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Detection of posterior pericardial effusion in a 28-year old female patient affected by non Hodgkin's lymphoma and treated by CHOP (Cyclophosphamide 750 mg/m 2 + Adriamycin 50 mg/m 2 + Vincristine 2 mg + Prednisone 100 mg) and previous mediastinal radiation therapy. The usual grading of pericardial effusion takes into account the diastolic separation between epicardium and pericardium: 1. small = < 10 mm corresponding to 300 ml, 2. moderate = 10–20 mm corresponding to 500 ml, 3. severe = > 20 mm corresponding to > 700 ml). In this patient the diastolic separation is < 10 mm (both in long and in short-axis vies), indicating mild pericardial effusion. Upper panel; visualization of diastolic pericardial effusion in parasternal long-axis (left panel) and short-axis view (right panel). Lower panel: visualization of systolic pericardial effusion in parasternal long-axis (left panel) and short-axis view (right panel).
Source publication
Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the qua...
Citations
... Similarly, pericardial effusion, as a complication of anticycline, is related to cardiac dysfunction, which also implies pericardial disease and hemodynamic instability. This may be a sign of early adverse progression of cardiotoxicity [45]. Therefore, LASSO regression analysis was performed on LVEF, pericardial effusion, and diastolic dysfunction in this paper. ...
This study aimed to establish and validate an effective nomogram to predict the risk of cardiotoxicity in children after each anthracycline treatment. According to the inclusion and exclusion criteria, the eligible children were randomly divided into the training cohort (75%) and the validation cohort (25%). Least absolute shrinkage and selection operator (LASSO) regression was used to select the predictors and a nomogram was developed. Then, concordance index (C-index), the area under the curve (AUC), Hosmer–Lemeshow (H–L) test, and decision curve analysis (DCA) were employed to evaluate the performance and clinical utility of nomogram. Internal validation was processed to inspect the stability of the model. A total of 796 eligible children were included in this study and divided into a training set (n = 597) and a validation set (n = 199). LASSO regression analysis revealed that cumulative anthracycline dose, ejection fractions, NT-proBNP, and diastolic dysfunction were effective predictors of cardiotoxicity. The nomogram was established based on these variables. The C-index and the AUC of the predicting nomogram were 0.818 in the training cohort and 0.773 in the validation cohort, suggesting that the nomogram had good discrimination. The calibration curve of the nomogram presented no significant deviation from the reference line, and the P-value of the H–L test was 0.283, implying a preferable degree of calibration. The threshold of DCA also reflects that the nomogram is clinically useful. A nomogram was developed to predict anthracycline chemotherapy-induced cardiotoxicity in children with hematological tumors. The nomogram has a good prediction effect and can provide a reference for clinicians’ diagnosis and treatment.
... This study measured changes in diastolic function (and not in systolic parameters) and can be compared with human studies that have demonstrated that diastolic function reduced before systolic dysfunction in some oncologic patients treated with doxorubicin. This suggests that filling indices of diastolic function may be more sensitive than variables of systolic function for detection of cardiotoxicity (Galderisi et al., 2007;Marchandise et al., 1989;Stoddard et al., 1992;Tjeerdsma et al., 1999). However, other studies in human patients showed a rapid decrease in TAPSE (within 45 days), correlated with increasing N-terminal probrain natriuretic peptide (NT-proBNP), although remaining within the reference range (Tanindi et al., 2011) and a decrease in TAPSE over one year was associated with the worst results in patients that received with Generalized Estimating Equations (GEE). ...
