ABSTRACT

Venous thromboembolism (VTE) continues to cause significant morbidity and excess mortality in patients with multiple myeloma. The report by Costa and colleagues demonstrates superiority of direct oral anticoagulants over aspirin in terms of VTE prevention, without increased bleeding complications seen. Commentary on: Costa et al. Direct oral anticoagulants versus aspirin for primary thromboprophylaxis in patients with multiple myeloma undergoing outpatient therapy: A systematic review and updated meta-analysis. Br J Haematol 2023 (Online ahead of print). doi: 10.1111/bjh.19017.

PMID:37581247 | DOI:10.1111/bjh.19056

17:22

PubMed articles on: Cancer & VTE/PE

Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort

Eur Radiol. 2023 Aug 12. doi: 10.1007/s00330-023-10044-0. Online ahead of print.

ABSTRACT

OBJECTIVES: Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19.

MATERIALS AND METHODS: We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4 months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4 months. Secondary endpoints included further CCT evaluation at 9 and 16 months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors.

RESULTS: Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4 months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9 months and 16 months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49).

CONCLUSION: At 4 months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16 months.

CLINICAL RELEVANCE STATEMENT: Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed.

KEY POINTS: • Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4 months, remaining stable at 16 months. • COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern. • COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.

PMID:37572192 | DOI:10.1007/s00330-023-10044-0

17:22

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:22

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:22

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:22

In reply to this message

PubMed articles on: Cancer & VTE/PE

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Transl Lung Cancer Res. 2023 Jul 31;12(7):1539-1548. doi: 10.21037/tlcr-23-346. Epub 2023 Jul 19.

ABSTRACT

BACKGROUND: There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE.

METHODS: This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed.

RESULTS: A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038-30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236-14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476-3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P

CONCLUSIONS: Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.

PMID:37577319 | PMC:PMC10413029 | DOI:10.21037/tlcr-23-346

C

19:25

Cardiotoxicity News

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

Cardiac Arrhythmias in Oncological Patients-Epidemiology, Risk Factors, and Management within the Context of the New ESC 2022 Guidelines

Curr Oncol Rep. 2023 Aug 17. doi: 10.1007/s11912-023-01445-x. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: To provide an update on epidemiology, risk factors, and management of cardiac arrhythmias in oncological patients within the context of the new European Society of Cardiology 2022 guidelines on cardio-oncology.

RECENT FINDINGS: One of the side effects of different chemotherapeutics is their pro-arrhythmic activity. Both atrial and ventricular arrhythmias may be induced by cancer itself or by anticancer treatment. Recent studies report on the cardiotoxic activity of such promising therapies as BRAF and MEK inhibitors, or CAR-T therapy. Risk factors of arrhythmias in oncological patients overlap with cardiovascular diseases risk factors, but there are some groups of anticancer drugs that increase the risk of cardiotoxicity. It is crucial to be aware of the risks associated with the oncological treatment and know how to act in case of cardiotoxicity.

PMID:37589940 | DOI:10.1007/s11912-023-01445-x

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

First-Pass Perfusion Cardiac Magnetic Resonance Imaging for Cancer-Associated Cardiac Masses: First Impressions Count!

JACC Cardiovasc Imaging. 2023 Aug 2:S1936-878X(23)00336-4. doi: 10.1016/j.jcmg.2023.06.020. Online ahead of print.

NO ABSTRACT

PMID:37589606 | DOI:10.1016/j.jcmg.2023.06.020

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

Editorial: The influence of lifestyle factors on cancer biology and treatment efficacy

Front Physiol. 2023 Jul 31;14:1254151. doi: 10.3389/fphys.2023.1254151. eCollection 2023.

NO ABSTRACT

PMID:37588853 | PMC:PMC10425544 | DOI:10.3389/fphys.2023.1254151

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

Cardioprotection in cardio-oncology: a case for concern?

Cardiovasc Res. 2023 Aug 17:cvad111. doi: 10.1093/cvr/cvad111. Online ahead of print.

NO ABSTRACT

PMID:37587745 | DOI:10.1093/cvr/cvad111

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

3D-based strain analysis and cardiotoxicity detection in cancer patients received chemotherapy

BMC Cancer. 2023 Aug 16;23(1):760. doi: 10.1186/s12885-023-11261-y.

ABSTRACT

BACKGROUND: Chemotherapy-induced cardiotoxicity has become a prevalent complication. Regular monitoring of patients who received chemotherapy using 3D strain parameters may aid in early detection of myocardial damage and its prevention. The purpose of this study was to evaluate the effectiveness of three-dimensional speckle tracking imaging (3D-STI) in diagnosing and predicting the likelihood of cardiotoxicity. This was achieved by conducting a systematic review of original research articles.

OBJECTIVES: To evaluate the role of 3D speckle tracking echocardiography in early detection of cardiotoxicity.

METHODS: Relevant case control studies published prior to December 2022 were extracted to assess cardiotoxicity by 3D STE in patients after chemotherapy.

RESULTS: A total of 1991 chemotherapy treated patients and control patients were included in the present review via pooling 22 studies.

CONCLUSIONS: 3D speckle tracking echocardiography has the utility of non-invasive and objective evaluation of changes in left ventricular function in cancer patients undergoing chemotherapy.

ROSPERO REGISTRATION NO: Study ID, CRD42023383790 on PROSPERO: International prospective register of systematic reviews.

PMID:37587421 | DOI:10.1186/s12885-023-11261-y

19:25

In reply to this message

PubMed articles on: Cardio-Oncology

Association of radiation dose to cardiac substructures with major ischaemic events following breast cancer radiotherapy

Eur Heart J. 2023 Aug 16:ehad462. doi: 10.1093/eurheartj/ehad462. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Patients with left-sided breast cancer receive a higher mean heart dose (MHD) after radiotherapy, with subsequent risk of ischaemic heart disease. However, the optimum dosimetric predictor among cardiac substructures has not yet been determined.

METHODS AND RESULTS: This study retrospectively reviewed 2158 women with breast cancer receiving adjuvant radiotherapy. The primary endpoint was a major ischaemic event. The dose-volume parameters of each delineated cardiac substructure were calculated. The risk factors for major ischaemic events and the association between MHD and major ischaemic events were analysed by Cox regression. The optimum dose-volume predictors among cardiac substructures were explored in multivariable models by comparing performance metrics of each model. At a median follow-up of 7.9 years (interquartile range 5.6-10.8 years), 89 patients developed major ischaemic events. The cumulative incidence rate of major ischaemic events was significantly higher in left-sided disease (P = 0.044). Overall, MHD increased the risk of major ischaemic events by 6.2% per Gy (hazard ratio 1.062, 95% confidence interval 1.01-1.12; P = 0.012). The model containing the volume of the left ventricle receiving 25 Gy (LV V25) with the cut-point of 4% presented with the best goodness of fit and discrimination performance in left-sided breast cancer. Age, chronic kidney disease, and hyperlipidaemia were also significant risk factors.

CONCLUSION: Risk of major ischaemic events exist in the era of modern radiotherapy. LV V25 ≥ 4% appeared to be the optimum parameter and was superior to MHD in predicting major ischaemic events. This dose constraint could aid in achieving better heart protection in breast cancer radiotherapy, though a further validation study is warranted.

PMID:37585426 | DOI:10.1093/eurheartj/ehad462

19:25

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

19:25

PubMed articles on: Cardio-Oncology

Radiation-Induced Pericardial Disease: Mechanisms, Diagnosis, and Treatment

Curr Cardiol Rep. 2023 Aug 16. doi: 10.1007/s11886-023-01933-3. Online ahead of print.