High-sensitivity troponin I as a predictor of left ventricular dysfunction in the use of cardiotoxic anticancer agents for breast cancer in patients with predominantly low and moderate risk of cardiotoxicity

Aim. To study the significance of monitoring high-sensitivity troponin I (hs-cTnI) for predicting anthracycline-induced left ventricular (LV) dysfunction in the treatment of breast cancer in patients with moderate and low risk of cardiotoxicity (CT).Material and methods. The study involved 49 patients with breast cancer aged 50±10 years who underwent neoadjuvant or adjuvant chemotherapy, which included doxorubicin at a course dose of 60 mg/m2 and an average cumulative dose of 251±60 mg/m2. The level of hs-cTnI was determined by an ultrasensitive method before the start of chemotherapy, after each course of anthracyclines and in 18 patients before the administration of anthracyclines. The level of hscTnI >0,017 ng/ml was considered elevated. Echocardiography was performed before the start of chemotherapy, after the end of anthracycline therapy, and every 3 months for 12 months thereafter. CT was defined as a decrease in LV ejection fraction (EF) by ≥10% to <53%.Results. CT risk before chemotherapy was considered low and moderate in 96% of patients. An increase in hs-сTnI was detected ≥1 times in 56,8% of patients: before chemotherapy — in 13,5%, after 1 and 2 courses of anthracycline therapy — in 13,9%, after 3, 4, 5 and 6 courses — in 44%, 62%, 71% and 66% of patients, respectively. The levels of hs-cTnI before and after administration of anthracyclines did not differ significantly. The development of LV dysfunction was observed in 16,3% of patients. There were following prognostic significance of an increase in hs-cTnI at any time of chemotherapy for a decrease in LV EF: sensitivity — 87,5%, specificity — 50%, the positive predictive value — 28%, the negative predictive value — 94,7%. The closest relationship was noted between CT and hs-cTnI value before the start of chemotherapy (β=0,45, p=0,005) and after the 3rd course of anthracycline therapy (β=0,56, p=0,002).Conclusion. An increase in hs-cTnI level before and during anthracycline thera py in patients with a low risk of cardiotoxicity has a prognostic value in relation to the development of left ventricular dysfunction. Hs-cTnI assessment should be performed before the start of therapy, and then starting from the 3rd course of anthracycline therapy in all patients, regardless of the risk of cardiotoxicity

Early echocardiographic alterations in cancer patients during chemotherapy

Aim. To evaluate the early manifestation of cardiotoxicity after the first course of multiagent chemotherapy (MAC) using echocardiography with an assessment of the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS).Material and methods. The study included 49 cancer patients with elective MAC.Results. After the first administration of a therapeutic dose of chemotherapy, a decrease in LVEF ≥10 and GLS >15 was demonstrated in more than 6,1% of patients, as well as a subclinical decrease in LVEF ≥5% in 22,4% and a decrease in GLS ≥12% in 24,5%.Conclusion. In cancer patients, after the first course of chemotherapy, GLS dynamics should be assessed during echocardiography as a marker of myocardial dysfunction

Risk factors for cardiovascular diseases in patients received complex treatment for cranial and craniospinal tumors in childhood

Aim. To study the traditional risk factors for cardiovascular disease (CVD), indicators of endothelial function and exercise tolerance in patients received complex treatment for cranial and craniospinal tumors in childhood, including radiation therapy.Material and methods. We compared examination data of 48 patients who underwent treatment for brain tumors using cranial and craniospinal irradiation in childhood (mean age, 21,7±4,3 years, mean period after the end of treatment, 6,9±5,4 years), and 20 healthy volunteers. Examination methods included assessment of lipid profile, vascular stiffness and endothelial function using the Photoplethysmography and occlusion test, cardiopulmonary test, and in patients who underwent craniospinal irradiation, also echocardiography and duplex ultrasound of extracranial arteries.Results. Compared to healthy individuals, patients after a brain tumor were found to have lower blood pressure, higher heart rate (HR), significantly lower exercise performance (peak oxygen consumption, 19,8±6,4 ml×min-1×kg vs 30,3±5,8 ml×min-1×kg, p<0,0001) and a higher prevalence of dyslipidemia (56% vs 5%, p<0,0001), as well as an increase in the augmentation index, indicating higher stiffness of large vessels (-7,3±16,3 vs -20,3±7,9, p=0,001), and a trend towards a decrease in the occlusion index (p=0,051). Echocardiography and duplex ultrasound revealed no radiation-associated abnormalities.Conclusion. Determining the mechanisms and prognostic significance of the identified risk factors for CVD (dyslipidemia, decreased exercise tolerance, increased heart rate and vascular stiffness) in this category of patients requires further research. Regular monitoring of risk factors, primarily the lipid profile, and the use of preventive measures for individuals with an increased risk of CVD should be recommended

Возможности портативного регистратора электрокардиограммы и пульсовой волны в выявлении систолической дисфункции левого желудочка

