of 0.79 with an AUC of 0.77. The GRS showed a sensitivity of 0.74 and a specificity of 0.66 with an AUC of 0.73. Conclusion 3D-STI strain parameters GAS and GLS showed good performance in detecting early cardiac dysfunction in patients with tumors receiving chemotherapy.

Perfil de liberación de biomarcadores miocárdicos en pacientes con enfermedades hemato-oncológicas que reciben trasplante de progenitores hematopoyéticos / Profile or myocardial biomarkers release in patients with hemato-oncological diseases who receive hematopoietic stem cell transplantation / Perfil de liberação de biomarcadores miocárdicos em pacientes com doenças hemato-oncológicas que recebem transplante de células-tronco hematopoéticas

Introducción: las enfermedades cardiovasculares (CV) son la primera causa de muerte en quienes sobreviven al cáncer. Aunque el trasplante de progenitores hematopoyéticos (TPH) se asocia con grados variables de cardiotoxicidad, estas complicaciones han sido escasamente caracterizadas. Objetivo: analizar el perfil de liberación de biomarcadores miocárdicos como potenciales indicadores subclínicos de cardiotoxicidad en pacientes sometidos a TPH. Material y método: estudio descriptivo, analítico, prospectivo transversal y unicéntrico, reclutando pacientes derivados a la policlínica de cardio-oncología, con indicación de TPH en octubre de 2018-marzo de 2020. Se realizaron controles clínicos, ECG, bioquímicos (troponina I TnI y péptido natriurético del tipo BBNP) e imagenológicos según algoritmo de seguimiento. Las variables discretas se presentan como n (%) y las continuas mediante media ± DE o mediana RIQ. Los valores evolutivos de biomarcadores séricos se compararon mediante test de Friedman. La fracciónde eyección del VI (FEVI) basal se comparó con la de los 3 meses del TPH mediante test de Wilcoxon. Resultados: se incluyeron 19 pacientes, 37% mujeres, de 43,8 ± 15,7 años. No se detectaron modificaciones significativas de la FEVI en los controles evolutivos. En ningún caso se observó aumento de la TnI. Los valores de BNP aumentaron en 6 pacientes (32%), con diferencias significativas al mes postrasplante (basal: 13,6 1;6,1-30,9 vs. primer mes: 38,9 16,3-120,0 pg/ml, p = 0,036); con una mayor elevación en aquellos pacientes que recibieron antimetabolitos vs. otros fármacos (basal: 13,6 1;6,1-30,9 vs. al primer mes: 67,0 ;21,3-174,9 pg/ml, p = 0,039). El aumento de BNP no se asoció con el riesgo CV. Conclusión: la liberación de BNP posterior al TPH es un fenómeno frecuente (32% de los pacientes), alcanza un máximo al mes, independientemente de la FEVI. El subgrupo de pacientes que recibió antimetabolitos presentó una mayor liberación precoz de BNP.

Introduction: cardiovascular (CV) diseases are the leading cause of death in those who survive cancer. Although hematopoietic stem cell transplantation (HSCT) is associated with diverse grades of cardiotoxicity, these complications have been poorly characterized. Objective: to analyze the release profile of myocardial biomarkers as a potential subclinical marker of cardiotoxicity in patients undergoing HSCT. Material and method: descriptive, analytical, prospective, cross-sectional, single-center study, recruiting patients referred to the cardio-oncology polyclinic, with indication for HSCT in October 2018-March 2020. Clinical, ECG, biochemical and imaging controls were performed according to the algorithm of follow-up. The evolutionary values of serum biomarkers were compared using the Friedman test. Baseline LVEF was compared with that of 3 months after HSCT using the Wilcoxon test. Results: 19 patients were included, 37% women, aged 43.8 ± 15.7 years. No changes in LVEF were detected. In no case was an increase in TnI observed. BNP values increased in 6 patients (32%), with significant differences one month after transplantation (baseline: 13.6 ;6.1-30.9 vs. first month: 38.9 ;16.3-120.0, p = 0.036), detecting a greater elevation in those patients who received antimetabolites vs. other rugs (baseline: 13.6 ;6.1-30.9 vs. at the first month: 67.0 21.3-174.0, p = 0.039). The increase in BNP was not associated with CV risk. Conclusion: BNP release after HSCT is frequent (32% of our patients), reaching a maximum at one month, regardless of LVEF. The subgroup of patients who received antimetabolites had a greater early release of BNP.

