Cardiovascular complications after radiotherapy

Over the past decades, effective cancer therapies have resulted in a significant improvement in thesurvival rates for a number of cancers and an increase in the number of cancer survivors. Radiationtherapy is widely used in the treatment of cancer, and it can induce various cardiotoxicities that differconsiderably from chemotherapy-induced cardiotoxicity. They occur primarily as late radiation-inducedcomplications, several years from the end of anticancer treatment and present as coronary artery disease,heart failure, pericardial disease, valvular heart disease and arrhythmias. Patients who recoveredfrom cancer disease suffer from cardiac complications of anticancer treatment, it affects the quality oftheir lives and life expectancy, especially if the diagnosis is delayed. These patients may present distinctsymptoms of cardiac injury, resulting from radiation-induced neurotoxicity and altered pain perception,which makes diagnosis difficult. This review highlights the need for a screening programme for patientswho have undergone radiation therapy and which will subsequently have a potentially profound impacton morbidity and mortality

The “athlete’s heart” features in amateur male marathon runners

Background: Training on a professional level can lead to cardiac structural adaptations called the “athlete’s heart”. As marathon participation requires intense physical preparation, the question arises whether the features of “athlete’s heart” can also develop in recreational runners.Methods: The study included 34 males (mean age 40 ± 8 years) who underwent physical examination, a cardiopulmonary exercise test and echocardiographic examination (ECHO) before a marathon. ECHO results were compared with the sedentary control group, reference values for an adult male population and those for highly-trained athletes. Runners with abnormalities revealed by ECHO were referred for cardiac magnetic resonance imaging (CMR).Results: The mean training distance was 56.5 ± 19.7 km/week, peak oxygen uptake was 53.7 ± 6.9 mL/kg/min and the marathon finishing time was 3.7 ± 0.4 h. Compared to sedentary controls, amateur athletes presented larger atria, increased left ventricular (LV) wall thickness, larger LV mass and basal right ventricular (RV) inflow diameter (p < 0.05). When compared with ranges for the general adult population, 56% of participants showed increased left atrial volume, indexed to body surface area (LAVI), 56% right atrial area and interventricular septum thickness, while 47% had enlarged RV proximal outflow tract diameter. In 50% of cases, LAVI exceeded values reported for highly-trained athletes. Due to ECHO abnormalities, CMR was performed in 6 participants, which revealed hypertrophic cardiomyopathy in 1 runner.Conclusions: “Athlete’s heart” features occur in amateur marathon runners. In this group, ECHO reference values for highly-trained elite athletes should be considered, rather than those for the general population and even then LAVI can exceed the upper normal value

