Malignant lymphoma survivors are at increased risk for anthracycline and/or radiotherapy-induced chronic cardiotoxicity. Proper long-term follow-up is essential for malignant lymphoma survivors after-care. This study aimed to assess TTE parameters of potential subclinical cardiotoxicity and to examine their utility in diagnosing chronic cardiotoxicity. Improvement of the diagnostic process may precede the manifestation of cardiac adverse events. Main objective of the study was to improve the identification of cancer survivors in increased risk of treatment cardiotoxicity. To achieve this goal, utility of various echocardiography parameters was examined.In this retrospective study we analysed TTE of 167 subjects with speckle tracking according to the European Society of Echocardiography guidelines during the follow-up period. 88 of them were long-term lymphoma survivors diagnosed with malignant lymphoma between the years 1994-2015. Minimum follow up period was 5 years with the median of 10 years after anti-cancer treatment cessation. TTE were performed between the years 2017-2022 at cardio-oncology outpatient office during regular follow-up period. A total of 79 volunteers with no history of chronic heart failure (CHF) or decline in LVEF, 51 (64.6%) of whom were males, with the median age of 46 (16-58) years were included in the analysis as control group. Control subjects had various indications for TTE (e.g. preoperative examination, benign palpitations, or with well controlled arterial hypertension taking two antihypertensives at most). Ischemic heart disease was ruled out by stress test. None of the control subjects had history of stroke or chronic lower limb ischemia. All control subjects were considered clinically stable with no sign of cardiac impairment caused by primary disease. Both cancer survivors and control group were divided into subgroups based on LVEF: lower normal LVEF (53-61%), and higher normal LVEF (> 61%). Survivors with lower normal LVEF (53-61%) had a statistically significant decline in GLS compared to those with higher normal LVEF (> 61%). This phenomenon was not observed in control group indicating a possible additional diagnostic value of this parameter. Inclusion of GLS assessment in follow-up TTE examination of subjects with lower normal LVEF may improve the sensitivity of detection of chronic cardiotoxicity. Patients with declined GLS and lower normal LVEF are candidates for intensified follow-up to precede manifestation of cardiac adverse events.
- MeSH
- antracykliny škodlivé účinky MeSH
- dospělí MeSH
- echokardiografie * MeSH
- funkce levé komory srdeční účinky léků MeSH
- globální longitudinální strain MeSH
- kardiotoxicita * etiologie diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfom * farmakoterapie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- přežívající onkologičtí pacienti * MeSH
- retrospektivní studie MeSH
- tepový objem účinky léků MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Treatment of malignant lymphoma has for years been represented by many cardiotoxic agents especially anthracyclines, cyclophosphamide, and thoracic irradiation. Although they are in clinical practice for decades, the precise mechanism of cardiotoxicity and effective prevention is still part of the research. At this article we discuss most routinely used anti-cancer drugs in chemotherapeutic regiments for malignant lymphoma with the focus on novel insight on molecular mechanisms of cardiotoxicity. Understanding toxicity at molecular levels may unveil possible targets of cardioprotective supportive therapy or optimization of current therapeutic protocols. Additionally, we review novel specific targeted therapy and its challenges in cardio-oncology.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
We present a case of a pregnant woman with systemic lupus erythematosus (SLE) who was diagnosed with asymptomatic complete heart block (CHB) during pregnancy. To evaluate possible risks and benefits of pacemaker (PM) implantation, a multidisciplinary counselling board was held. Its recommendation was to perform PM implantation to prevent intra-uterine growth restriction from insufficient cardiac output using a fluoroscopic protective shield. The procedure was performed without complications and established permanent pacing on onwards ECG examinations. The patient subsequently gave birth to a healthy newborn. After a retrospective clinical case evaluation and review of relevant literature, a presumptive association between CHB and the primary diagnosis was proposed. Above that, pregnant women with SLE who develop hypertension are commonly treated with methyldopa, which may cause conduction abnormalities. Clinical recommendations for young female patients expecting pregnancy are lacking in this area. Careful diagnostic and treatment approaches should be used in the management of possible SLE-related complications in women of child-bearing age, focusing on preventable events.