Introdução: as doenças cardiovasculares (CV) são a principal causa de morte em pessoas que sobrevivem ao câncer. Embora o transplante de células-tronco hematopoéticas (TCTH) esteja associado à diverso grado de cardiotoxicidade, essas complicações têm sido mal caracterizadas. Objetivo: analisar o perfil de liberação de biomarcadores miocárdicos como potenciais marcadores subclínicos de cardiotoxicidade em pacientes submetidos ao TCTH. Material e método: estudo descritivo, analítico, prospectivo, transversal, unicéntrico, com recrutamento de pacientes encaminhados à policlínica de cardio-oncologia, com indicação de TCTH de outubro de 2018 a março de 2020. Foram realizados controles clínicos, eletrocardiográficos, bioquímicos e de imagem de acordo com o algoritmo de acompanhamento. Os valores evolutivos dos biomarcadores séricos foram comparados pelo teste de Friedman. A FEVE basal foi comparada com a de 3 meses após o TCTH usando o teste de Wilcoxon. Resultados: foram incluídos 19 pacientes, 37% mulheres, com idade de 43,8 ± 15,7 anos. Nenhuma mudança na LVEF foi detectada. Em nenhum caso foi observado um aumento de TnI. Os valores de BNP aumentaram um mês após o transplante (linha de base: 13,6 6,1-30,9; vs. primeiro mês: 38,9 16,3-120,0, p = 0,036), se detectou uma maior elevação nos pacientes que receberam antimetabólitos vs. outros medicamentos (linha de base: 13,6 ;6,1-30,9; vs. no primeiro mês: 67,0 ;21,3-174,0;, p = 0,039). O aumento do BNP não foi associado ao risco CV. Conclusão: a liberação do BNP após o TCTH é frequente (32% de nossos pacientes), podendo chegar a no máximo um mês, independente da FEVE. O subgrupo de pacientes que recebeu antimetabólitos apresentou maior liberação precoce de BNP.

A case of lymphocytic myocarditis in a patient treated with an immune checkpoint inhibitor, a recent class of chemotherapy agents.

Chemotherapy-associated cardiotoxicity is a common adverse event. Immune checkpoint inhibitors (ICI) - a new class of monoclonal antibodies - have revolutionized the management of various diseases. Their use is expected to increase in the near future and their cardiac side effects have been increasingly recognized. CLINICAL CASE: We describe a case of a 67-year-old female patient with urothelial carcinoma undergoing treatment with pembrolizumab who presented to the emergency department with progressive fatigue, retrosternal pain and palpitations for three days. On admission she was diagnosed with acute heart failure (HF). The electrocardiogram revealed a right bundle branch block and ventricular bigeminy. Blood tests showed elevated troponin I, while transthoracic echocardiography revealed severe left ventricular dysfunction. Coronary angiography excluded coronary artery disease. Cardiac magnetic resonance revealed moderate left ventricular dysfunction and late gadolinium enhancement typical of myocarditis. Endomyocardial biopsy confirmed the diagnosis of lymphocytic myocarditis. In the first 48h of hospitalization, she developed transient complete AV block. Corticoid and HF therapy were initiated, leading to symptom improvement and disappearance of the rhythm disturbances. She was discharged on the 12th day, maintaining moderate LV dysfunction, which improved only mildly at a subsequent outpatient assessment. She died suddenly 35 days after discharge. CONCLUSION: Lymphocytic myocarditis is a serious cardiac side effect of ICI therapy. Pembrolizumab is increasingly used, so it is important to be aware of its effects, in order to perform an early diagnosis and provide adequate treatment. Corticosteroid therapy seems to be crucial in preventing disease progression and enabling ventricular remodeling.

The effect of paclitaxel plus carboplatin chemotherapy on subclinical cardiotoxicity in patients with non-small cell lung cancer: A speckle tracking echocardiography-based study.

BACKGROUND: Although chemotherapy-induced cardiotoxicity is an emerging problem, limited information is available on the effects of chemotherapy on left ventricular (LV) mechanical functions in patients with non-small cell lung cancer (NSCLC). OBJECTIVE: We aimed to explore chemotherapy-induced alterations in cardiac mechanical functions in patients with NSCLC using speckle tracking echocardiography (STE). METHODS: Seventy-one patients with NSCLC and 34 age and sex matched control subjects were consecutively included. Based on their good performance status (Eastern Cooperative Oncology Group performance status), 39 patients were treated with paclitaxel plus carboplatin (PC) regimen and 32 patients were treated with vinorelbine plus cisplatin (VC) regimen. All patients and controls underwent conventional two-dimensional echocardiography and STE at baseline to assess their LV functions. The echocardiographic examinations of NSCLC patients were repeated after the chemotherapy regimens. RESULTS: None of the NSCLC patients developed any signs or symptoms of clinical heart failure during or after the chemotherapy. There were not any significant differences in LV ejection fraction between NSCLC patients and controls before and after chemotherapy. There were not any significant differences in baseline LV global longitudinal strain (GLS), radial strain (RS), and circumferential strain (CS) between NSCLC patients and controls. However, all LV GLS, RS and CS significantly decreased in patients treated with the PC regimen resulting in a significant difference compared to both VC group and controls while no significant decreases were observed in strain measures in VC group. CONCLUSION: Paclitaxel plus carboplatin, but not VC, may induce subclinical cardiotoxicity in patients with NSCLC, which may be detected by STE.

Clinical experience of a cardio-oncology consultation at a tertiary university hospital in Portugal: An observational study.