The aim of this pilot study was to evaluate the cardioprotective effects of carvedilol in dogs receiving doxorubicin chemotherapy and provide suggestions to future studies based on results and limitations of our study. Thirteen dogs were randomized into two experimental groups: 6 dogs in carvedilol group and 7 dogs in placebo group. In carvedilol group, 0.39 mg/kg ± 0.04 twice-daily oral carvedilol was started on the day of the first doxorubicin treatment and continued throughout the chemotherapy protocol until the final cardiological evaluation. Cardiological evaluations were performed before the first doxorubicin administration and then 10 to 15 days after each subsequent dose. Troponin I and oxidative stress tests were performed with serum collected from dogs at the initial and final cardiological evaluation. Carvedilol produced some echocardiographic and electrocar-diographic changes (reduced E velocity and E/IVRT ratio, as well reduced heart rate and increased PR and QT interval) due to its beta-block effect. In placebo group Doppler study showed a significant increase in mitral flow deceleration time (EDT), as well increased amplitude of the S wave in the right, and R wave in the left, precordial chest leads. There were significant difference in the EDT, E/IVRT and A' velocity, as well heart rate, PR interval and R wave in V4/CV6LU precordial chest lead between groups. In conclusion, some indexes of diastolic function and in precordial chest leads were less affected by doxorubicin in carvedilol than in control group. This suggests that carvedilol may have a beneficial effect in canine cancer patients receiving doxorubicin.
... Cardiotoxicity, may be diagnosed biochemically [13] and by enzyme assays. Creatine kinase (CK-MB), AST, and lactate dehydrogenase-1 (LDH-1) especially are used to investigate cardiac function [6]. ...
... Creatine kinase (CK-MB), AST, and lactate dehydrogenase-1 (LDH-1) especially are used to investigate cardiac function [6]. Histopathological techniques can also be used to diagnose this type of toxicity [13]. Absence of significant differences between test animals and controls in serum LDH-1 activities (Fig 3) together with the fact that there was no organ hypertrophy, oedema or atrophy (Fig 7) suggests no damage to heart muscle fibres. ...
Mist Diodia(MD), is a poly-herbal preparation for the management of hypertension in Ghana. Acute and chronic toxicity studies were carried out on it and also, on Diodia scandens (DS) and Aframomum melegueta (AM) its two component plants, to ascertain its safety. For acute toxicity study, both sexes of Sprague-Dawley rats (SDRs) were given a single oral dose (5000 mg/kg) of aqueous extract of MD, DS and AM and observed for mortality and physical signs of toxicity occurring within 24 hours and for additional 13 days. For chronic toxicity study, the therapeutic dose (X), 10X, 20X of MD, DS and AM, respectively were orally administered daily to both sexes of SDRs for a period of 6 months. The acute toxicity study estimated the LD50 to be above5000 mg/kg for all the test materials. The AST, ALP, ALT, LDH-1 enzyme activities as well concentrations of bilirubin, creatinine and urea measured for chronic toxicity study did not indicate significant difference (p > 0.05) between control and treatment groups for all the test materials. Urinalysis and histopathological examination of the heart, kidneys and liver also did show injury to these organs including the lungs and the spleen. The body weights, wet organ weights of the rats as well as their haematological profiles were not affected by the extracts at the end of the treatment period. Pentobarbital-induced sleeping times of the animals were not altered by the extracts. Thus, no toxicity both acute and chronic was associated with Mist Diodia and its components: D. scandens and A. melegueta in both sexes of SDRs.
... Echocardiography is the optimal imaging technique for noninvasive diagnostic evaluation and therapeutic management of cancer-therapy induced cardiac diseases, providing detailed information about LV systolic and diastolic dysfunction, myocardial damage, pericardial, and valvular disease. [30,31] Systematic assessment of radiation-induced valvular heart diseases by cardiac imaging Transthoracic echocardiography is considered the gold standard for diagnosis and follow-up of VHD after radiation therapy involving the heart. Nevertheless, transesophageal echocardiography, cardiovascular magnetic resonance, and computed tomography [ Figure 2] could provide an added value in some cases. ...
... The European Association of Cardiovascular Imaging and the American Society of Echocardiography recommend a focused yearly history and physical examination with echocardiography in symptomatic patients; screening transthoracic echocardiogram at 10 years postradiation for asymptomatic patients, and serial exams every 5 years thereafter in patients with normal valves. [30,32] Echocardiography is considered the best option for serial imaging, [31,35] and it has been chosen as a reference method for most of the scientific researches on cancer therapy-induced VHD. Heidenreich et al. observed that >60% of patients irradiated for HL >20 years earlier had echocardiographic signs of valvular regurgitation, rarely identified by physical examination. ...
