Imagen en Cardio-Oncología: técnicas de imagen en el diagnóstico y seguimiento de pacientes oncológicos

Improvements in cancer treatment have markedly reduced cancer-related mortality. However these benefi ts do not come without risk and the cardiovascular eff ects of some treatments impact in the long-term mortality of cancer survivors. The new approach to minimize cardiotoxicity is based on a continuous cardiovascular monitoring, based on cardiac imaging techniques, to detect early changes predictive of cardiotoxicity, in order to minimize it and to start treatment in a reversible stage. This article reviews the current indications of the diff erent imaging techniques in cancer patients monitoring.Los avances en el diagnóstico precoz y tratamiento del cáncer han permitido reducir la mortalidad de los pacientes, pero el tratamiento del cáncer se comporta como un nuevo factor de riesgo y se asocia a efectos secundarios graves en el sistema cardiovascular. Las técnicas de imagen constituyen una herramienta imprescindible en la monitorización de los tratamientos oncológicos. El objetivo de un seguimiento protocolizado es facilitar el proceso del cáncer identifi cando y tratando pprecozmente las complicaciones cardiovasculares en una fase reversible. Este artículo revisa las indicaciones actuales de las diferentes técnicas de imagen en la monitorización de pacientes con cáncer

Biomechanical characteristics of different methods of neo-chordal fixation to the papillary muscles

Background and Aim of the Study Several techniques have been described for neo-chordal fixation to the papillary muscles without any reported clinical differences. The objective of this study is to compare in vitro the biomechanical properties of four of these common techniques. Methods We studied the biomechanical properties of expanded polytetrafluoroethylene neo-chordal fixation using four techniques: nonknotted simple stitch, nonknotted figure-of-eight stitch, knotted pledgeted mattress stitch, and knotted pledgeted stitch using commercially available prefabricated loops. Neo-chordae were submitted to a total of 20 traction-relaxation cycles with incremental loads of 1, 2, and 4 N. We calculated the elongation, the force-strain curve, elasticity, and the maximum tolerated load before neo-chordal failure. Results The elongation of the neo-chordae was lowest in the simple stitch followed by the figure-of-eight, the pledgeted mattress, and he commercially prefabricated loops (p < .001). Conversely, the elastic modulus was highest in the simple stitch followed by the figure-of-eight, the pledgeted mattress, and the prefabricated loops (p < .001). The maximum tolerated load was similar with the simple stitch (28.87 N) and with the figure-of-eight stitch (31.39 N) but was significantly lower with the pledgeted mattress stitch (20.51 N) and with the prefabricated loops (7.78 N). Conclusion In vitro, neo-chordal fixation by nonknotted simple or nonknotted figure-of-eight stitches resulted in less compliance as opposed to the use of knotted pledgeted stitches. Fixation technique seemed to influence neo-chordal biomechanical properties, however, it did not seem to affect the strength of the suture when subjected to loads within physiological rangesS

Endocarditis mitroaórtica complicada con aneurisma y perforación en velo anterior mitral

We present an 81-year-old male admitted for the study of fever associated with weight loss, asthenia, and decrease of appetite. The transoesophageal echocardiogram confirmed the existence of a complicated mitroaortic endocarditis with an aneurysm and perforation of the mitral anterior leaflet.Varón de 81 años que ingresa para estudio de un síndrome general y fiebre. En el ecocardiograma transesofágico se confirma la existencia de una endocarditis mitroaaortica complicada con un aneurisma y perforación del velo anterior mitral

Thirty-Second Sit-To-Stand Test as an Alternative for Estimating Peak Oxygen Uptake and 6-Min Walking Distance in Women With Breast Cancer: A Cross-Sectional Study

[Abstract] Purpose: To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. Methods: This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18-70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. Results: The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). Conclusion: The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported by a competitive grant from the Asociación Española Contra el Cáncer (AECC) Scientific Foundation — PRDLC21480DÍAZ — and by a competitive grant of the Spanish Health Research Fund of the Carlos III Health Institute (ISCIII) — PI17/01687, co-funded FEDER, through Strategic Action in Healthcare, 2017. The ISCIII is the national and international reference in biomedical research and public health in Spain. The AECC Scientific Foundation and the ISCIII had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding for open access charge will be supported by Universidade da Coruña/CISUGFundación Científica Asociación Española Contra el Cáncer; PRDLC21480DÍA

A Randomized Trial to Evaluate the Impact of Exercise-Based Cardiac Rehabilitation for the Prevention of Chemotherapy-Induced Cardiotoxicity in Patients With Breast Cancer: ONCORE Study Protocol

[Abstract] Background. Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods. The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion. The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk.Instituto de Salud Carlos III; PI17/0168