- MeSH
- komplikace těhotenství * terapie MeSH
- lidé MeSH
- novorozenec MeSH
- retrospektivní studie MeSH
- růstová retardace plodu MeSH
- srdeční blokáda terapie komplikace MeSH
- systémový lupus erythematodes * komplikace MeSH
- těhotenství MeSH
- těhotné ženy MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Sunitinib is a broad-spectrum multitargeted tyrosine kinase inhibitor mainly used as second-line therapy for non-resectable gastrointestinal stromal or first-line treatment option of metastatic renal cell carcinoma (mRCC), and as an "off-label" option in pediatric oncology. It has been previously reported that sunitinib elevates the mean corpuscular volume of erythrocytes (MCV) in treated subjects. The aim of this study was to assess time-dependent changes of this effect and evaluate its possible clinical relevance. In this study, 179 adult and 21 pediatric patients with solid tumors treated with sunitinib were retrospectively analyzed. The laboratory and treatment-related data were collected for each treatment period. The regression model with a broken-line relationship was used to fit time dependence of the MCV. In the adult group, the MCV was increasing during the first 21.6 weeks (median) of treatment in a median level of 99.8 fL, where it stabilized. MCV increase was faster in the patients who suffered from treatment-related adverse events (21.3 vs. 24.6 weeks, p = 0.010). In the pediatric cohort, the MCV dynamics were similar to adults. In conclusion, MCV changes during sunitinib treatment in pediatric and adult patients may be of clinical utility in monitoring sunitinib treatment course.
- MeSH
- dítě MeSH
- dospělí MeSH
- erytrocytární znaky MeSH
- indoly škodlivé účinky MeSH
- karcinom z renálních buněk * farmakoterapie patologie MeSH
- lidé MeSH
- nádory ledvin * farmakoterapie patologie MeSH
- protinádorové látky * škodlivé účinky MeSH
- pyrroly škodlivé účinky MeSH
- retrospektivní studie MeSH
- sunitinib farmakologie terapeutické užití MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Zvyšující se počet dlouhodobě přeživších po onkologické terapii čelí pozdním následkům léčby včetně zvýšeného rizika rozvoje metabolického syndromu. V tomto článku se zabýváme patofyziologií rozvoje metabolického syndromu po prodělané protinádorové terapii a nastiňujeme možnosti prevence v rámci komplexní péče o pacienta. S ohledem na možnost prevence metabolického syndromu je vhodné pro pacienty ve zvýšeném riziku zajistit screening, efektivní sledování a časné zahájení terapie jednotlivých složek metabolického syndromu.
The increasing number of long-term survivors that underwent the anti-cancer therapy faces the late treatment-related adverse effects and the increased risk of developing metabolic syndrome. This article defines the pathophysiology that underlies development of anti-cancer therapy-related metabolic syndrome and outlines the possibility of optimisation of comprehensive care focusing on prevention. Considering the preventability of metabolic syndrome, effective screening and follow-up appropriate for patients at increased risk of related adverse events should be established. Subsequently, early initiation of therapy targeting the hallmarks of metabolic syndrome may ease its manifestation in long-term perspective.
- MeSH
- dítě MeSH
- lidé MeSH
- metabolický syndrom * chemicky indukované patofyziologie prevence a kontrola MeSH
- mladiství MeSH
- nádory komplikace MeSH
- přežívající onkologičtí pacienti statistika a číselné údaje MeSH
- protinádorové látky * škodlivé účinky MeSH
- radioterapie škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
Kombinační léčba hypertenze je mnohem účinnější než monoterapie. Mezi doporučené dvojkombinace patří spojení kardioselektivních betablokátorů s dihydropyridinovými blokátory kalciových kanálů. Tato kombinace má aditivní a kardioprotektivní účinky. Používáme ji u pacientů se závažnější hypertenzí a u hypertenze s poškozením cílových orgánů.
- Klíčová slova
- kombinační léčba,
- MeSH
- beta blokátory terapeutické užití MeSH
- blokátory kalciových kanálů terapeutické užití MeSH
- dihydropyridiny terapeutické užití MeSH
- hypertenze farmakoterapie prevence a kontrola MeSH
- kardiovaskulární nemoci farmakoterapie prevence a kontrola MeSH
- krevní tlak účinky léků MeSH
- lidé MeSH
- výběr pacientů MeSH
- Check Tag
- lidé MeSH