INTRODUCTION: Heart disease and cancer are the two leading causes of morbidity and mortality worldwide. Advances in cancer screening and management have led to longer survival and better quality of life. Despite this progress, many cancer patients experience cardiovascular complications during and after cancer treatment. This study describes the experience of a cardio-oncology program at tertiary academic hospital. METHODS: In this retrospective observational study, cancer patients referred to the CHULN cardio-oncology consultation (COC) between January 2016 and December of 2019 were included. Data collected included: patient demographics, cancer type, reason for referral, cardiovascular risk factors, cardiac and oncologic treatments and clinical outcomes. RESULTS: A total of 520 patients (mean age: 65 ± 14 years; 65% women) were referred to the COC. The main reasons for referral were suspected heart failure (26%), pre-high risk chemotherapy assessment (20%) and decreased LVEF (15%). Pre-existing cardiovascular risk factors were common (79%) and 309 (59%) were taking cardiac medications. The most common type of malignancy was breast cancer (216, 41%) followed by gastrointestinal (139, 27%). More than half received anthracycline-based regimens (303, 58%). Most patients (401; 77%) successfully completed cancer therapy. At the time of last data collection, the majority of patients were alive (430, 83%). Cardiac-related mortality was observed in 16%. CONCLUSIONS: The close collaboration between cardiology and oncology teams and timely cardiac monitoring was the key to the majority of patients to completing their prescribed cancer therapy.

Cardio-oncology: Understanding the different mechanisms of cardiovascular toxicity.

Due to the success of finding treatments for various types of cancer, overall cancer survival has increased substantially in recent decades. Ironically, the clinical success of antineoplastic therapy is attenuated by the comorbidity of cardiovascular diseases, which appear to be the main complications of intense cancer treatment and are the second main cause of long-term morbidity and mortality among cancer survivors. Cardio-oncology is the new area of cardiology that aims to treat the specific cardiologic status of cancer patients. Most antineoplastic therapies are associated with some degree of cardiovascular toxicity, ranging from asymptomatic and transient cardiac events to clinically significant and long-lasting events. Antineoplastic agents are responsible for different cardiovascular injuries, which can be reversible or permanent. All anatomical structures of the heart can, however, be affected by transthoracic radiotherapy. Cardiotoxicity mechanisms are recognized according to the presence or absence of structural anomalies and their reversibility, being classified into Type I and Type II, aiming to distinguish the drugs that induce irreversible damage (Type I) from the drugs that predominantly induce reversible left ventricular dysfunction (Type II). While anthracyclines and anti-HER2 agents form the two major groups of cardiotoxic drugs, other antineoplastic agents, such as other monoclonal antibodies, certain tyrosine kinase inhibitors and antiangiogenic drugs can also be cardiotoxic via different mechanisms. This article presents the different pathophysiological mechanisms of cardiovascular toxicity according to the treatment regimen used.

Prevention of doxorubicin-induced experimental cardiotoxicity by Nigella sativa in rats.

INTRODUCTION: Doxorubicin (DOX) is an anthracycline cytotoxic chemotherapeutic drug that is commonly used in cancer treatment. A major side effect limiting the clinical use of DOX is cardiotoxicity due to oxidative injury. Nigella sativa (NS) is an annual flowering plant with antioxidant properties. Its seeds contain several bioactive constituents such as saturated and unsaturated fatty acids, thymoquinone, dithymoquinone, thymohydroquinone, and thymol. In this study, we investigated the effect of NS extract on DOX-induced cardiotoxicity. METHODS: The experimental study animals consisted of 28 male Sprague Dawley rats weighing between 300 and 400 g. Four study groups each of seven rats were defined: controls; NS extract; DOX; and DOX+NS. Control and DOX rats received standard food, while each rat in the NS and DOX+NS groups also received 100 mg/kg NS extract orally. At day 28 of follow-up, rats in the DOX groups were administered a single 10 mg/kg intraperitoneal dose of DOX, while rats in the control and NS groups received a single 10 mg/kg dose of physiological saline solution. All animals were monitored for 35 days. On day 35, the rats were decapitated and serum and cardiac tissue samples were obtained. Troponin and NT-proBNP levels were measured in blood sera, while malondialdehyde (MDA), nitric oxide, total antioxidant capacity (TAC), and total oxidative stress (TOS) levels were quantified in sera and tissue samples. Histological alterations that were assessed in cardiac tissue included myocyte disarray, small vessel disease, myocyte hypertrophy, and fibrosis. RESULTS: The DOX group had significantly higher NT-proBNP, TOS, and MDA, with greater histopathological derangement. TAC was significantly elevated in the DOX+NS group, which also exhibited significantly lower troponin, TOS, and MDA, as well as significantly higher TAC compared to the DOX group. Histopathological examination showed that the significant structural derangement observed in DOX rats was markedly and significantly reduced in DOX+NS rats. CONCLUSION: Our results suggest that NS extract may prevent DOX-induced cardiotoxicity and thus represents a promising cardioprotective agent.

