Showing papers by "Daniel J. Lenihan published in 2016"

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Abstract: 2-D : two-dimensional 3-D : three-dimensional 5-FU : 5-fluorouracil ACE : angiotensin-converting enzyme ARB : angiotensin II receptor blocker ASE : American Society of Echocardiography BNP : B-type natriuretic peptide CABG : coronary artery bypass graft CAD : coronary artery

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)

Abstract: No abstract available Keywords: European Society of Cardiology; arrhythmias; cancer therapy; cardio-oncology; cardiotoxicity; chemotherapy; early detection; ischaemia; myocardial dysfunction; surveillance.

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association.

Abstract: The intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA1 and other organizations,2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence,4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present.4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect.4 The term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease.5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this …

Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management

Abstract: Answer questions and earn CME/CNE Cancer and heart disease are the leading causes of morbidity and mortality in the industrialized world. Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer; however, these gains can come at a cost. Patients may experience adverse cardiovascular events related to their cancer treatment or as a result of an exacerbation of underlying cardiovascular disease. With longer periods of survival, late effects of cancer treatment may become clinically evident years or decades after completion of therapy. Current cancer therapy incorporates multiple agents whose deleterious cardiac effects may be additive or synergistic. Cardiac dysfunction may result from agents that can result in myocyte destruction, such as with anthracycline use, or from agents that appear to transiently affect left ventricular contractility. In addition, cancer treatment may be associated with other cardiac events, such as severe treatment-induced hypertension and vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including QTc prolongation, that may be rarely life-threatening. Early and late effects of chest radiation can lead to radiation-induced heart disease, including pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease, valvular disease, and arrhythmias, in the setting of myocardial fibrosis. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of cancer patients, whether they are receiving active treatment or are long-term survivors. Strategies to prevent or mitigate cardiovascular damage from cancer treatment are needed to provide the best cancer care. This review will focus on the common cardiovascular issues that may arise during or after cancer therapy, the detection and monitoring of cardiovascular injury, and the best management principles to protect against or minimize cardiotoxicity during the spectrum of cancer treatment strategies. CA Cancer J Clin 2016;66:309-325. © 2016 American Cancer Society.

Cancer Therapy–Related Cardiac Dysfunction and Heart Failure: Part 1: Definitions, Pathophysiology, Risk Factors, and Imaging

Abstract: Advances in cancer therapy have resulted in significant improvement in long-term survival for many types of cancer but have also resulted in untoward side effects associated with treatment. One such complication that has become increasingly recognized is the development of cardiomyopathy and heart failure. Whether a previously healthy person from a cardiovascular perspective develops cancer therapy-related cardiac dysfunction or a high-risk cardiovascular patient requires cancer therapy, the team of oncologists and cardiologists must be better equipped with an evidence-based approach to care for these patients across the spectrum. Although the toxicities associated with various cancer therapies are well recognized, limitations to our understanding of the appropriate course of action remain. In this first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In a subsequent second part, we discuss the prevention and treatment aspects, concluding with a section on evidence gap and future directions. We focus on adult patients in all stages of cancer therapy from pretreatment surveillance, to ongoing therapy, and long-term follow-up.

Cancer Therapy–Related Cardiac Dysfunction and Heart Failure Part 2: Prevention, Treatment, Guidelines, and Future Directions

Abstract: Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy–related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.

Cardiovascular Complications of Novel Multiple Myeloma Treatments.

Abstract: Case presentation: A 75-year-old woman was referred to cardiology for optimization of cardiovascular risk factors before starting a new cancer treatment. She was diagnosed with IgG-κ multiple myeloma (MM) 2 years previously that progressed after her previous treatments. Her medical history also included type 2 diabetes mellitus, hypertension, and a remote history of deep vein thrombosis treated with a “blood thinner” for 6 months. Her hematologist has determined that a combination of carfilzomib, lenalidomide, and dexamethasone is the best treatment option for this patient but is concerned about the risk of cardiovascular complications from the new treatment and wants the patient to undergo evaluation by a cardiologist. MM is a plasma cell malignancy characterized by clonal proliferation of malignant plasma cells in the bone marrow microenvironment, monoclonal protein in the blood or urine, and associated organ dysfunction.1 MM accounts for 1% of all cancers and ≈13% of all hematologic malignancies. Approximately 86 000 new cases of MM occur annually worldwide and affect primarily older individuals with a median age of diagnosis of ≈70 years.2 Over the past few decades, overall survival has improved from an age-adjusted 5-year relative survival of 35.6% in 1998 to 2001 to 44% in 2006 to 2009.3 This improvement is due largely to increased use of autologous stem cell transplantation and the introduction of novel agents, including immunomodulatory drugs (IMiDs; ie, thalidomide [Thalomid], lenalinomide [Revlimid], and pomalidomide [Pomalyst]) and proteasome inhibitors (PIs; ie, bortezomib [Velcade] and carfilzomib [Kyprolis]). Figure 1 shows the milestones in MM treatment. Figure 1. Milestones in multiple myeloma (MM) treatment. The treatment paradigm of multiple myeloma treatment shifted with the introduction of 2 categories of novel treatment, immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs), which significantly improved survival in patients with MM. Cancer is associated with increased risk of venous thromboembolic …

