Late cardiac effect of anthracycline therapy in physically active breast cancer survivors - a prospective study

The late-onset cardiotoxic effect of anthracycline is known, however the early detection and prevention of subclinical myocardial damage has not been fully understood yet. Besides medical therapy regular physical activities may also play a role in the prevention and reduction of side effects of chemotherapy. The aim of our present study was to detect the effect of regular physical activities on the diastolic function and on the symptoms of late heart failure in case of anthracycline chemotherapy. The prospective study included 55 female patients (age 31-65 year, average 49.5 years) with breast cancer and no cardiovascular risk factors. Proper cardiologic checkup included physical examination (blood pressure, pulse, etc.), ECG, standard echocardiography parameters (EF, LV dimensions etc.) and specific tissue Doppler (TDI) measurements. Symptoms of heart failure were also recorded. After five years of follow-up, symptoms of heart failure were evaluated again. Patients were assigned into two groups depending on their physical activity: 36 patients did perform regular physical activities (mean age 49.2 years) and 19 patients did not (average age 50.1 years). There was no significant difference between the two groups in basic physiological or standard echocardiography parameters neither at the baseline nor at the later time points. Diastolic dysfunction (decreased E/A) was detected 6 months after the beginning of the treatment (T2 time point) in both groups. In the inactive group this value fell below one however there was no significant difference (1.1+/-0.25 vs. 0.95+/-0.22). One year after the beginning of the treatment (T3) a significant difference could be detected between the two groups (1.05+/-0.28 vs. 0.86+/-0.25. P=0.038). Consistent change in diastolic function (Ea/Aa) could be detected with the more sensitive TDI (Tissue Doppler Imaging) measurements after treatments in both groups, especially in the septal segment (in the non active group the Ea/Aa decreased markedly but not significantly at T2 - 1.1+/-0.55 vs. 0.81+/-0.44, and this difference became significant at T3 and 2 years after treatment (T4), p=0.007 and p=0.065). The filling pressure (E/Ea) rose above 10 (p=0.09) in the non active group at T2; and it kept rising in both groups and became significant at T3 (p=0.012). Five years after the onset of the treatment symptoms of heart failure were less frequently reported in the physically active group than in the inactive one (19.45% vs. 68.42%). The data of our study show that the diastolic dysfunction of the left ventricle related to the anthracycline therapy became evident in the physically active group later and the symptoms of heart failure were less frequent than in the non active group after five years period. Enrollment in sport activities could be a good means for partial prevention in this group of patients. Cardiologic checkup at proper intervals plays a pivotal role in detection of possible cardiotoxicity. This is a strong indication for changes in the lifestyle of the patient and the treatment protocol alike

Ischaemiás szívbetegség és tumoros betegségek együttes előfordulása. Kérdések és problémák | Ischaemic heart disease in cancer patients. Questions and problems

Európában a tumoros és cardiovascularis betegségek okozzák a halálozások több mint felét, Magyarországon 2015-ben ez több mint 70% volt. Bizonyos onkológiai kezelések 4–7-szeresére emelhetik az akut coronariaszindróma kialakulásának lehetőségét, mindemellett az onkológiai betegségek önmagukban többszörösére növelik szívinfarktus esetén a halálozást. A kezeléseket tovább nehezíti, hogy nagyon kis esetszámú összesített klinikai adat áll rendelkezésre a tumoros betegek kardiológiai ellátásának hatásairól, mivel ezeket a betegeket rendre kizárták a klinikai vizsgálatokból. Onkológiai betegek esetében hiányosak a protokollok az esetleges konzervatív vagy invazív beavatkozás szükségességének eldöntésére, így egyéni tapasztalatokra, eseti közleményekre kell hagyatkoznunk. Az onkokardiológia fontosságát kiemeli, hogy az onkológiai kezelések fejlődése miatt egyre nő a daganatot túlélők aránya. Csak az Egyesült Államokban 2025-re 20 millió ilyen beteggel számolnak, így nem meglepő, hogy az American College of Cardiology 2014-ben az onkokardiológiát kiemelt területnek minősítette, az Európai Kardiológiai Társaság 2016-ban pedig kiadta első kardioonkológiai ajánlását. Cikkünkben a tumoros ischaemiás szívbetegek ellátásának főbb kérdéseit és javaslatait vesszük sorra a jelenleg használt ajánlásokat, publikációkat és helyi protokollokat alapul véve. Orv Hetil. 2017; 158(43): 1691–1697. | Abstract: Cardiovascular and oncologic diseases are the causes of more than 50 percent of mortality in Europe. In 2015 oncologic and cardiovascular mortality reached 70 percent in Hungary. Patients who receive anticancer therapies are at a 2- to 7-fold greater long-term risk of acute coronary syndrome; also concomittant oncologic diseases further increase the mortality of myocardial infarction. Unfortunately there is not enough data concerning cardiovascular treatment of oncologic patients because they were excluded from most of the studies and registries. Because there is no clear protocol to treat such patients, only small studies and personal experiences could guide our medical therapies. The role of cardio-oncology is even more important, because due to the new treatments the number of tumor survivors rapidly increases. In the US more than 20 millions survivals are expected by 2025 who were treated by any kind of malignant tumors. It is not surprising that in 2014 the American Society of Cardiology declared cardio-oncology as a special and important field in cardiology, and in 2016 European Society of Cardiology released the first cardio-oncologic guideline. In this review we summarize questions and problems concerning the treatment of oncologic patient with ischaemic heart disease based on resent guidelines, published studies and local protocols. Orv Hetil. 2017; 158(43): 1691–1697