Rastreamento, Diagnóstico e Manejo da Fibrilação Atrial em Pacientes com Câncer: Evidências Atuais e Perspectivas Futuras / Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives

Resumo A fibrilação atrial (FA) é a arritmia cardíaca sustentada mais comum na população geral, tendo uma alta carga de morbimortalidade, e isso também é válido para pacientes com câncer. A associação entre FA e câncer vai ainda mais longe, com alguns estudos sugerindo que a FA pode ser um marcador de câncer oculto. Há, no entanto, uma notável escassez de dados sobre os desafios específicos do manejo da FA em pacientes com câncer. O reconhecimento e o manejo imediatos da FA nesta população especial podem diminuir a morbidade relacionada à arritmia e ter um importante benefício prognóstico. Esta revisão se concentrará nos desafios atuais de diagnóstico e manejo da FA em pacientes com câncer, com ênfase especial nas estratégias e dispositivos de rastreamento da FA e na terapia de anticoagulação com anticoagulantes orais não antagonistas da vitamina K (NOACs) para prevenção tromboembólica nesses pacientes. Alguns insights sobre as perspectivas futuras para a prevenção, diagnóstico e tratamento da FA nesta população especial também serão abordados.

Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.

Factores de riesgo de cardiotoxicidad precoz por quimioterapia en pacientes con cáncer de mama / Risk factors for early cardiotoxicity due to chemotherapy in patients with breast cancer / Fatores de risco para cardiotoxicidade precoce por quimioterapia em pacientes com câncer de mama

RESUMEN Introducción: la quimioterapia triplica el riesgo de toxicidad miocárdica. Junto con las segundas neoplasias, es la causa más frecuente de mortalidad en pacientes con cáncer de mama con larga supervivencia. Objetivo: identificar los factores de riesgo de cardiotoxicidad precoz por quimioterapia en pacientes con cáncer de mama Métodos: se realizó un estudio longitudinal prospectivo de cohorte única, con 224 pacientes portadoras de cáncer de mama en tratamiento con quimioterapia seguidas en consulta de cardio-oncologíade la policlínica de especialidades del Hospital Provincial General "Carlos Manuel de Céspedes", Bayamo, Granma, Cuba, en el periodo comprendido entre 15 de enero de 2019 a 23 marzo de 2021. Los predictores independientes de cardiotoxicidad se obtuvieron usando regresión logística multivariable. Resultados: la prevalencia de cardiotoxicidad fue de 19,2 % con edad media de 60,4 años, desviación estándar 12,7; hipertensión arterial, dislipidemia y otros marcadores de riesgo para enfermedades cardiovasculares como diabetes mellitus (riesgo relativo 2,8), cardiopatía hipertensiva (riesgo relativo 7,8), hipertrofia ventricular izquierda (riesgo relativo 3,3)y grasa epicárdica mayor de 6 mm, fueron variables relacionadas significativamente al riesgo de cardiotoxicidad. Conclusiones: cardiopatía hipertensiva, hipertrofia ventricular izquierda, diabetes mellitus, edad igual o mayor de 65 años y dislipidemia, incrementaron el riesgo de aparición de cardiotoxicidad y se relacionaron significativamente con ella, por tanto, resultaron ser factores de riesgo con influencia independiente sobre la cardiotoxicidad. Los resultados obtenidos nos permiten proyectar estudios de predicción de desarrollo y reversibilidad de cardiotoxicidad en pacientes de alto riesgo que reciban tratamientos cardioprotectores.

ABSTRACT Introduction: chemotherapy triples the risk of myocardial toxicity. Along with second neoplasms, it is the most frequent cause of mortality in long-surviving breast cancer patients. Objective: to identify the risk factors for early cardiotoxicity due to chemotherapy in patients with breast cancer. Methods: a prospective longitudinal study of a single cohort was carried out, with 224 patients with breast cancer undergoing chemotherapy treatment followed up in the cardio-oncology consultation of the specialties polyclinic at the General Provincial Hospital "Carlos Manuel de Céspedes." Bayamo. Granma, Cuba in the period from January 15, 2019 to March 23, 2021. Independent predictors of cardiotoxicity were obtained using multivariate logistic regression. Results: the prevalence of cardiotoxicity was 19.2% with a mean age of 60.4 years, standard deviation 12.7; arterial hypertension, dyslipidemia and other risk markers for cardiovascular diseases such as diabetes mellitus (relative risk 2.8), hypertensive heart disease (relative risk 7.8), left ventricular hypertrophy (relative risk 3.3) and epicardial fat greater than 6 mm, were variables significantly related to the risk of cardiotoxicity. Conclusions: hypertensive heart disease left ventricular hypertrophy, Diabetes Mellitus, age ≥65 years and dyslipidemia increased the risk of cardiotoxicity and were significantly related to it, therefore, they turned out to be risk factors with independent influence on cardiotoxicity. The results obtained allow us to plan studies to predict the development and reversibility of cardiotoxicity in high-risk patients receiving cardioprotective treatments.