Valvular heart diseases (VHD) may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to the left ventricle dysfunction. The incidence of VHD is especially in younger survivors treated with thoracic radiation therapy for certain malignancies, such as Hodgkin's lymphoma and breast cancer. The mechanism of radiation-induced damage to heart valves is not clear and includes diffuse fibrocalcific thickening of the valve. VHD is commonly diagnosed after a long latent period, in the context of clinical symptoms, or suspected on the basis of a new murmur. The evaluation includes identification of anatomical valve abnormalities, valve dysfunction, and assessing the functional consequences of valve dysfunction on the ventricles. Echocardiography is the optimal imaging technique for diagnostic and therapeutic management. Cardiovascular magnetic resonance and computed tomography (CT) may be used to assess the severity of VHD, but cardiac CT is mainly useful for detecting extensive calcifications of the ascending aorta. Patients exposed to mediastinal radiotherapy and minimal valve dysfunction require follow-up of 2-3 years, with moderate valve disease yearly, with severe, should be assessed for valve surgery.
... Some studies have shown that young age at diagnosis is associated with an increased risk of cardiac impairment (24). Other factors involved in the occurrence of CIC highlight cardiac pathology, metabolic deficits (25), and the type of administered AC product, doxorubicin being more toxic to cardiac tissue than epirubicin (16). ...
... Early diagnosis of cardiac impairment in ALL children is important to modulate chemotherapy and to add cardioprotective agents (25). Distance monitoring after end of treatment is useful to select survivors at risk of developing late cardiotoxic effect (24). ...
Acute lymphoblastic leukemia is the most common hematological malignancy at pediatric age. Cardiotoxicity holds the first place among the causes of morbidity and mortality in these patients. Anthracyclines are cytostatic drugs frequently associated with cardiotoxicity. Early diagnosis of cardiac impairment during the treatment of pediatric patients is extremely important, both for modulating future chemotherapy and for administering cardioprotective agents. Long term monitoring after chemotherapy helps to identify the risk of late cardiotoxicity among cancer survivors. There are several biomarkers, already in use or still under study, which may represent an operator-independent alternative for echocardiography in the diagnosis of cardiotoxicity. In case of cardiac damage, the clinician has options for treating or limiting the progression, either with the use of already approved agents, such as Dexrazoxane, or by administrating other cardioprotective drugs. International experts are still attempting to establish the best algorithm for early detection of cardiotoxicity, as well as the most efficient treatment plan in case of already existing myocardial damage in these patients. We present a review on treatment-related cardiotoxicity, including mechanisms of development, useful biomarkers and treatment options, after carefully analyzing specialty literature.
... A systematic assessment of cardiac function should precede treatment and careful cardiac monitoring of patients receiving chemotherapy agents should be longstanding. Echocardiogram is the non-invasive choice test for the evaluation of LVEF, contributing to the early detection and rapid management of post-treatment systolic and/or diastolic dysfunction [10]. ...
... Treatment with trastuzumab was resumed in 25 patients [7] . and rapid management of post-treatment systolic and / or diastolic dysfunction [10]. ...
We report the case of a young patient with left breast cancer with stage IIB (T2N1M0), negative hormone receptors, HER2-positive and no particular medical history. The patient was particularly sensitive to the neurological and allergic-type toxicity of the adjuvant treatment she received and it required the stopping and successive change of the various prescribed protocols. Trastuzumab was continued as monotherapy for one year; asymptomatic cardiotoxicity was reported following the fall in LVEF (a 17.9% drop from baseline with a value below 50%). Active notification was made jointly with the pharmacovigilance team to establish a causal link between the use of trastuzumab and the development of cardiotoxicity. An imptability score calculation was done independently for each product administered subsequently or in combination with trastuzumab and it was concluded that trastuzumab was the most incriminated with a very similar intrinsic score (I4). Multidisciplinary care has been taken. Pharmacological treatment and temporary discontinuation of trastuzumab were initiated and trastuzumab was safely restarted after improvement of echocardiographic parameters. A risk management plan and a surveillance strategy for securing trastuzumab in oncology have been proposed.
