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Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials. 预防和治疗蒽环类药物引起的心脏毒性:随机对照试验的系统回顾和网络荟萃分析。
IF 3.2
Cardio-oncology Pub Date : 2025-07-10 DOI: 10.1186/s40959-025-00360-3
Siyu Li, Wenrui Li, Mengfei Cheng, Xiaoxiao Wang, Wanyi Chen
{"title":"Prevention and treatment of anthracycline-induced cardiotoxicity: a systematic review and network meta-analysis of randomized controlled trials.","authors":"Siyu Li, Wenrui Li, Mengfei Cheng, Xiaoxiao Wang, Wanyi Chen","doi":"10.1186/s40959-025-00360-3","DOIUrl":"10.1186/s40959-025-00360-3","url":null,"abstract":"<p><strong>Background: </strong>Anthracyclines are cornerstone chemotherapeutics, but cardiotoxicity limits their use.</p><p><strong>Objective: </strong>This study aims to evaluate the efficacy of various drugs in preventing and treating anthracycline-induced cardiotoxicity (AIC).</p><p><strong>Methods: </strong>We conducted an extensive search across seven databases to identify randomized controlled trials (RCTs) pertinent to the prevention and treatment of AIC with medications. Subsequently, a Bayesian Model-based network meta-analysis was performed in the R 4.4.0.</p><p><strong>Results: </strong>A total of 128 RCTs involving 10,431 cancer patients treated with anthracyclines and 78 drug regimens were included in this study. The network meta-analysis results showed that, compared with patients who did not receive cardioprotective drugs, those treated with Calcium Dibutyryladenosine Cyclophosphate (Mean Difference [95% Credible Interval], 8.760 [0.5917, 16.92]), Carvedilol (4.024 [0.5372, 7.656]), Carvedilol + Candesartan (7.934 [3.159, 12.91]), Compound Salvia Miltiorrhiza + Levocarnitine (9.087 [0.9160, 17.25]), Dexrazoxane (5.066 [2.589, 7.540]), Dexrazoxane + Cinobufacini (11.61 [4.590, 18.70]), Dexrazoxane + Shenqi Fuzheng (13.05 [4.640, 21.40]), Nicorandil (14.24 [5.122, 23.31]), Qiliqiangxin (11.38 [2.826, 19.91]), and Xinmai Long (6.371 [1.735, 11.02]) experienced less decrease in LVEF after chemotherapy. The SUCRA ranking results indicated that the most effective treatment option for preserving LVEF was Nicorandil (SUCRA 91.76%).</p><p><strong>Conclusion: </strong>Apart from Dexrazoxane, Carvedilol, a β-blocker, also appears to show significant potential in preventing AIC. Furthermore, our results indicate that there is insufficient evidence to support the beneficial effects of statins, Sildenafil, Ivabradine, Levocarnitine, N-acetylcysteine, Glutathione, Coenzyme Q10, Vitamin E, and Vitamin C in preventing LVEF decline and exerting a positive effect on the prevention of AIC.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"66"},"PeriodicalIF":3.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating cardioprotective strategies for anthracycline-induced cardiotoxicity in breast cancer: insights from a systematic review and network meta-analysis. 评估蒽环类药物引起的乳腺癌心脏毒性的心脏保护策略:来自系统综述和网络荟萃分析的见解。
IF 3.2
Cardio-oncology Pub Date : 2025-07-07 DOI: 10.1186/s40959-025-00332-7
Runyu Liu, Cong Fan, Xiaoling Liu, Mengmeng Li, Yuan Zhang, Mei Zhang
{"title":"Evaluating cardioprotective strategies for anthracycline-induced cardiotoxicity in breast cancer: insights from a systematic review and network meta-analysis.","authors":"Runyu Liu, Cong Fan, Xiaoling Liu, Mengmeng Li, Yuan Zhang, Mei Zhang","doi":"10.1186/s40959-025-00332-7","DOIUrl":"10.1186/s40959-025-00332-7","url":null,"abstract":"<p><strong>Introduction: </strong>Anthracycline-induced cardiotoxicity is a significant concern for breast cancer patients undergoing treatment, often leading to chronic cardiovascular complications and reduced long-term survival. The study aimed to systematically evaluate the efficacy of nine classes of pharmacological agents in protecting against cardiotoxicity in breast cancer patients treated with anthracyclines.