Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS≥400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12±4 months, CCS≥400, 10–399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85–0.93) for CCS was superior to 0.69 (95% CI: 0.61–0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD

Cardiotoxicity after anticancer treatment: clinical investigations and molecular mechanisms

Steeds meer mensen overleven kanker. Daarom moet er aandacht zijn voor de schadelijke bijwerkingen van de behandeling. Vooral hartschade is een belangrijk probleem. Patrick Perik onderzocht hoe deze schade te voorspellen of op te sporen is. Dit is moeilijk, maar het 'harthormoon' BNP lijkt een oplossing te bieden: dit BNP kan mogelijk voorspellen of iemand hartschade krijgt en zelfs de patiënten opsporen die een verhoogd risico lopen op hartschade als gevolg van hun kankerbehandeling. Patiënten met hartfalen hebben doorgaans meer BNP in hun bloed; Perik ontdekte dat het hormoongehalte stijgt na de behandeling. Twee andere mogelijke opsporingsmethoden geven minder aanknopingspunten. Perik onderzocht patiënten die voor borstkanker waren behandeld met het antilichaam trastuzumab. Hij maakte toegediende trastuzumab zichtbaar op een scan. Hiermee kunnen uitzaaiingen worden aangetoond, maar de scan blijkt niet van waarde voor het voorspellen van hartschade. Patiënten die chemotherapie hebben gehad en zijn bestraald, hebben merkstoffen in hun bloed die zijn gerelateerd aan celdood. De promovendus ontdekte een tijdelijke verandering in de bloedspiegels van deze merkstoffen, vooral bij degenen die een hoge dosis chemotherapie kregen. Maar de meting lijkt niet bruikbaar voor de vroege opsporing van hartschade.

Cardiovascular toxicity caused by cancer treatment:strategies for early detection

Cardiovascular toxicity is one of the most devastating complications of cancer treatment and can arise during or shortly after treatment, or even several years later. Identification of the left ventricular ejection fraction (LVEF) is the most common method to screen for toxic effects on the heart; however, this approach underestimates cardiac damage and additional strategies for the monitoring of treatment-induced cardiotoxicity are being explored. Guidelines for monitoring have been formulated for several cancer treatments; however, appropriate underlying evidence is still largely absent. In this Review, we summarise conventional and contemporary methods for early detection of cardiotoxicity and designate a level of evidence for the basis of each method

Cardiovascular toxicity caused by cancer treatment: strategies for early detection

Cardiovascular toxicity is one of the most devastating complications of cancer treatment and can arise during or shortly after treatment, or even several years later. Identification of the left ventricular ejection fraction (LVEF) is the most common method to screen for toxic effects on the heart; however, this approach underestimates cardiac damage and additional strategies for the monitoring of treatment-induced cardiotoxicity are being explored. Guidelines for monitoring have been formulated for several cancer treatments; however, appropriate underlying evidence is still largely absent. In this Review, we summarise conventional and contemporary methods for early detection of cardiotoxicity and designate a level of evidence for the basis of each method