Cardiovascular outcomes in breast cancer survivors:a systematic review and meta-analysis

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.Methods and results We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I 2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.Conclusion Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.</p

Antrasiklinlere Bağlı Elektro-Mekanik Değişiklikler: Kardiyotoksisiteyi Erken Dönemde Öngörmede Strain Ekokardiyografinin Repolarizasyon Belirteçleri ile Birlikte Kullanımı

Objective: The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer. Methods: A total of 35 consecutive patients (all females, mean age: 48.9 +/- 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional electrocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other. Results: In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 +/- 27.63 (T0), 468.00 +/- 38.98 (T1), 467.86 +/- 35.09 (T2)], QT dispersion [49.85 +/- 19.52 (T0), 69.54 +/- 16.06 (T1), 57.63 +/- 14.42 (T2)], and T-wave peak-to-end interval [94.00 +/- 45.46 (T0), 131.20 +/- 17.79 (T1), 120.00 +/- 18.32 (T2)]; P <.001). There was no significant change in global longitudinal strain values before and after treatment (global longitudinal strain avg: -21 +/- 7.1%; P =.8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (-17.2 +/- 3.5 to -13 +/- 2.84; P <.001, 45.1 +/- 8.3 to 35.6 +/- 10; P <.001, and 12.1 +/- 3.5 to 7.7 +/- 2.1; P <.001, respectively). Conclusion: Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy

Is neuropathic pain associated with cardiac sympathovagal activity changes in patients with breast cancer?

WOS: 000427901600008PubMed ID: 29447081Objective: Heart rate variability (HRV) is a good indicator of the autonomic nervous system (ANS) activity. A few studies have been conducted recently and have shown a relationship between reduced HRV and conditions that lead to neuropathic pain (NP). In this study, we aimed to investigate whether NP is associated with changes in cardiac sympathovagal activity in patients with breast cancer (BC). Methods: We used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 70 patients with BC. The patients were subjected to a 24-h Holter ECG monitorization to determine heart rate variability (HRV). Standard deviation (SD) of the normal-to-normal RR intervals (SDNN), SD of the mean of the RR intervals (SDAAN), mean of the SD of the NN interval (SDNN Index), low-frequency component/high-frequency component ratio (LF/HF), and the mean heart rate of the patients were recorded. Results: According to the LANSS questionnaire, 18 (25.7%) of the patients were classified as NP (+). The SDNN (P = 0.001), SDAAN (P = 0.003), and SDDN index (P = 0.007) were significantly lower in patients with NP than in patients without NP, whereas LF/HF ratio (P = 0.000) and mean heart rate were found to be significantly higher in patients with NP (P = 0.006). Conclusion: According to our findings, NP (+) patients with BC had increased cardiac sympathetic activity, which was suggested to be associated with increased cardiovascular morbidity and mortality

Primary Carnitine Deficiency as a Treatable Cause of Heart Failure in Young Patients

Non-ischemic dilated cardiomyopathy is the most common subgroup of heart failure in young adults. Several metabolic defects could be the underlying etiology in these young heart failure patients. However, most cases are considered idiopathic. Primary carnitine deficiency is an overlooked inherited metabolic disease causing cardiomyopathy in these patients. Oral carnitine replacement therapy could prevent primary carnitine deficiency patients from progressing to advanced heart failure and life-threatening arrhythmias. In this case report, we present an index primary carnitine deficiency case and his brother's diagnosis and successful treatment period to draw attention to primary carnitine deficiency as a treatable cause of heart failure in young adults

The real-life data of hospitalized patients with heart failure: On behalf of the Journey HF-TR study investigators

WOS: 000462344800006PubMed ID: 30587703Objective: Acute heart failure (AHF) is a life-threatening clinical syndrome characterized by rapid onset of heart failure (HF) symptoms and signs and requires urgent therapy. The aim of the present study was to evaluate the overall clinical characteristics, management, and in-hospital outcomes of hospitalized patients with AHF in a large sample of Turkish population. Methods: The Journey HF-TR study is a cross-sectional, multicenter, non-invasive and observational trial. Patients who were hospitalized with a diagnosis of AHF in the intensive care unit (ICU)/coronary care unit and cardiology wards between September 2015 and September 2016 were included in our study. Results: A total of 1606 (male: 57.2%, mean age: 67.8 +/- 13 years) patients who were diagnosed with AHF were enrolled in the study. Seventeen percent of the patients were admitted to the hospital with a diagnosis of new onset AHF. Hypertension (67%) and coronary artery disease (CAD) (59.6%) were the most frequent underlying diseases. Acute coronary syndrome accompanying HF (14.7%), infection (29.3%), arrhythmia (25.1%), renal dysfunction (23%), and non-compliance with medication (23.8%) were the precipitating factors. The median length of stay in the ICU was 3 days (interquartile range, IQR 1-72) and 7 days (IQR 1-72) for in-hospital journey. The guideline recommended medications were less likely used in our patient population (<73%) before admission and were similar to European and US registers at discharge. The in-hospital mortality rate was 7.6%. Hypertension and CAD were the most frequent underlying diseases in our population similar to other European surveys. Although our study population was younger than other registers, in-hospital mortality was high. Conclusion: Analyses of such real-world data will help to prepare a national database and distinctive diagnosis and treatment algorithms and to provide observing compliance with the current European Society of Cardiology guidelines for more effective management of HF

Cardiovascular outcomes in breast cancer survivors:a systematic review and meta-analysis

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.Methods and results We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I 2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.Conclusion Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.</p

Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis

Aims It is unclear whether the future risk of cardiovascular events in breast cancer (bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with bc. Methods and results We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. Conclusion Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. Registration CRD42022298741

Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Myocarditis

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