... The main limiting factor for using echocardiography for diagnosis is its relatively low reproducibility because of elevated intra-and inter-observer inconsistency. 7 Along with several serum cardiac makers as Troponin I (TnI), Creatine Kinase (CK), Creatine Kinase-MB Relative Index (CK-MBRI) and Lactic Dehydrogenase (LDH). Although cardiac markers could confer acceptable sensitivity, they mostly lack specificity. ...
... The main limiting factor for using echocardiography for diagnosis is its relatively low reproducibility because of elevated intra-and inter-observer inconsistency. 7 Along with several serum cardiac makers as Troponin I (TnI), Creatine Kinase (CK), Creatine Kinase-MB Relative Index (CK-MBRI) and Lactic Dehydrogenase (LDH). Although cardiac markers could confer acceptable sensitivity, they mostly lack specificity. ...
Objectives
The study aimed to evaluate the dose delivered to the heart during radiotherapy of left-sided and right-sided breast cancer (BC) patients, correlate the dose and laterality of radiotherapy to the possible cardiac damage and evaluate whether Left-ventricular Ejection Fraction (LVEF), Troponin-I (TnI), Creatinine Kinase (CK), Creatine Kinase-MB Relative Index (CK-MBRI) or Lactic Dehydrogenase (LDH) could be used to detect the possible onset of radiotherapy-related cardiotoxicity.
Subjects and methods
80 females were assigned as; 30 left-sided BC patients, 30 right-sided BC patients and 20 healthy females. Patients were treated by radical mastectomy followed by FAC-based chemotherapy and radiotherapy. CT-based 3D-planning was used to generate cardiac dose-volume histograms to assess mean dose received by the heart.
Echocardiography was done to all patients before and 1 year after completing radiotherapy. In serum, TnI and CK-MB concentration and CK and LDH activities were determined before and 1 year after radiotherapy.
Results
In left-sided patients, mean dose delivered to the heart was significantly higher in left-sided patients with significant association with total radiotherapy dose in left- but not right-sided patients. LVEF before and after radiotherapy were statistically different only in left-sided patients. LVEF one year after radiotherapy dropped 20% or more (ΔLVEF) in 6 patients, all were left-sided.
Using cut-off values 0.08 ng/mL for TnI and 1.4 for CK-MBRI; 11 left-sided patients had abnormal TnI and CK-MBRI vs 5 right-sided patients, the 6 patients identified with ΔLVEF ≥ 20 were all among them.
Conclusion
the mean dose delivered to the heart is significantly higher in left-sided patients, and it was correlated to the total radiotherapy dose. One year after radiotherapy, ΔLVEF is possibly good marker of cardiotoxicity onset, however, the persistent elevation of both TnI and CK-MBRI could identify both patients with cardiotoxicity and patients that are thought to be in subclinical phase of cardiac damage.
... Cardiac toxicity can become chronic, with significant irreversible morbidity and even mortality [38][39][40]. The diagnostic imaging techniques that can be used to assess cardiac toxicity include echocardiography, scintigraphy, CT, and MRI [41][42][43][44]. However, the early prediction of cardiac injury remains challenging; easier prediction would be desirable in order to accordingly adapt chemotherapy for optimal clinical management. ...
Multimodal imaging is commonly used in the management of patients with cancer. Imaging plays pivotal roles in the diagnosis, initial staging, treatment response assessment, restaging after treatment and the prognosis of many cancers. Indeed, it is difficult to imagine modern precision cancer care without the use of multimodal molecular imaging, which is advancing at a rapid pace with innovative developments in imaging sciences and an improved understanding of the complex biology of cancer. Cancer therapy often leads to undesirable toxicity, which can range from an asymptomatic subclinical state to severe end organ damage and even death. Imaging is helpful in the portrayal of the unwanted effects of cancer therapy and may assist with optimal clinical decision-making, clinical management, and overall improvements in the outcomes and quality of life for patients.