</p><p><strong>Methods: </strong>A comprehensive search of databases was performed from January 2000 to October 2024 to identify randomized controlled trials (RCTs) investigating cardioprotective agents. The risk of bias in the studies was evaluated using the Cochrane risk-of-bias tool. Bayesian network meta-analysis was conducted in Stata 15.1.</p><p><strong>Results: </strong>Of 3718 studies identified, 29 RCTs involving 2599 patients were included in the network systematic review. The study found that trimetazidine significantly improved left ventricular ejection fraction (LVEF), with a Surface Under the Cumulative Ranking (SUCRA) of 94.0%. The combination of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with beta-blocker (AA-BB) significantly improved global longitudinal strain (GLS), with a SUCRA of 72.8%. Dexrazoxane was highly effective, significantly reducing B-type natriuretic peptide (BNP) levels, cardiac troponin (cTn) levels, and the E/e' ratio (ratio of the mitral early filling velocity to the mean early relaxation tissue velocity), with SUCRA values of 98.9%, 98.2%, and 99.9%, respectively. Additionally, mineralocorticoid receptor antagonist (MRA) showed the highest SUCRA of 88.4% for improving the E/A ratio (ratio of the mitral early diastolic velocity to the late diastolic velocity).</p><p><strong>Discussion: </strong>Trimetazidine, ACEI/ARB, beta-blocker, dexrazoxane, and MRA demonstrate potential as cardioprotective agents in breast cancer patients undergoing anthracycline chemotherapy. Further research is needed to elucidate the specific cardioprotective mechanisms against anthracycline-induced cardiotoxicity.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"65"},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
QT STAR: concomitant QTc-prolonging medication use among patients with HR+/HER2- metastatic breast cancer receiving a CDK4/6 inhibitor in first line. QT STAR:在一线接受CDK4/6抑制剂的HR+/HER2转移性乳腺癌患者中同时使用延长qtc的药物
IF 3.2
Cardio-oncology Pub Date : 2025-07-04 DOI: 10.1186/s40959-025-00364-z
Susan Dent, Heather Moore, Michael Fradley, Chloe Grace Rose, Stella Stergiopoulos, Connie Chen, Benjamin Li, Avirup Guha
{"title":"QT STAR: concomitant QTc-prolonging medication use among patients with HR+/HER2- metastatic breast cancer receiving a CDK4/6 inhibitor in first line.","authors":"Susan Dent, Heather Moore, Michael Fradley, Chloe Grace Rose, Stella Stergiopoulos, Connie Chen, Benjamin Li, Avirup Guha","doi":"10.1186/s40959-025-00364-z","DOIUrl":"10.1186/s40959-025-00364-z","url":null,"abstract":"<p><strong>Background: </strong>The risk of drug-induced corrected QT interval (QTc) prolongation is an important consideration in clinical decision-making for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC). This retrospective analysis described concomitant QTc-prolonging medication use in patients with HR+/HER2- mBC who received first-line (1L) treatment with a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) plus an aromatase inhibitor (AI).</p><p><strong>Methods: </strong>This retrospective claims analysis utilized the Optum Clinformatics Data Mart database to identify patients with HR+/HER2- mBC who initiated 1L CDK4/6i plus AI treatment between January 2017 and March 2022. Exposure to QTc-prolonging medications (overall and by Torsades de Pointes [TdP] risk, per www.crediblemeds.org ) was assessed at index (i.e., CDK4/6i treatment initiation) and during follow-up (i.e., duration of CDK4/6i treatment) in the overall cohort and cohorts stratified by patient age.</p><p><strong>Results: </strong>A total of 1517 patients met the study criteria; 33.8%, 35.5%, and 30.8% were aged < 65, 65-74, and ≥ 75 years, respectively. Exposure to ≥ 1 QTc-prolonging medication or ≥ 1 medication with known TdP risk was observed in 53.3% and 15.4% of patients at index, respectively, and 78.6% and 57.1% of patients during follow-up, respectively. Patients were exposed to QTc-prolonging medications for 54.6% of total person-time during follow-up. Patients aged ≥ 65 years had higher exposure to medications with conditional TdP risk than those aged < 65 years, primarily driven by increased diuretic use.