Dysfunkcja węzła zatokowego jako późne powikłanie leczenia chłoniaka Hodgkina

Cardiotoxicity and cardiovascular complications associated with radiation therapy can be revealed many years after oncological therapy, most often 15-20 years after this treatment. A 45-year-old man was admitted to hospital due to syncope with accompanying head injury. At the age of 30, he was diagnosed with Hodgkin lymphoma (clinical stage III) and underwent chemotherapy (including doxorubicin), followed by thoracic radiotherapy. Complete remission of the disease was achieved and the patient remained under constant hematological control for the following years. On admission to the hospital, sinus bradycardia up to 25 bpm was recorded in electrocardiographic (ECG) examination, without other abnormalities. ECG monitoring carried out in the following hours revealed episodes of sinus arrest (up to 17 seconds). Laboratory test results were in the normal range. Transthoracic echocardiography showed no abnormalities. Oncological treatment has been considered the most likely cause of sinus node damage. Due to symptomatic sinus node dysfunction, the patient was implanted with a dual chamber pacemaker. The presented case report confirms the need for indefinite cardiological supervision in patients after oncological treatment in childhood or youth, especially when thorax irradiation and chemotherapy with proven cardiotoxicity were required.Kardiotoksyczność i powikłania sercowo-naczyniowe związane ze stosowaną radioterapią mogą ujawnić się wiele lat po zakończeniu leczenia onkologicznego, najczęściej 15-20 lat po jego zakończeniu. 45-letni mężczyzna został przyjęty do szpitala z powodu utraty przytomności z towarzyszącym urazem głowy. W wieku 30 lat w związku z rozpoznaniem chłoniaka Hodgkina (stadium III) był leczony chemioterapią z zastosowaniem m.in. doksorubicyny oraz radioterapią śródpiersia. Po leczeniu uzyskano całkowitą remisję, a pacjent objęty był nadzorem hematologicznym, nie zgłaszając alarmujących objawów. Przy przyjęciu do szpitala w badaniu elektrokardiograficznym (EKG) zarejestrowano bradykardię zatokową ok. 25/min, bez innych nieprawidłowości. Prowadzone w kolejnych godzinach monitorowanie EKG wykazało epizody zahamowania zatokowego (do 17 sek. W badaniach laboratoryjnych nie stwierdzono istotnych odchyleń od normy. Przezklatkowe badanie echokardiograficzne nie wykazało nieprawidłowości. Za najbardziej prawdopodobną przyczynę uszkodzenia węzła zatokowego uznano przebyte leczenie onkologiczne. W związku z objawową dysfunkcją węzła zatokowego pacjentowi implantowano dwujamowy stymulator serca. Prezentowany opis przypadku potwierdza konieczność bezterminowego nadzoru kardiologicznego pacjentów po przebytym w dzieciństwie lub młodości leczeniu onkologicznym, zwłaszcza pacjentów, u których koniecznie było stosowanie radioterapii klatki piersiowej oraz chemioterapii o udowodnionej kardiotoksyczności

Global Longitudinal Strain in Cardio-Oncology: A Review

Several therapies used in cancer treatment are potentially cardiotoxic and may cause left ventricular (LV) dysfunction and heart failure. For decades, echocardiography has been the main modality for cardiac assessment in cancer patients, and the parameter examined in the context of cardiotoxicity was the left ventricular ejection fraction (LVEF). The assessment of the global longitudinal strain (GLS) using speckle tracking echocardiography (STE) is an emerging method for detecting and quantifying subtle disturbances in the global long-axis LV systolic function. In the latest ESC guidelines on cardio-oncology, GLS is an important element in diagnosing the cardiotoxicity of oncological therapy. A relative decrease in GLS of >15% during cancer treatment is the recommended cut-off point for suspecting subclinical cardiac dysfunction. An early diagnosis of asymptomatic cardiotoxicity allows the initiation of a cardioprotective treatment and reduces the risk of interruptions or changes in the oncological treatment in the event of LVEF deterioration, which may affect survival

Right Ventricular Diastolic Dysfunction after Marathon Run

It has been raised that marathon running may significantly impair cardiac performance. However, the post-race diastolic function has not been extensively analyzed. We aimed to assess whether the marathon run causes impairment of the cardiac diastole, which ventricle is mostly affected and whether the septal (IVS) function is altered. The study included 34 male amateur runners, in whom echocardiography was performed two weeks before, at the finish line and two weeks after the marathon. Biventricular diastolic function was assessed not only with conventional Doppler indices but also using the heart rate-adjusted isovolumetric relaxation time (IVRTc). After the run, IVRTc elongated dramatically at the right ventricular (RV) free wall, to a lesser extent at the IVS and remained unchanged at the left ventricular lateral wall. The post-run IVRTc_IVS correlated with IVRTc_RV (r = 0.38, p < 0.05), and IVRTc_RV was longer in subjects with IVS hypertrophy (88 vs. 51 ms; p < 0.05). Participants with measurable IVRT_RV at baseline (38% of runners) had longer post-race IVRTc_IVS (102 vs. 83 ms; p < 0.05). Marathon running influenced predominantly the RV diastolic function, and subjects with measurable IVRT_RV at baseline or those with IVS hypertrophy can experience greater post-race diastolic fatigue