Chemotherapy-related cardiac dysfunction(CTRCD)remains a major barrier to optimal cancer survivorship,threatening quality of life and long-term outcomes.Contemporary guidelines emphasize early detection through multim...Chemotherapy-related cardiac dysfunction(CTRCD)remains a major barrier to optimal cancer survivorship,threatening quality of life and long-term outcomes.Contemporary guidelines emphasize early detection through multimodal strategies,including echocardiographic global longitudinal strain(GLS)and cardiac biomarkers,but their real-world uptake is inconsistent.In this issue,Méndez-Toro et al present a retrospective cohort from Colombia that highlights this gap,reporting a CTRCD incidence of 8.8%in high-risk oncology patients.Although the authors observed clear declines in left ventricular ejection fraction and GLS among affected patients,less than 40%underwent end-of-treatment echocardiography and only one-quarter had biomarker surveillance.The study underscores three critical lessons:Multimodal monitoring is under-utilized,reported incidence likely underestimates the true burden,and low-and middle-income countries face unique challenges in implementing structured cardio-oncology programs.These findings demand a shift from sporadic monitoring to pragmatic,risk-adapted protocols that can translate early detection into meaningful cardioprotection.展开更多
BACKGROUND It remains unclear whether the current arbitrary screening recommendations of trastuzumab-related cardiotoxicity provides an adequate balance between preventing heart damage and curtailing a curative treatm...BACKGROUND It remains unclear whether the current arbitrary screening recommendations of trastuzumab-related cardiotoxicity provides an adequate balance between preventing heart damage and curtailing a curative treatment.AIM To determine the incidence rate and consequences of trastuzumab-induced cardiotoxicity as adjuvant treatment in a real-world scenario.METHODS We present a retrospective analysis of cardiac function measured by echocardiogram at baseline and every 3 mo during trastuzumab treatment.Cardiotoxicity was defined as a drop in left ventricular ejection fraction(LVEF)≥10%from baseline and/or any drop<50%.RESULTS Between January 2011 and December 2014,407 patients were selected.Most(93.6%)were treated with an anthracycline followed by a taxane-based regimen and trastuzumab for 12 mo.Forty patients(9.8%)had cardiotoxicity.None of them were symptomatic,and 28(72.5%)completely recovered LVEF.Cardiotoxicity happened early as shown by LVEF measured on echocardiogram 2 to 4 as compared to 5 to 7(odds ratio=2.47,95%confidence interval:1.09,5.63,P=0.024).There were 54 deaths(13.3%)during the 70-mo follow-up period;1(0.2%)was attributed to late cardiotoxicity(4 years after treatment).The absence of symptomatic cardiotoxicity during trastuzumab treatment and moreover the early occurrence on the treatment period may translate into a strategy to evaluate less frequently.CONCLUSION We observed a 10%rate of asymptomatic cardiotoxicity,which mirrors the results from the large adjuvant trials.Despite being transient,an LVEF drop led to frequent treatment delays and interruptions.It remains unclear whether LVEF decline is predictive of late cardiotoxicity,and treatment efficacy is compromised.展开更多
目前由于癌症治疗引起的心脏毒性极其复杂,如何能够准确的评估心脏结构、功能和心肌组织特征至关重要,从而需要更先进的非侵入性检查方法。心脏核磁(cardiac magnetic resonance,CMR)的特殊应用,包括通过检测心肌应变、检测微循环功能...目前由于癌症治疗引起的心脏毒性极其复杂,如何能够准确的评估心脏结构、功能和心肌组织特征至关重要,从而需要更先进的非侵入性检查方法。心脏核磁(cardiac magnetic resonance,CMR)的特殊应用,包括通过检测心肌应变、检测微循环功能障碍和检测亚临床左室功能障碍,以及对于免疫检查点抑制剂引起的炎症更敏感的检测等可以用来评估癌症治疗引起的心脏毒性。CMR在癌症治疗引起的心脏毒性的非侵入性检测中起着重要的作用,本文就CMR在检测癌症治疗过程中心脏毒性的作用做一综述。展开更多
文摘Chemotherapy-related cardiac dysfunction(CTRCD)remains a major barrier to optimal cancer survivorship,threatening quality of life and long-term outcomes.Contemporary guidelines emphasize early detection through multimodal strategies,including echocardiographic global longitudinal strain(GLS)and cardiac biomarkers,but their real-world uptake is inconsistent.In this issue,Méndez-Toro et al present a retrospective cohort from Colombia that highlights this gap,reporting a CTRCD incidence of 8.8%in high-risk oncology patients.Although the authors observed clear declines in left ventricular ejection fraction and GLS among affected patients,less than 40%underwent end-of-treatment echocardiography and only one-quarter had biomarker surveillance.The study underscores three critical lessons:Multimodal monitoring is under-utilized,reported incidence likely underestimates the true burden,and low-and middle-income countries face unique challenges in implementing structured cardio-oncology programs.These findings demand a shift from sporadic monitoring to pragmatic,risk-adapted protocols that can translate early detection into meaningful cardioprotection.
文摘BACKGROUND It remains unclear whether the current arbitrary screening recommendations of trastuzumab-related cardiotoxicity provides an adequate balance between preventing heart damage and curtailing a curative treatment.AIM To determine the incidence rate and consequences of trastuzumab-induced cardiotoxicity as adjuvant treatment in a real-world scenario.METHODS We present a retrospective analysis of cardiac function measured by echocardiogram at baseline and every 3 mo during trastuzumab treatment.Cardiotoxicity was defined as a drop in left ventricular ejection fraction(LVEF)≥10%from baseline and/or any drop<50%.RESULTS Between January 2011 and December 2014,407 patients were selected.Most(93.6%)were treated with an anthracycline followed by a taxane-based regimen and trastuzumab for 12 mo.Forty patients(9.8%)had cardiotoxicity.None of them were symptomatic,and 28(72.5%)completely recovered LVEF.Cardiotoxicity happened early as shown by LVEF measured on echocardiogram 2 to 4 as compared to 5 to 7(odds ratio=2.47,95%confidence interval:1.09,5.63,P=0.024).There were 54 deaths(13.3%)during the 70-mo follow-up period;1(0.2%)was attributed to late cardiotoxicity(4 years after treatment).The absence of symptomatic cardiotoxicity during trastuzumab treatment and moreover the early occurrence on the treatment period may translate into a strategy to evaluate less frequently.CONCLUSION We observed a 10%rate of asymptomatic cardiotoxicity,which mirrors the results from the large adjuvant trials.Despite being transient,an LVEF drop led to frequent treatment delays and interruptions.It remains unclear whether LVEF decline is predictive of late cardiotoxicity,and treatment efficacy is compromised.
文摘目前由于癌症治疗引起的心脏毒性极其复杂,如何能够准确的评估心脏结构、功能和心肌组织特征至关重要,从而需要更先进的非侵入性检查方法。心脏核磁(cardiac magnetic resonance,CMR)的特殊应用,包括通过检测心肌应变、检测微循环功能障碍和检测亚临床左室功能障碍,以及对于免疫检查点抑制剂引起的炎症更敏感的检测等可以用来评估癌症治疗引起的心脏毒性。CMR在癌症治疗引起的心脏毒性的非侵入性检测中起着重要的作用,本文就CMR在检测癌症治疗过程中心脏毒性的作用做一综述。