</p><p><strong>Conclusions: </strong>QTc-prolonging medication use was common in patients with HR+/HER2- mBC receiving 1L CDK4/6i plus AI treatment, highlighting the importance of reviewing concomitant medications to inform CDK4/6i selection and patient monitoring while on treatment.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"64"},"PeriodicalIF":3.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Atrial fibrillation or flutter in patients undergoing stem cell transplantation, in-hospital and post-discharge outcomes in a large nationwide sample across the United States. 在美国全国范围内进行干细胞移植患者的心房颤动或扑动,住院和出院后的结果
IF 3.2
Cardio-oncology Pub Date : 2025-07-03 DOI: 10.1186/s40959-025-00346-1
Raja Zaghlol, Elena Deych, Nina Manian, Ahmed Altibi, Joshua D Mitchell
{"title":"Atrial fibrillation or flutter in patients undergoing stem cell transplantation, in-hospital and post-discharge outcomes in a large nationwide sample across the United States.","authors":"Raja Zaghlol, Elena Deych, Nina Manian, Ahmed Altibi, Joshua D Mitchell","doi":"10.1186/s40959-025-00346-1","DOIUrl":"10.1186/s40959-025-00346-1","url":null,"abstract":"<p><strong>Background: </strong>Stem Cell Transplantation (SCT) is a cornerstone therapy in managing several malignant and benign hematological conditions. Atrial fibrillation/atrial flutter (AF) are commonly encountered in patients receiving SCT. There is a paucity of large-scale data on the prevalence of AF and their effect on outcomes following SCT.</p><p><strong>Methods: </strong>The United States National Readmission Database (NRD) was used to identify hospitalized patients who underwent SCT. Baseline demographics, comorbidities, the presence or absence of AF, the indication, and type of SCT were identified using diagnostic and procedural International Classification of Diseases 10th Edition (ICD-10) codes. Patients with AF were compared to those without AF for differences in baseline characteristics, in-hospital mortality, cardiovascular (CV) complications, length and cost of hospitalization, and post-discharge 90-day readmissions and mortality.</p><p><strong>Results: </strong>Between January 2016 and September 2020 there were 59,284 weighted admissions for SCT, of which 5797 (9.8%) patients had AF. Patients in the AF group were more likely to be older males with an increased burden of baseline comorbidities compared to the no-AF group ((64 [9] vs. 56 [14] years, p < 0.001) and (3893 [67%] vs. 30,886 [58%] males, p < 0.001) respectively). Adjusted for differences in baseline demographics, comorbidities, indication and type of SCT, patients with AF had higher in-hospital mortality (adjusted odds ratio (AOR) 3.65 [3.02-4.41]) and adverse events including cardiac complications [composite of acute heart failure, acute myocardial infarction, cardiogenic shock, and cardiac arrest] (AOR 4.92 [4.22-5.75]), bleeding (AOR 1.32 [1.15-1.53]), and respiratory failure (AOR 3.40 [2.97-3.90]) compared to patients without AF. Additionally, the AF group had longer hospitalizations (21 [16-27] vs. 19 [15-25] days, p < 0.001) with higher cost ($268,031 [$170,957-$455739] vs. $250,178 [$153,680-$415239], p < 0.001) compared to the no-AF group. Among survivors to hospital discharge, patients with AF also had higher adjusted 90-day all-cause inpatient mortality (adjusted hazard ratio (AHR) 1.54 [1.19-1.99], p = 0.001), all-cause readmissions (AHR 1.15 [1.07-1.24], p < 0.001), and CV readmissions (AHR 2.29 [1.85-2.82], p < 0.001).</p><p><strong>Conclusions: </strong>In a large national cohort of SCT recipients, AF were common and independently associated with increased in-hospital mortality and CV adverse events, along with increased 90-day mortality and readmissions among survivors to hospital discharge.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"61"},"PeriodicalIF":3.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiac biomarkers for risk stratification in newly diagnosed high-risk multiple myeloma in the GMMG-CONCEPT trial. 在GMMG-CONCEPT试验中,新诊断的高危多发性骨髓瘤的风险分层的心脏生物标志物。
