In recent years, considerable progress has been made in the diagnosis and treatment of cancer diseases, and patient mortality has been significantly reduced. However, the adverse reactions of cancer treatments still reduce the survival rate and quality of life of cancer patients. Today’s cancer treatment trends have targeted the prevention, detection and treatment of cancer therapeutics related cardiac dysfunction (CTRCD). Cardiovascular disease is the second leading cause of illness and death in cancer patients. CTRCD can be induced by the direct toxic effects of chemotherapy (CT) and radiotherapy (RT), and may lead to varying degrees of clinical symptoms of heart failure. CTRCD is highly associated with many adverse outcomes, including heart transplantation, ventricular assist device placement, and even death.
In the past, many CT drugs have been found to be harmful to the cardiovascular system, especially anthracyclines, trastuzumab,
tyrosine kinase inhibitors & vascular endothelial growth factor inhibitors, etc. Direct irradiation of RT to the chest/mediastinal cavity can also induce heart failure immediately or several years later. CTRCD may result from the direct impact of CT/RT on cardiac structure and function, or accelerate the worsening of existing cardiovascular disease. Cancer disease itself can also induce accelerated aging of cardiomyocytes. In other words, heart failure originally caused by degenerative factors such as advanced age may be further worsened by subsequent CT/RT.
Therefore, identifying high-risk groups and early detection and treatment of CTRCD have become prominent contemporary science in cancer treatment. Compared with other imaging examination tools, transthoracic echocardiography (TTE) is easy to obtain, easy to be widely used, relatively safe and cost-effective, and is particularly important in the clinical application of CTRCD.
In the future, cardiac ultrasound will be combined with other examination tools, such as portable electrocardiograms, high-end imaging equipment such as computed tomography/magnetic resonance/positron examinations, innovative applications such as AI artificial intelligence and big data machine learning, etc., and is expected to provide cancer patients with better medical care. Care and Life Vision.
Four major opportunities for cardiac ultrasound interventional cancer treatment
Currently, the opportunities for cardiac ultrasound to be used in patients undergoing cancer treatment include the following four categories:
(1) Cancer patient risk grading and basic cardiac function assessment:
Cancer patients have higher rates of cardiovascular-related morbidity and mortality than non-cancer groups. Cardiologists and oncologists can arrange treatment follow-up visits based on the cancer patient’s basic cardiac functional risk, CT/RT prescription type and dose, and logistical factors related to the occupational environment. And actively improving the cardiovascular risk factors confirmed by TTE-based functional assessment and existing heart problems will help reduce the risk of subsequent CTRCD. Including actively improving the three highs, smoking cessation, weight loss, moderate exercise, dietary guidance, etc.
(2)Clinical monitoring during and after cancer treatment:
Cancer patients with existing cardiovascular symptoms should undergo periodic TTE cardiac function evaluation during CT/RT and after completion of treatment. Taking a study of breast cancer patients as an example, regardless of basic cardiac function, cardiac function (LVEF) dropped by more than 5% within 3 months after CT; CTRCD may occur after a median follow-up of 4.5 years. Patients receiving low-risk CT cumulative doses (e.g. anthracycline ≤ 240g/m2) should undergo TTE re-evaluation after completing the course of treatment and 6 months after the course of treatment. If the cumulative dose of CT exceeds the above, TTE should be re-evaluated before each course of treatment. If cancer patients develop CD symptoms, imaging or cardiac enzyme abnormalities, TTE should be repeated and further consultation and evaluation by a cardiologist should be conducted to facilitate diagnosis. Patients who receive high-dose chest RT (e.g., >30 Gy) should also undergo TTE 10 to 15 years after the initial RT, and follow up regularly every 5 years thereafter.
(3) Combining cardiac ultrasound and biomarker examination to track CTRCD:
According to the current European Society for Medical Oncology (ESMO) guidelines, there are two options for timing tracking of CTRCD. Plan 1 only uses ultrasound imaging; Plan 2 combines cardiac enzymes and ultrasound imaging, and regularly arranges follow-up after the completion of basic cardiac function assessment and TTE. Taking option 1 as an example, TTE can be followed regularly before CT treatment, at 3, 6, and 9 months between treatments, and at 12 and 18 months after the start of treatment.
Taking option 2 as an example, serum troponin can be assessed regularly after each CT course. If serum troponin remains negative, annual TTE is still recommended. Through the use of medical resources in the above different solutions, CTRCD will be continuously tracked.
(4) Primary protection and treatment of CTRCD using cardiac ultrasound intervention:
Current literature shows that administration of two types of primary protective drugs, β blockers (such as carvedilol) or ACE inhibitors (such as lisinopril), may be associated with lowering CTRCD and reducing the increase in troponin in cancer patients preparing for CT. Many evidences show that early detection of CTRCD is the key to good cardiovascular prognosis. If CTRCD is found in asymptomatic patients during TTE follow-up, the CT regimen formula should be changed or terminated, primary cardioprotective drugs should be administered, and a follow-up monitoring schedule should be established.
In the future, cardiac ultrasound will be combined with other examination tools, such as portable electrocardiograms, high-end imaging equipment such as computed tomography/magnetic resonance/positron examinations, innovative applications such as AI artificial intelligence and big data machine learning, etc., and is expected to provide cancer patients with better medical care. Care and Life Vision.
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Source: Chinese Health Network
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2024-03-15 00:00:00
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