Thrombotic Events in Cancer Patients

Cancer poses the highest clinical and social burden throughout the world and is the second cause of death after is chemic heart disease, although will be predicted the first in 2060. Cancer patients are high risk for thrombotic events that are characterized as the second cause of death after cancer itself. Thrombotic events seem to be increasing over recent years according to improved patients survival, novel thrombogenic cancer treatment and central catheter using. As we know thromboprophylaxis reduces the risk of VTE and primary prevention seems to be more effective way to reduce morbidity and mortality in these patients several criteria was designed to reduce this risk. Khorana risk score is the most important of them which designed for ambulatory cancer patients. Some other risk factors for thrombotic events consist of major abdominal surgery and prolonged immobility after surgery, use of thrombogenic medications (chemotherapy agents), old age, obesity, distant metastasis or advanced stage at the time of diagnosis, hyperthermic intraperitoneal chemotherapy (HIPEC) as a new surgery technique, anemia that requires blood transfusion that recommend special attention should be paid to them

The Potential Ameliorating Role of Spironolactone in Trastuzumab Mediated Cardiotoxicity: A Narrative Review

Background: Around 20% of breast cancers (BC) overexpress human epidermal growth factor receptor 2 (HER-2). HER-2 upregulation has been linked to increased tumor aggressiveness and poor prognosis. Trastuzumab, an anti-HER2 monoclonal antibody, has improved overall survival in early-stage and metastatic BC but at the expense of developing cardiac morbidity. In the current review, we aimed to discuss the pathogenesis of trastuzumab-induced cardiac toxicity and the potential preventive properties of spironolactone in this regard. Methods: We thoroughly searched PubMed, Embase, Scopus, and Web of Science according to the following search terms: trastuzumab, cardiotoxicity, heart failure, Spironolactone. Results: Trastuzumab deteriorates mitochondrial function and subsequently leads to the accumulation of reactive oxygen species (ROS) in cardiomyocytes. Published clinical studies have offered conflicting results regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers (BB) in respect of trastuzumab-induced cardiotoxicity. On the other hand, spironolactone has been found to exert both antioxidant and anti-inflammatory properties. Recent in vivo studies have supported the cardioprotective effect of spironolactone through maintaining mitochondrial ultrastructure and reducing ROS production. Conclusions: Although spironolactone mitigates oxidative stress and mitochondrial dysfunction, there is a lack of clinical evidence to support the effectiveness of spironolactone in trastuzumab-induced cardiotoxicity. Design and implementation of clinical trials are of the essence to determine the potential beneficial impacts of spironolactone upon trastuzumab-induced cardiotoxicity

Dislodged Interatrial Septum Occluder was Found in an Incredible Place: A Case Report

Secundum type atrial septal defect (ASD) is the most common type of interatrial septum defects. Transcatheter closure of secundum ASD has replaced traditional surgical ASD closure in most cases. Embolization of device is relatively uncommon (0.3%), but it can be a life-threatening situation that needs emergency open heart surgery. We presented a 44-year-old woman who underwent a successful ASD device closure, but the day after procedure, she presented with dyspnea and frequent paroxysmal supraventricular tachycardia with absence of device in interatrial septum (IAS) position. Further investigation by transesophageal revealed atrial septal occluder in the right pulmonary artery that extracted by surgery successfully

Post-revascularization Ejection Fraction Prediction for Patients Undergoing Percutaneous Coronary Intervention Based on Myocardial Perfusion SPECT Imaging Radiomics:a Preliminary Machine Learning Study

In this study, the ability of radiomics features extracted from myocardial perfusion imaging with SPECT (MPI-SPECT) was investigated for the prediction of ejection fraction (EF) post-percutaneous coronary intervention (PCI) treatment. A total of 52 patients who had undergone pre-PCI MPI-SPECT were enrolled in this study. After normalization of the images, features were extracted from the left ventricle, initially automatically segmented by k-means and active contour methods, and finally edited and approved by an expert radiologist. More than 1700 2D and 3D radiomics features were extracted from each patient’s scan. A cross-combination of three feature selections and seven classifier methods was implemented. Three classes of no or dis-improvement (class 1), improved EF from 0 to 5% (class 2), and improved EF over 5% (class 3) were predicted by using tenfold cross-validation. Lastly, the models were evaluated based on accuracy, AUC, sensitivity, specificity, precision, and F-score. Neighborhood component analysis (NCA) selected the most predictive feature signatures, including Gabor, first-order, and NGTDM features. Among the classifiers, the best performance was achieved by the fine KNN classifier, which yielded mean accuracy, AUC, sensitivity, specificity, precision, and F-score of 0.84, 0.83, 0.75, 0.87, 0.78, and 0.76, respectively, in 100 iterations of classification, within the 52 patients with 10-fold cross-validation. The MPI-SPECT-based radiomic features are well suited for predicting post-revascularization EF and therefore provide a helpful approach for deciding on the most appropriate treatment.</p

Mitral Regurgitation after Percutaneous Balloon Mitral Valvotomy in Patients with Rheumatic Mitral Stenosis: A Single-Center Study

Background: Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. Methods: We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated. Results: Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm2 before BMV vs. 1.90 ± 0.22 cm2 after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications. Conclusion: In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV

Relationship between Breast Cancer and Cardiac Myxoma

Cancer treatment approaches are greatly improved in recent years. Myxomas are the most frequent intracardiac neoplasm, accounting for nearly 50% of all benign tumors. The left atrium with 75% of cases and the right atrium with 20% of cases are the most common locations of myxomas. Atrial myxomas are benign, slow-growing neoplasms that arise from the interatrial septum and extend into the left or right atrium. Right atrial myxomas may present as right-sided heart failure and pulmonary embolism. Breast cancer is the second most common cause of death among women worldwide. Eight percent of patients are presented with distant metastases. A large number of breast tumors are not random events, and some of them are due to the human genome alteration. Mammary carcinoma is a common familial cancer, which is transmitted in an autosomal dominant manner. We have noticed that patients with breast cancer visiting our cardio-oncology department are occasionally presented with cardiac myxoma

Tissue Doppler Imaging Values in Hypertrophic Cardiomyopathy According to Left Ventricular Outflow Gradient

Background: The aim of the present study was to investigate the effects of the left ventricular outflow gradient on tissue doppler imaging (TDI) values in patients with hypertrophic cardiomyopathy (HCM). Methods: This prospective observational study was conducted in a tertiary referral heart hospital (Tabriz, Iran) from March 2004 to March 2008. Fifty two patients (28 men and 24 women) with definite diagnoses of HCM were selected for the study. 2D, M-mode echocardiography and TDI were performed for all patients. In TDI, the velocities of myocardium was measured at lateral and septal corner of the mitral valve annulus in peak early diastolic (Ea), peak late diastolic (Aa) and peak systolic (Sa). Then, the TDI velocities were compared in patients with left ventricle outflow gradient less and more than 30 mmHg. Results: The mean age of the patients was 42.13 ± 12.22 years. All patients were in New York Heart Association functional class I or II. The mean EF was 55 ± 7%. It was found that TDI velocities are reduced in patients with HCM, compared to normal vaues and Ea in septal corners of the mitral annulus was reduced more in patients with left ventricle outflow gradient > 30 mmHg (5.3±1.6 vs 7.1±1.2, P=0.01). Conclusion: TDI findings specially peak early diastolic (Ea) mitral annular velocity are good parameters in HCM patients assessment