IF 3.2
Cardio-oncology Pub Date : 2025-07-03 DOI: 10.1186/s40959-025-00358-x
Lisa B Leypoldt, Linlin Guo, Britta Besemer, Mathias Hänel, Marc-S Raab, Christoph Mann, Christian S Michel, Hans Christian Reinhardt, Igor Wolfgang Blau, Martin Görner, Yon-Dschun Ko, Maike de Wit, Hans Salwender, Christof Scheid, Ullrich Graeven, Rudolf Peceny, Peter Staib, Annette Dieing, Hartmut Goldschmidt, Carsten Bokemeyer, Tanja Zeller, Dirk Westermann, Katja C Weisel, Raphael Twerenbold, Antonia Beitzen-Heineke
{"title":"Cardiac biomarkers for risk stratification in newly diagnosed high-risk multiple myeloma in the GMMG-CONCEPT trial.","authors":"Lisa B Leypoldt, Linlin Guo, Britta Besemer, Mathias Hänel, Marc-S Raab, Christoph Mann, Christian S Michel, Hans Christian Reinhardt, Igor Wolfgang Blau, Martin Görner, Yon-Dschun Ko, Maike de Wit, Hans Salwender, Christof Scheid, Ullrich Graeven, Rudolf Peceny, Peter Staib, Annette Dieing, Hartmut Goldschmidt, Carsten Bokemeyer, Tanja Zeller, Dirk Westermann, Katja C Weisel, Raphael Twerenbold, Antonia Beitzen-Heineke","doi":"10.1186/s40959-025-00358-x","DOIUrl":"10.1186/s40959-025-00358-x","url":null,"abstract":"<p><p>Cardiovascular adverse events (CVAE) are clinically relevant side effects during treatment with the proteasome inhibitor carfilzomib. We investigated the predictive value of cardiac biomarkers for onset of CVAE in patients with newly diagnosed high-risk multiple myeloma treated with isatuximab, carfilzomib, lenalidomide, and dexamethasone in the GMMG-CONCEPT study (NCT03104842). Patients included in this prospective, multicenter correlative study were eligible if a serum sample before treatment initiation and at ≥ 1 later study time point were available. N-terminal pro-b-type natriuretic peptide (NT-proBNP) and high-sensitive Troponin I (hsTropI) were measured using immunoassays. Time-to-event analyses were performed using Kaplan-Meier estimators and log-rank test was used for statistical analysis. Among 126 patients included in this study, 40 reported incident CVAE. No significant differences were observed for age, sex, cardiovascular risk factors and cardiovascular comorbidities between patients who experienced CVAE compared to patients without CVAE. NT-proBNP levels were elevated at baseline in 96 (76%) patients. Neither baseline levels nor change in NT-proBNP level during early induction cycles were predictive for the occurrence of CVAE. In contrast, elevation of hsTropI above the 99th percentile was rare. Patients with hsTropI level ≥ 2.9 ng/L, corresponding to the lower limit of quantification, showed a higher risk for CVAE compared to patients with hsTropI < 2.9 ng/L at baseline (p = 0.0023). In conclusion, in patients with newly diagnosed high-risk multiple myeloma undergoing carfilzomib-based quadruplet treatment, low hsTropI pretreatment levels are of high negative predictive value for the occurrence of CVAE whereas elevated NT-proBNP levels are very common before treatment initiation.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"63"},"PeriodicalIF":3.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Atrial fibrillation is associated with increased in-hospitality mortality during Chimeric Antigen Receptor T-cell therapy hospitalizations: a retrospective cohort study in the United States. 美国的一项回顾性队列研究表明,在接受嵌合抗原受体t细胞治疗的住院期间,房颤与住院死亡率增加有关。
IF 3.2
Cardio-oncology Pub Date : 2025-07-03 DOI: 10.1186/s40959-025-00334-5
Nischit Baral, Nabin R Karki, Daniel A Ladin, Raja Zaghlol, Mahmoud Ibrahim, Alexander Rabadi, Tarec K Elajami, Olivia Mechanic, Arvind Kunadi, Joshua D Mitchell