Depression and Oropharynx Cancer Outcome.

Abstract: BackgroundStudies have shown a modest relationship between depression and mortality in patients with cancer. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and followin

Plasma hepatocyte growth factor is a novel marker of AL cardiac amyloidosis.

Abstract: Background: Cardiac amyloidosis is an infiltrative cardiomyopathy that is challenging to diagnose. We hypothesized that the novel biomarkers hepatocyte growth factor (HGF), galectin-3 (GAL-3), interleukin-6 (IL-6), and vascular endothelial growth factor (VEGF) would be elevated in cardiac amyloidosis and may be able to discriminate from non-cardiac systemic amyloidosis or other cardiomyopathies with similar clinical or morphologic characteristics.Methods: Patients were selected from the Vanderbilt Main Heart Registry according to the following groups: (1) amyloid light-chain (AL) cardiac amyloidosis (n = 26); (2) transthyretin (ATTR) cardiac amyloidosis (n = 7); (3) left ventricular hypertrophy (LVH) (n = 45); (4) systolic heart failure (n = 42); and (5) non-cardiac systemic amyloidosis (n = 7). Biomarkers were measured in stored plasma samples. Biomarkers' discrimination performance in predicting AL cardiac amyloidosis (i.e., Concordance index) was reported. A survival analysis was used to explor...

Clinical and research considerations for patients with hypertensive acute heart failure: a consensus statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group.

Abstract: Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF.

Biomarkers in Specific Disease States: Cardio-Oncology

Abstract: Cancer related mortality has been dramatically reduced in recent decades due to more effective cancer treatments, especially chemotherapy and radiation therapy. However, the use of these treatment modalities may be limited by the risk of significant cardiac damage. The current standard for cardiac safety assessment, in order to limit cardiotoxicity, predominantly focuses on serial cardiac imaging to identify changes in left ventricular ejection fraction (LVEF). Unfortunately, this method is imperfect and frequently is a late finding. Potentially permanent cardiac damage manifesting as a significantly reduced LVEF has to occur before any important change in management is undertaken. One alternative and complimentary approach is the appropriate use of cardiac biomarkers to identify subclinical cardiac damage allowing for earlier detection and institution of cardio-protective interventions. This chapter will highlight the clinical use of cardiac biomarkers, specifically natriuretic peptides, cardiac troponins, as well as emerging biomarkers, for the detection of cardiac injury in the context of cardio-oncology.

Childhood Cancer Survivorship Late Cardiotoxicity, and CV Prevention

Abstract: The initial presentation in this session was a comprehensive outline of Late onset cardiotoxicity: incidence, risk and individual risk prediction by Dr Gregory Armstrong from St. Jude’s Children’s Hospital in Memphis, TN. He presented many primary studies from the Childhood Cancer Survival Study that indicated the extent and prognosis related to CV outcomes in long-term survivors of childhood cancer. He reported on the high quality data that has been systematically collected for the past 2 decades. The degree that cancer therapy, whether radiation or chemotherapy or the combination, can affect the CV outcomes of patients is profound [1, 2]. It is difficult to discern what exact profiles of patients are at highest risk but certainly the dose of radiation and chemotherapy is an important modifier of risk. Additionally, underlying CV risk factors that developed over time can have a major impact of overall outcomes [2]. Understanding what screening tests are most effective in detecting CV issues at a modifiable state is of paramount importance [3, 4]. These data inform our current strategies for optimal cancer survivorship cancer [5].