What to do if cancer chemotherapy and radiotherapy cause heart failure!Ultrasound examination safety precautions
The direct toxicity of cancer chemotherapy or radiotherapy may induce heart failure or even death. Wang Chenxu, an attending physician in the General Cardiac Intensive Care Unit of the Cardiovascular Center of Cathay General Hospital, said that the current trend of cancer treatment has targeted heart failure caused by cancer treatment (cancer therapeutics related cardiac dysfunction, referred to as CTRCD) for prevention, detection and treatment. Prethoracic cardiac ultrasound examination (TTE) is easy to obtain and use, relatively safe and cost-effective, and is particularly important in the clinical application of CTRCD.
Chemoradiotherapy toxicity induces heart failure
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 focused on the prevention, detection, and management of cancer treatment-induced heart failure (CTRCD).
Wang Chenxu pointed out that 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 heart disease. Clinical symptoms of 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 may 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 widely use, relatively safe and cost-effective, and is particularly important in the clinical application of CTRCD.
Four major opportunities for TTE to be used in cancer patients
Wang Chenxu said that cancer patients have higher cardiovascular-related disease and mortality rates 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. Actively improving the cardiovascular risk factors diagnosed 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.
Cancer patients with existing cardiovascular symptoms should undergo periodic TTE cardiac function assessment during CT/RT and after the completion of treatment.
Taking a study of a breast cancer patient 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 who receive low-risk CT cumulative doses (such as 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 (Crohn’s disease) symptoms, imaging or cardiac enzyme abnormalities, TTE should be repeated and further treatment should be received by a cardiologist. Consultation and evaluation to facilitate diagnosis. Patients who receive high-dose chest RT (e.g., >30 Gy) should also undergo TTE 10 to 15 years after initial RT, and follow-up regularly every 5 years thereafter.
According to the current European Society for Medical Oncology (ESMO) guidelines, there are two options for time-series 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.
Current literature shows that administration of these two primary protective drugs, beta 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.
The doctor finally said that in the future, cardiac ultrasound will be combined with other examination tools, such as portable electrocardiogram, computerized tomography, magnetic resonance imaging, positron examination and other high-end imaging equipment, AI artificial intelligence and big data machine learning and other innovative applications, and is expected to provide cancer patients with Better medical care and vision of life.
2024-03-14 04:47:07
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