{"title":"Atrial fibrillation is associated with increased in-hospitality mortality during Chimeric Antigen Receptor T-cell therapy hospitalizations: a retrospective cohort study in the United States.","authors":"Nischit Baral, Nabin R Karki, Daniel A Ladin, Raja Zaghlol, Mahmoud Ibrahim, Alexander Rabadi, Tarec K Elajami, Olivia Mechanic, Arvind Kunadi, Joshua D Mitchell","doi":"10.1186/s40959-025-00334-5","DOIUrl":"10.1186/s40959-025-00334-5","url":null,"abstract":"<p><strong>Background: </strong>Chimeric Antigen Receptor (CAR) T-cell therapy (CAR-T) has emerged as a promising treatment for specific hematological malignancies. While some studies suggest an association between CAR-T and atrial fibrillation (AF), more data are needed on the association of AF with CAR-T outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the National Inpatient Sample (NIS) 2017-2020 to explore in-hospital outcomes in cancer patients with AF while undergoing CAR-T. Comparisons were drawn between patients with and without AF during the hospitalization, assessing various parameters including mortality rates, length of hospital stay, and occurrences of acute heart failure, pulmonary edema, and gastrointestinal (GI) bleeding.</p><p><strong>Results: </strong>Of the 236,270 cancer-related hospitalizations, 1,030 cases (0.44%) received CAR-T. The average age of CAR-T recipients was 55.6 years ± 18.1 years, and females constituted 40.5% of the total CAR-T recipients. Of the 1030 patients receiving CAR-T, 97 (9.4%) had an associated diagnosis of AF during their hospitalization. A multivariable logistic regression analysis, adjusted for age, sex, race, comorbidity, and income, revealed that hospitalized cancer patients who underwent CAR-T therapy with AF had increased odds of in-hospital mortality (adjusted odds ratio, aOR: 3.87), acute pulmonary edema (aOR: 3.29), GI bleeding (aOR: 5.46), acute heart failure (aOR: 10.2), and extended hospital stays (Beta coefficient: 0.18) compared to hospitalizations with CAR-T but without AF. Similar results were observed in two sensitivity analyses: one limited to patients with diffuse B-cell lymphoma, and another excluding patients who had sepsis or respiratory failure while receiving CAR-T therapy.</p><p><strong>Conclusions: </strong>In cancer patients receiving CAR-T, inpatient AF is independently associated with a higher risk of in-hospital mortality, acute pulmonary edema, gastrointestinal bleeding, acute heart failure, and prolonged hospitalization.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"60"},"PeriodicalIF":3.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12224371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dynamic cardiac changes in low cardiovascular risk patients with triple negative breast cancer treated with chemo-immunotherapy. 化疗免疫治疗低心血管风险三阴性乳腺癌患者的动态心脏变化
IF 3.2
Cardio-oncology Pub Date : 2025-07-03 DOI: 10.1186/s40959-025-00361-2
Jean Philippe Nesseler, Katrina D Silos, Olivia Peony, Asneh Singh, Patrick Belen, Mitchell R Kamrava, Julie K Jang, Stephen L Shiao, Alan C Kwan, Cody Ramin, Raymond H Mak, Andriana P Nikolova, Katelyn M Atkins
{"title":"Dynamic cardiac changes in low cardiovascular risk patients with triple negative breast cancer treated with chemo-immunotherapy.","authors":"Jean Philippe Nesseler, Katrina D Silos, Olivia Peony, Asneh Singh, Patrick Belen, Mitchell R Kamrava, Julie K Jang, Stephen L Shiao, Alan C Kwan, Cody Ramin, Raymond H Mak, Andriana P Nikolova, Katelyn M Atkins","doi":"10.1186/s40959-025-00361-2","DOIUrl":"10.1186/s40959-025-00361-2","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy-immunotherapy is the new standard of care for high-risk early-stage triple negative breast cancer (TNBC). As anthracyclines, pembrolizumab, and radiotherapy may each contribute to an increased risk of cardiovascular events, real-world assessment of early cardiovascular changes is of clinical interest.