Syövän hoitojen sydänvaikutukset

Vertaisarvioitu• Syövän hoitojen sydänvaikutusten vuoksi lisääntynyt kuolleisuus ja sairastavuus vähentävät hoitojen ¬kokonaishyötyä. • QT-ajan muutos on yleisin ja sydämen vajaatoiminta merkittävin syövän hoitojen haittavaikutus. • Haittoja pyritään vähentämään ehkäisemällä, seulomalla ja hoitamalla niitä varhain. • Syövän, sen hoidon ja sydänterveyden ympärille on kehittymässä uusi osaamiskokonaisuutensa, ¬kardio-onkologia.Peer reviewe

Sädehoidon sydänvaikutukset

Sädehoito on tärkeä osa nykyaikaista syöpähoitoa. Potilaat elävät syöpäsairautensa jälkeen pidempään, minkä vuoksi myöhään ilmaantuvat haittavaikutukset ovat nousseet merkittävämpään rooliin. Rintakehälle annetun sädehoidon tiedetään lisäävän sydänsairauksien riskiä noin kaksinkertaiseksi, ja tärkein riskiä suurentava tekijä on kumulatiivinen kokonaissädeannos. Sädehoidon merkittävimmät haittavaikutukset ilmaantuvat vasta vuosien kuluttua hoidosta. Kuolleisuus näihin myöhäisilmentymiin vähentää sädehoidosta saatua kokonaishyötyä. Erityisesti potilaat, jotka ovat aikaisemmin saaneet sädehoitoa vasemman rinnan syövän tai Hodgkinin lymfooman vuoksi, ovat alttiimpia sädehoidon sydänvaikutuksille. Terveen kudoksen sädekuormitusta on nykyaikaisella sädehoitotekniikalla saatu pienennettyä, mutta turvallista sädeannosta ei tiedetä. Nykyannoksillakin on havaittavissa varhaisia subkliinisiä sydänmuutoksia sädehoidolle altistuneilla alueilla

Dynamic Integrated Backscatter Detects Radiotherapy-induced Cardiac Changes Better than Strain Analysis - A Prospective Three-year Study

Background/Aim: Radiotherapy (RT) related myocardial changes were analyzed by deformation imaging echocardiography in this study. Patients and Methods: Ninety-nine breast cancer patients were studied at baseline, after chemotherapy, after RT, and three years after RT (3Y). Eighty patients received RT only, and twenty patients had right-sided breast cancer. Echocardiography included cyclic variation of the integrated backscatter in the septum (sCV) and posterior wall (pCV), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF). Results: In patients with left-sided breast cancer, sCV declined from 11.3??3.3 dB at baseline to 10.3??2.9 dB after RT (p=0.001). No changes were observed after chemotherapy (p=0.211) or in patients with right-sided breast cancer after RT (p=0.977). No other parameters declined after RT. The decline in sCV was independently associated with the left anterior descending coronary artery radiation dose (??=???0.290, p=0.020). Conclusion: In contrast to other parameters, sCV correlated with heart radiation dose.Peer reviewe

3-Year Follow-Up of Radiation-Associated Changes in Diastolic Function by Speckle Tracking Echocardiography

BACKGROUND Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function. OBJECTIVES The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function. METHODS Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points: prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function. RESULTS Regional changes in SRe, particularly the apical and anteroseptat segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range: 1.01 to 1.39) s(-1) at baseline to 1.02 (interquartile range: 0.79 to 1.15) s(-1) at 3 years of follow-up (p < 0.001). This decline was associated with the left ventricular maximal radiation dose (beta = 0.36, p = 0.007). The global SRe was CONCLUSIONS RT resulted in changes in the SRe in the apical and anteroseptat segments over 3 years of follow-up. Changes in SRe apical segments were present even in patients with preserved systolic function and were independently associated with RT dose and cardiovascular comorbidities. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Peer reviewe

Syöpäpotilaan sydän - tutkimukset ja hoidon optimointi

English summaryPeer reviewe

Decreases in TGF-1 and PDGF levels are associated with echocardiographic changes during adjuvant radiotherapy for breast cancer

BackgroundRadiation-induced heart disease is mainly caused by activation of the fibrotic process. Transforming growth factor-beta 1 (TGF-1) and platelet-derived growth factor (PDGF) are pro-fibrotic mediators. The aim of our study was to evaluate the behavior of TGF-1 and PDGF during adjuvant radiotherapy (RT) for breast cancer and the association of these cytokines with echocardiographic changes.MethodsOur study included 73 women with early-stage breast cancer or ductal carcinoma in situ (DCIS) receiving post-operative RT but not chemotherapy. TGF-1 and PDGF levels in serum samples taken before and on the last day of RT were measured by an enzyme-linked immunosorbent assay. Echocardiography was also performed at same time points. Patients were grouped according to a15% worsening in tricuspid annular plane systolic excursion (TAPSE) and pericardium calibrated integrated backscatter (cIBS).ResultsIn all patients, the median TGF-1 decreased from 25.0 (IQR 21.1-30.3) ng/ml to 23.6 (IQR 19.6-26.8) ng/ml (p=0.003), and the median PDGF decreased from 18.0 (IQR 13.7-22.7) ng/ml to 15.6 (IQR 12.7-19.5) ng/ml (pPeer reviewe