RESUMO Introdução: a quimioterapia triplica o risco de toxicidade miocárdica. Juntamente com as segundas neoplasias, é a causa mais frequente de mortalidade em pacientes com câncer de mama de longa sobrevida. Objetivo: identificar os fatores de risco para cardiotoxicidade precoce por quimioterapia em pacientes com câncer de mama. Métodos: foi realizado um estudo longitudinal prospectivo de coorte única, com 224 pacientes com câncer de mama em tratamento com quimioterapia acompanhadas na consulta de cardio-oncologia da policlínica de especialidades do Hospital Geral Provincial "Carlos Manuel de Céspedes", Bayamo, Granma, Cuba, no período de 15 de janeiro de 2019 a 23 de março de 2021. Os preditores independentes de cardiotoxicidade foram obtidos por meio de regressão logística multivariada. Resultados: a prevalência de cardiotoxicidade foi de 19,2% com média de idade de 60,4 anos, desvio padrão de 12,7; hipertensão arterial, dislipidemia e outros marcadores de risco para doenças cardiovasculares como diabetes mellitus (risco relativo 2,8), cardiopatia hipertensiva (risco relativo 7,8), hipertrofia ventricular esquerda (risco relativo 3,3) e gordura epicárdica maior que 6 mm, foram variáveis ​​significativamente relacionadas ao risco de cardiotoxicidade. Conclusões: cardiopatia hipertensiva, hipertrofia ventricular esquerda, diabetes mellitus, idade ≥65 anos e dislipidemia aumentaram o risco de cardiotoxicidade e estiveram significativamente relacionados a ela, portanto, revelaram-se fatores de risco com influencia independente na cardiotoxicidade. Os resultados obtidos permitem planejar estudos para prever o desenvolvimento e a reversibilidade da cardiotoxicidade em pacientes de alto risco recebendo tratamentos cardioprotetores.

Reabilitação em pacientes onco-hematológicos pediátricos e sua relação com a cardiotoxicidade induzida pela quimioterapia / Rehabilitation in pediatric oncohematologicalpatients and its relationship to chemotherapy-induced cardiotoxicity

Objetivo: Apresentar os efeitos da reabilitação em pacientes onco-hematológicos pediátricos e analisar se os protocolos de reabilitação interferem na cardiotoxicidade induzida pela quimioterapia. Métodos: Foi realizada uma revisão de literatura integrativa utilizando os descritores: "câncer", "child", "cardiotoxicity", "rehabilitation" e "exercise training". As seguintes bases de dados foram utilizadas: Scientific Eletronic Library (Scielo), National Library of Medicine (Pubmed), Biblioteca Virtual em Saúde (Medline) eSpringer Nature (Springer Link). Foram definidos como critério de inclusão, artigos publicados entre os anos de 2008 a 2020. Foram excluídos os artigos de cânceres exclusivamente não hematológicos. Resultados: Foram selecionados 10 artigos e verificou-se que o exercício físico aplicado em cânceres hematológicos em crianças é benéfico no que tange aos efeitos colaterais das doenças e do tratamento. Apresentou efeitos positivos na capacidade funcional muscular e cardiorrespiratória; melhora da sensação de fadiga e qualidade de vida; e ganhos na aptidão física, composição corporal e saúde óssea. Conclusão: A implementação de programas de exercícios são eficazes e fazem um diferencial na manutenção e melhora da qualidade de vida dos pacientes oncológicos infantis. São necessários mais estudos na área de reabilitação em onco-hematologia pediátrica, sobretudo relacionada às complicações resultantes da cardiotoxicidade.

Cardiotoxicidad por antraciclinas en supervivientes de cáncer durante la infancia / Cardiotoxicidade das antraciclinas em sobreviventes de câncer na infância / Anthracycline cardiotoxicity in childhood cancer survivors

Introducción: a nivel mundial, cada año cerca de 300.000 niños entre 0 y 19 años son diagnosticados con cáncer. El porcentaje de supervivientes va en aumento, llegando a 80% en países desarrollados y 60% en América Latina. Sin embargo, la expectativa y la calidad de vida de estas personas pueden verse comprometidas ante el desarrollo de cardiotoxicidad, un efecto adverso asociado al uso de algunos agentes antineoplásicos, como los antracíclicos. Objetivo: resaltar los aspectos clínicos relevantes para la prevención, detección oportuna, tratamiento y seguimiento de la cardiotoxicidad secundaria a la administración de antraciclinas durante la infancia. Síntesis de contenido: reflexión teórica que presenta consideraciones clínicas relevantes para guiar las acciones de enfermería y del equipo multidisciplinario en la atención y el cuidado de la salud cardiovascular de los supervivientes de cáncer a cualquier edad. Es importante destacar que en población pediátrica la única estrategia efectiva de prevención primaria para cardiotoxicidad por antraciclinas es la administración de dexrazoxano, mientras que la prevención secundaria debe incluir detección oportuna, control y seguimiento de las alteraciones de la función cardíaca y de los factores de riesgo cardiovascular. Por su parte, la prevención terciaria se centra en el control de la enfermedad y el manejo farmacológico. Conclusiones: no existe un tratamiento estándar para la cardiotoxicidad inducida por quimioterapia o radioterapia, siendo el objetivo principal de este tipo de tratamientos prevenir o retrasar la remodelación del ventrículo izquierdo. Todos los supervivientes requieren seguimiento vitalicio y búsqueda activa de signos de cardiotoxicidad, siendo fundamental la acción conjunta de diferentes profesionales y la consolidación de los servicios de cardio-oncología.