</p><p><strong>Methods: </strong>Retrospective analysis of 85 women with early-stage TNBC treated with chemotherapy-pembrolizumab between 2018 and 2023 and had ≥ 1 transthoracic echocardiogram (TTE) available. Grade ≥ 2 cardiac common terminology criteria for adverse events (CTCAE) cumulative incidence estimates and Fine-Gray regressions (accounting for non-cardiac death as a competing risk) were calculated. Electrocardiogram (ECG) and TTE parameters during/following systemic therapy (vs. baseline) were compared.</p><p><strong>Results: </strong>The median follow-up from immunotherapy start was 18.7 months [interquartile range (IQR) 13.6-39.1]. The median age was 50 years (IQR 38-61), 19% had hypertension, most (82%) with no detectable coronary artery calcium (CAC = 0), and 0% known cardiovascular disease. 9/85 (11%) experienced a grade ≥2 cardiac event with a median onset of 7.3 months (IQR 4.0-8.0) and a one-year cumulative incidence of 9.6%. Most (7/9) were grade 2 (n = 5 ejection fraction [EF] decline, n = 1 heart failure, n = 1 pericarditis); 2/9 were grade ≥ 3 (myocarditis, urgent percutaneous coronary intervention); all occurred among those receiving carboplatin, paclitaxel, doxorubicin, and cyclophosphamide-based therapy. Adjusting for age and CAC, mean left anterior descending coronary artery radiation dose was associated with an increased risk of cardiac events (sub-distribution hazard ratio 1.16/Gy, 95% confidence interval 1.01-1.35; p = 0.041). QTc prolongation ≥450ms was more common during treatment vs. baseline (39% vs. 15%; p = 0.025). On assessment for recovery, early grade 2 EF decline recovered in 3/5 patients (2/5 with absence of follow-up). In those with baseline and post-treatment TTE, 5/20 (25%) developed new moderate diastolic dysfunction, that persisted in a later TTE in 2/5 patients, downgraded to mild in 1/5, and not reevaluated by TTE in 2/5.</p><p><strong>Conclusion: </strong>Early cardiovascular toxicity was observed during multi-modality TNBC treatment, even in young patients with low cardiovascular risk profiles, highlighting the importance of diligent surveillance. Longer follow-up and further studies are warranted, given the degree of recovery and later effects of these treatments may not yet be fully observed.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"11 1","pages":"62"},"PeriodicalIF":3.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiotoxicity of combined pegylated liposomal doxorubicin and bevacizumab therapy: a propensity-matched cohort study and disproportionality analysis. 聚乙二醇脂质体阿霉素和贝伐单抗联合治疗的心脏毒性:一项倾向匹配的队列研究和歧化分析。
IF 3.2
Cardio-oncology Pub Date : 2025-07-02 DOI: 10.1186/s40959-025-00351-4
Christopher W Hoeger, Arrush Choudhary, Andrea Nathalie Rosas Diaz, Theresa Pinto, Sarah Smalec, Charles Doladille, Rishi Wadhera, Meghan Shea, Sumanth Khadke, Joe-Elie Salem, Sarju Ganatra, Aarti Asnani
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引用次数: 0
Primary cardiac sarcoma: insights from two decades of multimodal management at LMU Munich. 原发性心脏肉瘤:来自慕尼黑大学二十年多模式管理的见解。
IF 3.2
Cardio-oncology Pub Date : 2025-06-26 DOI: 10.1186/s40959-025-00359-w
Anton Burkhard-Meier, Dorit Di Gioia, Vindi Jurinovic, Michael Hoberger, Sinan E Güler, Michael Völkl, Stefanie Corradini, Aurélie V Gaasch, Annabel H S Alig, Thomas Knösel, Christian Hagl, Christian Schneider, Wulf Sienel, Wolfgang G Kunz, Caspar Burkhard-Meier, Michael von Bergwelt-Baildon, Lars H Lindner, Luc M Berclaz
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引用次数: 0
Correction: Machine learning for cardio-oncology: predicting global longitudinal strain from conventional echocardiographic measurements in cancer patients. 修正:心脏肿瘤学的机器学习:预测癌症患者常规超声心动图测量的整体纵向应变。
IF 3.2
Cardio-oncology Pub Date : 2025-06-20 DOI: 10.1186/s40959-025-00357-y
Tagayasu Anzai, Kenji Hirata, Ken Kato, Kohsuke Kudo
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引用次数: 0
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