Associations between ECG changes and echocardiographic findings in patients with acute non-ST elevation myocardial infarction

Background: ST segment depression (STD) and T wave inversion (TWI) are typical electrocardiographic (ECG) findings in non-ST elevation myocardial infarction (NSTEMI). In ST elevation myocardial infarction, ST changes represent transmural ischemia. The pathophysiological mechanisms of the ECG changes in NSTEMI are unclear. Purpose: We studied the associations between ECG and the echocardiographic findings in NSTEMI patients. Methods: Twenty patients with acute NSTEMI were recruited during their hospital stay. A comprehensive echocardiography study was performed. The findings were compared with blinded ECG analyses. Results: Nine (45%) patients had STD, and 16 (85%) patients had TWI. In multivariable analysis, STD was independently associated with a lower global early diastolic strain rate (beta=-5.061, p=0.033). TWI was independently associated with lower circumferential strain (beta=0.132, p =0.032). Conclusions: The typical ECG changes in NSTEMI patients were associated with subtle echocardiographic changes. STD was related to changes in diastolic function, and TWI was associated with systolic deterioration. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

ST2 levels increased and were associated with changes in left ventricular systolic function during a three-year follow-up after adjuvant radiotherapy for breast cancer

Objectives: To search for biomarkers of RT-induced cardiotoxicity, we studied the behavior of ST2 during RT and three years after RT, and the associations with echocardiographic changes. Materials and methods: We measured soluble ST2 (ng/ml) in serum samples from 63 patients receiving RT for early breast cancer. Sampling and echocardiography were performed at baseline, after RT and at the three-year follow-up. Patients were grouped by >15% (group 1) and Results: ST2 levels tended to increase during RT, from a median (interquartile range; IQR) of 17.9 (12.4 - 22.4) at baseline to 18.2 (14.1-23.5) after RT (p = 0.075). By the three-year follow up, ST2 levels increased to 18.7 (15.8-24.2), p = 0.018. The increase in ST2 level was associated with worsening cardiac systolic function at three-year follow-up, GLS (rho = 0.272, p = 0.034) and left ventricular ejection fraction (LVEF) (rho = -0.343, p = 0.006). Group 1 (n = 14) had a significant increase in ST2 levels from 17.8 (12.3-22.5) at baseline to 18.4 (15.6-22.6) after RT, p = 0.035 and to 19.9 (16.0-25.1) three years after RT, p = 0.005. ST2 levels were stable in group 2 (n = 47): 17.8 (12.3-22.0) at baseline, 17.7 (12.6-23.5) after RT and 18.0 (15.5-22.4) at three years. Conclusion: ST2 may be useful for determining which patients are at risk for long-term cardiovascular toxicity following adjuvant breast cancer RT, but prospective clinical studies are needed to confirm this hypothesis. (C) 2019 Elsevier Ltd.Peer reviewe

Lymfoomahoitojen jälkeiset pitkäaikaishaitat, niiden ehkäisy ja seuranta

Myöhäishaitat ovat edelleen tavallisia lymfoomahoitojen jälkeen, ja niiden riski jatkuu koko elämän. Vaikka hoitojen kehittyminen on vähentänyt haittoja, varsinkin sekundaarisyövät sekä sydän- ja verisuonitaudit aiheuttavat ylikuolleisuutta. Perusterveydenhuollon tuleekin olla tietoinen mahdollisista ongelmista ja hoitaa riskitekijöitä tehokkaasti. Psykososiaalisten haittojen ehkäisemiseksi tarvitaan lisää tukea potilaille. Suomen Lymfoomaryhmä on tehnyt suosituksen myöhäishaittojen ehkäisemiseksi ja seuraamiseksi. </p

A Higher Mean Heart Radiation Dose Induces Higher Frequency of Multiple Cardiac Changes

Background/Aim: Radiotherapy (RT) induces late changes in all cardiac structures. Most studies of early changes focus on individual parameters. Patients and Methods: Data from eighty early-stage breast cancer patients at baseline, post-RT and three-year follow-up visit were assessed prospectively. Changes in ten cardiac parameters were collected including electrocardiogram (ECG), echocardiography, and biomarkers. A percentage of abnormal changes was calculated. Results: The mean heart radiation dose (Dmean) was independently associated with the increased incidence of changes post-RT (?? =0.403, pPeer reviewe