Introdução: em todo o mundo, a cada ano cerca de 300.000 pessoas entre 0 e 19 anos de idade são diagnosticadas com câncer. A porcentagem de sobreviventes aumentou e atingiu a cifra de 80% nos países desenvolvidos e 60% na América Latina; no entanto, a expectativa e a qualidade de vida podem ser comprometidas devido ao desenvolvimento de cardiotoxicidade, um efeito adverso associado ao uso de alguns agentes antineoplásicos, como os antracíclicos. Objetivo: destacar os aspectos clínicos relevantes para a prevenção, a detecção oportuna, o tratamento e o monitoramento da cardiotoxicidade secundária à administração de antraciclinas na infância. Síntese de conteúdo: reflexão teórica que apresenta as considerações clínicas relevantes para orientar as ações da enfermagem e da equipe multiprofissional na assistência e no cuidado à saúde cardiovascular do sobrevivente de qualquer idade. É importante observar que, na população pediátrica, a única estratégia eficaz de prevenção primária da cardiotoxicidade das antraciclinas é a administração de dexrazoxano; enquanto a prevenção secundária deve incluir a detecção oportuna, o controle e o acompanhamento de alterações da função cardíaca e dos fatores de risco cardiovascular; a prevenção terciária se concentra no controle da doença e no manejo farmacológico. Conclusões: não existe um tratamento-padrão para a cardiotoxicidade induzida por quimioterapia ou radioterapia, seu principal objetivo é prevenir ou retardar a remodelação ventricular esquerda. Todos os sobreviventes necessitaram de acompanhamento vitalício e busca ativa de sinais de cardiotoxicidade, sendo essencial a ação conjunta de diferentes profissionais e a consolidação dos serviços de cardio-oncologia.

Introduction: Every year, nearly 300,000 children aged 0 to 19 are diagnosed with cancer worldwide. The percentage of survivors has increased significantly, reaching 80% in developed countries and 60% in Latin America. However, the life expectancy and quality of life of these individuals can be severely compromised in the face of the development of cardiotoxicity, an adverse effect associated with the use of antineoplastic agents such as anthracyclics. Objective: To highlight relevant clinical aspects for the prevention, timely detection, treatment and follow-up of cardiotoxicity secondary to the administration of anthracyclines during childhood. Content synthesis: Theoretical reflection that presents relevant clinical considerations to guide the actions of nursing professionals and the interdisciplinary teams in charge of providing cardiovascular health care to cancer survivors at any age. We emphasize that the only effective primary prevention strategy for anthracycline cardiotoxicity in the pediatric population is the administration of dexrazoxane, while secondary prevention should include timely detection, control, and follow-up of cardiac function alterations and cardiovascular risk factors, and tertiary prevention must be focused on disease control and pharmacological management. Conclusions: There is no standard treatment for chemotherapy or radiotherapy-in-duced cardiotoxicity, and the main objective of current treatment methods is to prevent, or delay, left ventricular remodeling. All survivors require life-long monitoring and an active search for signs of cardiotoxicity, where the joint action of different professionals and the consolidation of cardio-oncology services becomes essential.

Aumento de Captação Cardíaca de 18F-FDG Induzida por Quimioterapia em Pacientes com Linfoma: Um Marcador Precoce de Cardiotoxicidade? / Chemotherapy-induced Cardiac18F-FDG Uptake in Patients with Lymphoma: An Early Metabolic Index of Cardiotoxicity?

Resumo Fundamento Ainda não está estabelecido se a captação de fluorodesoxiglicose no miocárdio ocorre exclusivamente por características fisiológicas ou se representa um desarranjo metabólico causado pela quimioterapia. Objetivo Investigar os efeitos da quimioterapia no coração dos pacientes com linfoma por tomografia por emissão de pósitrons associada a tomografia computadorizada (PET/CT) com 2-[18F]-fluoro-2-desoxi-D-glicose (18F-FDG PET/CT) antes, durante e/ou após a quimioterapia. Métodos Setenta pacientes com linfoma submetidos a 18F-FDG PET/CT foram retrospectivamente analisados. O nível de significância foi de 5%. A captação de 18F-FDG foi avaliada por três medidas: captação máxima no ventrículo esquerdo ( standardized uptake value , SUV max), razão SUV cardíaco / aorta e SUV cardíaco / SUV no fígado. Também foram comparados peso corporal, glicemia de jejum, tempo pós-injeção e dose administrada de 18F-FDG entre os exames. Resultados A idade média foi de 50,4 ± 20,1 anos e 50% dos pacientes eram mulheres. A análise foi realizada em dois grupos - PET/CT basal vs. intermediário e PET/CT basal vs pós-terapia. Não houve diferença significativa entre as variáveis clínicas e do protocolo dos exames entre os diferentes momentos avaliados. Nós observamos um aumento na SUV máxima no ventrículo esquerdo de 3,5±1,9 (basal) para 5,6±4,0 (intermediário), p=0,01, e de 4,0±2,2 (basal) para 6,1±4,2 (pós-terapia), p<0,001. Uma porcentagem de aumento ≥30% na SUV máxima no ventrículo esquerdo ocorreu em mais da metade da amostra. O aumento da SUV cardíaca foi acompanhado por um aumento na razão SUV máxima no ventrículo esquerdo / SUV máxima na aorta e SUV média no ventrículo esquerdo /SUV média no fígado. Conclusão O estudo mostrou um aumento evidente na captação cardíaca de 18F-FDG em pacientes com linfoma, durante e após quimioterapia. A literatura corrobora com esses achados e sugere que a 18F-FDG PET/CT pode ser um exame de imagem sensível e confiável para detectar sinais metabólicos precoces de cardiotoxicidade.