Highlights. The article presents a novel and unique method for assessment of left ventricular systolic disfunction using electrocardiography and photoplethysmography data. This method will improve and simplify the detection of cardiovascular diseases.Aim. To evaluate left ventricular (LV) systolic function using electrocardiogram (ECG) and photoplethysmogram (PPG) signals recorded by a single-channel ECG and PPG-based monitor.Methods. The prospective study included 489 patients over 18 years old with various cardiovascular diseases. All participants underwent echocardiography to determine the main indicators of LV systolic function: LV ejection fraction (EF), LV outflow tract velocity time integral (LVOT VTI), and global longitudinal strain (GLS). Moreover, all patients underwent 1-lead ECG and PPG recording using a single-channel ECG and PPG-based monitor (CardioQvark). The obtained data were analyzed, and ROC curve analysis was performed.Results. We have identified ECG and PPG parameters associated with a decrease in LV contractile function. During the analysis, the ECG, T-wave amplitude (TA) and RonsF parameters showed the highest diagnostic accuracy. With EF below 55%, the area under the ROC curve (AUC) was 0.822, sensitivity (Se) 80%, specificity (Sp) 69% in EF below 55% in TA; in RonsF AUC was 0.743, Se 81%, Sp 77%. With EF below 40%, AUC was 0.915, Se 85%, Sp 83% in TA, and in RonsF AUC was 0.844, Se 82%, Sp 82%. Diagnostic accuracy of ECG signals in case of LVOT VTI lower than 16 cm was measured: TA (AUC 0.755, Se 82%, Sp 70%), RonsF (AUC 0.620, Se 77%, Sp 72%). PPG signals were not significantly associated with reduced EF; however, the pulse wave parameters were associated with lower LVOT VTI: in DP-B0 AUC was 0.687, Se 71%, Sp 74%. The combination of ECG and PPG signals was significantly associated with EF below 40% (RonsF * DP-SEP (AUC 0.877, Se 86%, Sp 85%). ECG and PPG signals were not associated with LV GLS.Conclusion. Assessment of LV systolic function can be performed by analyzing ECG and PPG signals recorded using a portable single-channel CardioQvark monitor.Основные положения. Описана возможность диагностики снижения систолической функции левого желудочка по данным электро- и фотоплетизмограммы. Разработка метода оценки систолической функции левого желудочка на основе электро- и фотоплетизмограммы позволит улучшить и упростить выявление сердечно-сосудистых заболеваний. Метод оценки систолической функции сердца, изложенный в исследовании, представлен впервые и является уникальным.Цель. Оценка систолической функции левого желудочка (ЛЖ) на основе параметров электро- (ЭКГ) и фотоплетизмограммы (ФПГ), зарегистрированных одноканальным монитором ЭКГ с функцией фотоплетизмографии.Материалы и методы. В проспективное исследование включено 489 пациентов в возрасте старше 18 лет, имеющих заболевания сердечно-сосудистой системы. Всем участникам исследования выполнена эхокардиография с определением основных показателей систолической функции ЛЖ: фракции выброса (ФВ) ЛЖ, интеграла линейной скорости кровотока в выносящем тракте ЛЖ (VTI в ВТЛЖ), глобальной деформации ЛЖ (GLS). Также всем больным проведена регистрация ЭКГ в I отведении и ФПГ с использованием монитора ЭКГ с функцией фотоплетизмографии (CardioQVARK). Проведены расчет всех полученных параметров, затем ROC-анализ данных.Результаты. Выявлены параметры ЭКГ и ФПГ, ассоциированные со снижением сократительной функции ЛЖ. При анализе ЭКГ параметры TA (амплитуда T-волны) и RonsF (частота максимальной энергии переднего фронта R-волны) имели наибольшую диагностическую точность. При ФВ менее 55% для TA площадь под ROC-кривой (AUC) составила 0,822, чувствительность (Se) 80%, специфичность (Sp) 69%, а для параметра RonsF – AUC 0,743, Se 81%, Sp 77%. При ФВ менее 40%: AUC для TA составила 0,915, Se 85%, Sp 83%, для RonsF – AUC 0,844, Se 82%, Sp 82%. Диагностическая точность параметров ЭКГ при снижении VTI в ВТЛЖ менее 16 см: TA (AUC 0,755, Se 82%, Sp 70%), RonsF (AUC 0,620, Se 77%, Sp 72%). При оценке параметров ФПГ достоверной взаимосвязи со снижением ФВ не выявлено, однако параметры пульсовой волны ассоциированы с уменьшением VTI в ВТЛЖ: для DP-B0 AUC 0,687, Se 71%, Sp 74%. Комбинации параметров ЭКГ и ФПГ достоверно взаимосвязаны со значением ФВ менее 40% (RonsF*DP-SEP (AUC 0,877, Se 86%, Sp 85%)). Взаимосвязи параметров ЭКГ и ФПГ со значением GLS ЛЖ не обнаружено.Заключение. Определение систолической функции ЛЖ возможно при анализе параметров ЭКГ и ФПГ, зарегистрированных с помощью портативного одноканального монитора CardioQVARK

Comparative Characteristics of Beta-Blockers in Patients with Congenital Long QT Syndrome

Congenital long QT syndrome is a pathology that requires special attention and knowledge about the safety and effectiveness of various medications. Prolongation of the QT interval due to congenital or acquired causes is an important factor in the development of an unfavorable life forecast with the formation of an elongated QT syndrome. With an unfavorable course, patients suffer from loss of consciousness, episodes of tachycardia. Often, stable polymorphic ventricular tachycardia develops. The risk of sudden cardiac death in this pathology can vary from 0.33% to 5%. In people who have suffered an episode of cardiac arrest, and do not have a permanent prescribed antiarrhythmic therapy, the mortality rate reaches 50% within 15 years. Preventive administration of antiarrhythmic drugs is not always effective. A positive result of treatment depends on the severity of long QT syndrome and its genotype. Beta-blockers are often prescribed to patients of different ages with various cardiac pathologies, including for the prevention of arrhythmia in long QT syndrome. Beta-blockers differ in various pharmacokinetic and pharmacodynamic parameters (lipophilicity/hydrophilicity, selectivity, presence/absence of internal sympathomimetic activity), which, along with the variant of the disease genotype, can affect their effectiveness and safety in the considered pathology. This review article presents the results of major studies on the safety and effectiveness of different groups of beta blockers in various variants of long QT syndrome. The preferred beta-blockers for various genotypes of the syndrome were determined, and a comparative characteristic of beta-blockers for their safety and preventive effectiveness was given