1,721,064 research outputs found
Risk of Myocardial Infarction in Patients Treated With 5-Fluorouracil: Balancing the Evidence With Black Boxes
No full textN/
Adjudication of Adverse Cardiovascular Events in Patients with Chronic Lymphocytic Leukaemia Treated with Ibrutinib: Deaths in GLOW or Blowing in the Wind?
Full text linkAnti-cancer tyrosine kinase inhibitors are less selective than usually believed and may cause cardiovascular off-target effects. Ibrutinib, a firstin-class covalent inhibitor of Bruton tyrosine kinase, is a pillar of treatment of chronic lymphocytic leukaemia (CLL) and other B-cell malignancies yet is associated with risks of hypertension, AF and, less frequently, heart failure or ventricular tachyarrhythmias, which may lead to sudden death. The GLOW trial of ibrutinib plus the Bcl-2 inhibitor venetoclax as the first-line, fixed-duration treatment of CLL in elderly patients reported a number of cardiac and sudden deaths; these have been cited by many to downplay the otherwise unprecedented efficacy of this treatment. This article demonstrates that deaths in GLOW were mistakenly attributed to ibrutinib and should have been interpreted in the light of a complex composite of patient characteristics and the dynamics of cardiovascular events. Critical analysis of deaths in GLOW should serve as a lesson to improve clinicians' appraisal of the risk:benefit ratio of using one cancer drug or another
Advances in Bruton tyrosine kinase (Btk) inhibition are steered by Bruton tyrosine kinase phylogeny
Full text linkBruton tyrosine kinase (Btk) has long been known to play a key role in chronic lymphatic leukaemia, Waldenström macroglobulinaemia and other B-cell proliferative disorders. An impressive programme of drug discovery and clinical development led to the approval of covalent and non-covalent Btk inhibitors that became pillars of treatment of such malignancies. However, both a risk of cardiovascular events and the emergence of an elusive mutational landscape seem to complicate the clinical use of each Btk inhibitor. In this plain language mini-review, we show that the search for better Btk inhibitors is challenged by the ancestral origin of Btk, its homology with innocent kinases in cardiovascular system and unique phylogenetic-like modalities with which Btk can mutate upon exposure to one inhibitor or another. Whereas basic and clinical pharmacology is already at work to explore new avenues of Btk inhibition, phylogeny remains behind the curtain to steer achievements and failures in this field
Anthracycline Cardiotoxicity in Adult Cancer Patients: JACC: CardioOncology State-of-the-Art Review
Full text linkSince their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area
Current Practices and Perspectives on the Use of Intravenous Vasodilators in Acute Heart Failure: An International Survey
No full textAlthough a solid pathophysiological rationale supports intravenous vasodilators (IVV) for acute heart failure (AHF), trial evidence is conflicting and international guidelines offer only weak recommendations. We conducted an international survey to capture contemporary, real-world practice and clinician opinion regarding IVV use in AHF.A 29-item, web-based questionnaire was distributed to cardiologists involved in AHF management. Items explored indications, contraindications, preferred agents, monitoring strategies, and interaction with guideline-directed medical therapy. We analysed responses from 170 physicians in 32 countries (67 % male; mostly aged 30-50 years). Sixty-two percent treat fewer than ten patients per month with IVV; nitroglycerin is the drug of choice for 48%, followed by sodium nitroprusside in 29%. Nearly half (48%) would start IVV also out of the intensive-care setting and 58% consider repeated non-invasive blood-pressure monitoring sufficient. Key indications are acute decompensated HF (88%) and pulmonary oedema (87%), yet 42 % would also use IVV for advanced low-output HF, 25% for cardiogenic shock, and 24% for isolated right ventricular failure. Hypotension is cited as the principal contraindication (51%), although the reported thresholds for blood pressure vary widely. Respondents favour IVV in reduced or mildly reduced ejection fraction (55%) more often than in preserved EF (17%). Opinions diverge sharply on whether to pause or continue oral neuro-hormonal therapies during infusion. This survey shows that IVV are used in a limited number of AHF patients and practice is highly heterogeneous across centres. These findings underscore the need for prospective trials to clarify which subsets derive haemodynamic or prognostic benefit