Abstract Background It is uncertain whether myocardial fluorodeoxyglucose uptake occurs solely due to physiological features or if it represents a metabolic disarrangement under chemotherapy. Objective To investigate the chemotherapy effects on the heart of patients with lymphoma by positron emission tomography associated with computed tomography scans (PET/CT) with 2-deoxy-2[18F] fluoro-D-glucose (18F-FDG PET/CT) before, during and/or after chemotherapy. Methods Seventy patients with lymphoma submitted to18F-FDG PET/CT were retrospectively analyzed. The level of significance was 5%.18F-FDG cardiac uptake was assessed by three measurements: left ventricular maximum standardized uptake value (SUVmax), heart to blood pool (aorta) ratio, and heart to liver ratio in all the exams. Body weight, fasting blood sugar, post-injection time, and the injected dose of18F-FDG between the scans were also compared. Results Mean age was 50.4 ± 20.1 years and 50% was female. The analysis was carried out in two groups: baseline vs. interim PET/CT, and baseline vs. post-therapy PET/CT. There was no significant difference in clinical variables or protocol scans variables. We observed an increase in left ventricular (LV) SUVmax from 3.5±1.9 (baseline) to 5.6±4.0 (interim), p=0.01, and from 4.0±2.2 (baseline) to 6.1±4.2 (post-therapy), p<0.001. A percentage increase ≥30% of LV SUVmax occurred in more than half of the sample. The rise of cardiac SUV was accompanied by an increase in LV SUVmax/Aorta SUVmax and LV SUVmean/Liver SUVmean ratios. Conclusion This study showed a clear increase in cardiac18F-FDG uptake in patients with lymphoma during and/or after chemotherapy. The literature corroborates with these findings and suggests that18F-FDG PET/CT is a sensitive and reliable imaging exam to detect early metabolic signs of cardiotoxicity.

Validação do protocolo assistencial de enfermagem para mulheres com câncer de mama em quimioterapia cardiotóxica / Validation of the nursing care protocol for women with breast cancer undergoing cardiotoxic chemotherapy

Introdução: O câncer é responsável por 13% das causas de óbitos no mundo, sendo o de mama a primeira causa de mortes em mulheres no Brasil. Apesar dos benefícios da quimioterapia, estudos têm identificado efeitos cardiotóxicos a curto e longo prazo em mulheres com câncer de mama. Diante disso, a avaliação e manejo do enfermeiro de mulheres com câncer de mama submetidas a quimioterapia é fundamental para prevenção e reconhecimento precoce destes efeitos. Apesar disso, ainda não existem protocolos assistenciais de enfermagem para acompanhamento de mulheres com câncer de mama. Objetivo: Validar o conteúdo do Protocolo Assistencial de Enfermagem para Mulheres com Câncer de Mama submetidas à Quimioterapia Cardiotóxica. Método: Estudo metodológico realizado em três etapas: adaptação do conteúdo e modelo de um protocolo assistencial de enfermagem para pacientes adultos submetidos à terapia oncológica cardiotóxica para utilização com mulheres com câncer de mama de acordo com Appraisal of Guidelines for Research & Evaluation (AGREE II); avaliação da qualidade do protocolo por quatro enfermeiras especialistas na área de oncologia (02) e cardiologia (02). Foi utilizada uma escala likert de 7 pontos para avaliação. As médias foram calculadas de acordo com as notas dos especialistas em cada domínio proposto; validação do conteúdo do protocolo quanto a clareza, pertinência e relevância por 19 enfermeiros assistenciais com análise dos dados pelo índice de validação do conteúdo e análise de concordância pelo teste de Gwet. Foram realizados ajustes no protocolo para atender as sugestões dos experts e por fim, o protocolo foi validado por consenso com experts na área. Resultados: As quatro pesquisadoras atribuíram média de superior a cinco de acordo com os critérios avaliados no AGREEII. A avaliação da clareza, pertinência e relevância do protocolo obteve índice de validação de conteúdo global superior a 0,9 em todos os critérios (p˂0,001) por enfermeiros da prática assistencial. Por último, foi realizado um comitê de especialistas formado por enfermeiros pesquisadores e enfermeiros assistenciais na área de cardiologia e oncologia que, por consenso em duas reuniões, realizaram uma revisão e a validação do conteúdo do protocolo. Conclusão: O protocolo assistencial de enfermagem para mulheres com câncer de mama irá contribuir para uma prática de enfermagem pautada em evidências científicas, facilitando a identificação e manejo de sinais e sintomas cardiotóxicos, prevenindo complicações cardiovasculares e contribuindo para a documentação e informação sobre estes efeitos em mulheres com câncer de mama.

Introduction: Cancer is responsible for 13% of the causes of death in the world, with breast cancer being the leading cause of death in women in Brazil. Despite the benefits of chemotherapy, studies have identified short- and long-term cardiotoxic effects in woman with breast cancer. In this scenario, the nurse's assessment and management of woman with breast cancer undergoing chemotherapy is essential for prevention and early recognition of these effects. However, there are no nursing care protocols for monitoring women with breast cancer. Objectives: Validate the content of the Nursing Care Protocol for Women with Breast Cancer undergoing Cardiotoxic Chemotherapy. Method: Methodological study carried out in three stages: adaptation of the nursing care protocol for adult patients undergoing cardiotoxic cancer therapy for women with breast cancer according to the Appraisal of Guidelines for Research & Evaluation (AGREE II); protocol quality assessment by four specialist nurses in the fields of oncology (02) and cardiology (02). A 7-point Likert scale was used for evaluation. The averages were calculated according to the experts' scores in each proposed domain; validation of protocol content regarding clarity, suitability and relevance by 19 oncology care nurses with data analysis using the content validation index and agreement analysis using the Gwet test. Adjustments were made to the protocol to answer the researchers' suggestions and, finally, the protocol was validated by consensus with experts in the field. Results: The four researchers attributed an average of more than five according to the criteria evaluated in the AGREE. The assessment of clarity, suitability and relevance of the protocol obtained a global content validation index higher than 0.9 in all criteria (p˂0.001) by nurses working in the care practice. Finally, a committee of specialists formed by research nurses and clinical nurses in the area of cardiology and oncology was created and, by consensus in two meetings, carried out a review and validation of the protocol content. Conclusion: A nursing care protocol for women with breast cancer will contribute to a nursing practice based on scientific evidence, facilitating the identification and management of cardiotoxic signs and symptoms, preventing cardiovascular complications and contributing to the documentation and information about these effects in women with breast cancer

Strain longitudinal global como preditor de cardiotoxicidade induzida por quimioterapia / Global longitudinal strain as predictor of chemotherapy-induced cardiotoxicity

Fundamento: A cardiotoxicidade induzida por quimioterapia (CiC) é uma complicação importante entre os pacientes que recebem antraciclinas. Biomarcadores e parâmetros de imagem têm sido estudados por sua capacidade de identificar pacientes com risco de desenvolver essa complicação. O strain longitudinal global do ventrículo esquerdo (SLG-VE) tem sido descrito como um parâmetro sensível para detectar disfunção sistólica, mesmo na presença de fração de ejeção do ventrículo esquerdo (FEVE) preservada. Objetivo: avaliar o papel do SLG-VE como preditor de CiC. Métodos: O presente estudo consiste em uma análise post-hoc do estudo CECCY (Carvedilol for Prevention of ChemotherapyRelated Cardiotoxicity [Carvedilol para Prevenção da Cardiotoxicidade Relacionada à Quimioterapia]), que avaliou a prevenção primária de cardiotoxicidade com carvedilol durante quimioterapia com doxorrubicina em uma população com câncer de mama. Definiu-se cardiotoxicidade como uma redução >10% na FEVE. O SLG-VE foi obtido antes da quimioterapia em pacientes sem doença cardiovascular prévia ou anormalidades no ecocardiograma. Resultados: Trinta e um pacientes submetidos a estudo ecocardiográfico completo incluindo avaliação de SLG-VE antes da quimioterapia foram incluídos nesta análise. Um SLG-VE absoluto <16,9% antes da quimioterapia mostrou 100% de sensibilidade e 73% de especificidade para predizer cardiotoxicidade (AUC=0,85; IC 95% 0,680­0,959, p<0,001). Nesta população, os valores de FEVE antes da quimioterapia não foram preditores de CiC (IC 95% 0,478 a -0,842, p=0,17). A associação de baixos níveis séricos de SLG-VE (<17%) e BNP (>17 pg/mL) dois meses após a quimioterapia aumentou a precisão para detectar CiC de início precoce (100% de sensibilidade, 88% de especificidade, AUC=0,94; IC 95% 0,7810,995, p<0,0001). Conclusões: Nossos dados sugerem que o SLG-VE é um possível preditor de cardiotoxicidade induzida por quimioterapia. São necessários estudos maiores para confirmar a relevância clínica desse parâmetro ecocardiográfico nesse cenário clínico. (AU)

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing ChC. Left ventricular global longitudinal strain (LV-GLS) is a sensitive parameter for detecting systolic dysfunction despite the presence of preserved left ventricular ejection fraction (LVEF). Objective: To evaluate the role of the LV-GLS as a predictor of ChC. Methods: This was a post-hoc analysis of the Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity trial, which evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population of patients with breast cancer. Cardiotoxicity was defined as a reduction ≥10% in LVEF. LV-GLS was determined before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients for whom a complete echocardiography study including measurement of LV-GLS was performed before chemotherapy were included in this analysis. An absolute LV-GLS<16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.680­0.959; p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95% CI, 0.478 to -0.842; p=0.17). The association of low LV-GLS (<17%) and brain-type natriuretic peptide serum levels (>17 pg/mL) at 2 months after chemotherapy increased the accuracy for detecting early-onset ChC (100% sensitivity, 88% specificity; AUC, 0.94; 95% CI, 0.781­0.995; p<0.0001). Conclusions: Our data suggest that LV-GLS is a potential predictor of ChC. Larger studies are needed to confirm its clinical relevance in this clinical setting. (AU)