In ®Entresto we trust
No full textSacubitril/Valsartan (S/V) is a novel and remarkably effective opportunity to treat heart failure with reduced ejection fraction (HFrEF). However, patients with HFrEF induced by cancer therapy were a priori excluded from the registration study. The value of S/V in this important subgroup of patients needs to be firmly established. In this issue of Cardio-Oncology, Gregorietti et al. report on the effects of S/V in a small group of cancer patients, primarily women with breast cancer treated with anthracyclines. The data are limited but seem to confirm the encouraging results of prior studies, paving the way to foster the use of S/V in cardio-oncology patients and hopefully, to design ad hoc prospective studies in this highly vulnerable population
Pheochromocytoma-induced cardiogenic shock: A multicentre analysis of clinical profiles, management and outcomes
No full textObjective: There is still uncertainty about the management of patients with pheochromocytoma-induced cardiogenic shock (PICS). This study aims to investigate the clinical presentation, management, and outcome of patients with PICS. Methods: We collected, retrospectively, the data of 18 patients without previously known pheochromocytoma admitted to 8 European hospitals with a diagnosis of PICS. Results: Among the 18 patients with a median age of 50 years (Q1-Q3: 40–61), 50% were men. The main clinical features at presentation were pulmonary congestion (83%) and cyclic fluctuation of hypertension peaks and hypotension (72%). Echocardiography showed a median left ventricular ejection fraction (LVEF) of 25% (Q1-Q3: 15–33.5) with an atypical- Takotsubo (TTS) pattern in 50%. Inotropes/vasopressors were started in all patients and temporary mechanical circulatory support (t-MCS) was required in 11 (61%) patients. All patients underwent surgical removal of the pheochromocytoma; 4 patients (22%) were operated on while under t-MCS. The median LVEF was estimated at 55% at discharge. Only one patient required heart transplantation (5.5%), and all patients were alive at a median follow-up of 679 days. Conclusions: PICS should be suspected in case of a CS with severe cyclic blood pressure fluctuation and rapid hemodynamic deterioration, associated with increased inflammatory markers or in case of TTS progressing to CS, particularly if an atypical TTS echocardiographic pattern is revealed. T-MCS should be considered in the most severe cases. The main challenge is to stabilize the patient, with medical therapy or with t-MCS, since it remains a reversible cause of CS with a low mortality rate
Current use of echocardiography in cardio-oncology: nationwide real-world data from an ANMCO/SIECVI joint survey
No full textAims: The need for cardio-oncology competencies is constantly growing, and with the establishment of cardio-oncology services, cardiovascular imaging, particularly transthoracic echocardiography (TTE), has become pivotal in patients' management. However, care pathways for oncologic patients largely depend on local health structures' resources. This survey from Associazione Italiana Medici Cardiologi Ospedalieri and the Italian Society of Echocardiography and Cardiovascular Imaging aimed at investigating the use of echocardiography in cardio-oncology services and knowledge levels on cancer patients' care. Methods and results: Data were obtained via an electronic survey based on a structured questionnaire uploaded to the promoting societies' websites. Responses came from 159 centres with echocardiography. According to one-third of participating centres, workload related to cancer patients represented >30% of the total requests. The most common TTE indication (85%) was left ventricular ejection fraction (LVEF) evaluation. Many centres (55%) still assessed LVEF solely by bidimensional method or visual estimation in case of inadequate acoustic windows. At the same time, almost 40% of centres reported routinely using global longitudinal strain when feasible. We further performed a sub-analysis according to the presence (33%) or absence (77%) of dedicated cardio-oncologists, revealing significant differences in cardiovascular surveillance strategies and cardiotoxicity management. Conclusion: This survey on echocardiography practice for cancer patients reveals a significant gap between actual clinical practice and standards proposed by recommendations, underlying the need for stronger partnerships between cardiologists and oncologists and dedicated, well-structured cardio-oncology services
- …
