Nádorová onemocnění u dětí představují druhou nejčastější příčinu úmrtí hned za úrazy. Dramatický pokrok dosažený v léčbě nádorových onemocnění u dětí s sebou přináší i klinický problém maximalizovat benefit z protinádorové terapie a zároveň v co největší míře eliminovat pozdní následky. Velmi závažným nežádoucím efektem léčby nádorového onemocnění je kardiotoxicita. Metodou volby její detekce je echokardiografické vyšetření srdce. V klinické praxi jsou ke zhodnocení systolické funkce levé komory stále široce využívány konvenční echokardiografické modality, jako je např. měření ejekční frakce Teichholzovou metodou. V současné době však máme k dispozici nové echokardiografické parametry pro včasnou detekci změn kontraktilní funkce myokardu. Jedná se o tzv. speckle tracking echokardiografii, která je schopna hodnotit jak globální, tak regionální deformaci myokardu. Tato metoda je neinvazivní ultrazvukovou metodou a umožňuje detekci časného stadia dysfunkce levé komory v době, kdy je její ejekční frakce ještě normální. Především hodnota globálního longitudinálního strainu by měla být zásadní pro predikci změny ejekční frakce. Tato metoda vykazuje velký potenciál časné stratifikace rizikových pacientů na poli kardioonkologie.
Cancer in children is the second most common cause of death after injuries. The dramatic progress achieved in the treatment of cancer in children also brings with it the clinical problem of maximizing the benefit of anticancer therapy and at the same time eliminating the late consequences as much as possible. Cardiotoxicity is a very serious side effect of cancer treatment. The method of choice for its detection is echocardiographic examination of the heart. In clinical practice, conventional echocardiographic modalities, such as the measurement of the ejection fraction by the Teichholz method, are still widely used to evaluate left ventricular systolic function. However, we currently have new echocardiographic parameters for early detection of changes in myocardial contractile function. It is a Speckle tracking echocardiography that is able to assess both global and regional myocardial deformity. This method is a non-invasive ultrasound method and detects early stages of left ventricular dysfunction at a time when its ejection fraction is still normal. In particular, the value of the global longitudinal strain should be crucial for predicting the change in ejection fraction. This method shows great potential for time stratification of high-risk patients in the field of cardiooncology.
- MeSH
- antitumorózní látky škodlivé účinky toxicita MeSH
- dítě MeSH
- echokardiografie metody MeSH
- globální longitudinální strain MeSH
- kardiotoxicita * diagnóza MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- tepový objem MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Serum biomarkers are an important tool in the baseline risk assessment and diagnosis of cardiovascular disease in cancer patients receiving cardiotoxic cancer treatments. Increases in cardiac biomarkers including cardiac troponin and natriuretic peptides can be used to guide initiation of cardioprotective treatments for cancer patients during treatment and to monitor the response to cardioprotective treatments, and they also offer prognostic value. This position statement examines the role of cardiac biomarkers in the management of cancer patients. The Cardio-Oncology Study Group of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the Cardio-Oncology Council of the ESC have evaluated the current evidence for the role of cardiovascular biomarkers in cancer patients before, during and after cardiotoxic cancer therapies. The characteristics of the main two biomarkers troponin and natriuretic peptides are discussed, the link to the mechanisms of cardiovascular toxicity, and the evidence for their clinical use in surveillance during and after anthracycline chemotherapy, trastuzumab and HER2-targeted therapies, vascular endothelial growth factor inhibitors, proteasome inhibitors, immune checkpoint inhibitors, cyclophosphamide and radiotherapy. Novel surveillance clinical pathways integrating cardiac biomarkers for cancer patients receiving anthracycline chemotherapy or trastuzumab biomarkers are presented and future direction in cardio-oncology biomarker research is discussed.
- MeSH
- antitumorózní látky * aplikace a dávkování škodlivé účinky MeSH
- kardiotonika aplikace a dávkování MeSH
- kardiotoxicita * krev diagnóza etiologie MeSH
- lidé MeSH
- nádorové biomarkery krev MeSH
- nádory * krev farmakoterapie MeSH
- srdeční selhání * krev chemicky indukované diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- MeSH
- antitumorózní látky toxicita MeSH
- časná detekce nádoru MeSH
- karcinogeny toxicita MeSH
- kardiotoxicita * diagnóza etiologie MeSH
- kardiotoxiny toxicita MeSH
- kritické orgány MeSH
- lidé MeSH
- nádorové biomarkery MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kongresy MeSH
- zprávy MeSH
Drug-induced cardiotoxicity is a serious problem associated with the administration of many drugs. MicroRNAs (miRNAs) have been reported to be affected by drugs and other xenobiotics, and the potential of miRNAs as biomarkers and diagnostic tools has been considered. In recent years, an association of certain miRNAs with the cardiotoxicity of some drugs, namely anthracyclines, bevacizumab, cyclosporine A and isoprenaline, has already been found. This review article summarizes available information about the changes in miRNA levels induced by cardiotoxic drugs. Three aspects are discussed: the altered expression of miRNAs in the heart upon treatment with cardiotoxic drugs, circulating miRNAs as promising early biomarkers of cardiotoxicity, and the potential of miRNAs in the prevention and/or attenuation of drug-induced cardiotoxicity. The targeted changes in the level of certain miRNAs by antagomiRs and miRNA mimics are also described and evaluated. In addition, the cardioprotective mechanism of various natural compounds via their effect on miRNA levels are examined.
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- MeSH
- adjuvantní radioterapie * metody normy využití MeSH
- celková dávka radioterapie * normy MeSH
- frakcionace dávky záření MeSH
- hypofrakcionace při ozařování normy MeSH
- kardiotoxicita diagnóza komplikace prevence a kontrola MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- nádory prsu * farmakoterapie radioterapie terapie MeSH
- receptor erbB-2 antagonisté a inhibitory terapeutické užití účinky záření MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- společnosti lékařské MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Anthracycline antibiotic doxorubicin (DOX) is a very potent and extensively prescribed chemotherapeutic drug. It is widely utilized in the therapy of variety of haematological and solid tumours, although its administration is commonly accompanied with several severe side effects. The most serious one is a development of dose-dependent and cumulative cardiotoxicity. In the course of time, many strategies have been investigated in order to avoid or at least to diminish DOX-induced cardiac dysfunction; these include reduction of toxic effect by coadministration with iron chelators (dexrazoxane), trastuzumab, taxanes, statins, and ACE-inhibitors. However, the attenuation of cardiotoxic effect is still not satisfactory yet. OBJECTIVE: This review represents an overall appraisal of studies concerning with the utilization of various doxorubicinloaded nanoparticles in the cancer treatment with specific emphasis on those studies evaluating their influence on the reduction of heart tissue damage. CONCLUSION: Introduction of nanoscale drug delivery systems undoubtedly represents nowadays one of the most promising tools for lowering systemic toxicity. Nanoparticles enable to target the therapeutic payload directly towards the tumor tissue, thus leading to the increased accumulation of the drug in the desired tissue and simultaneously protecting surrounding healthy tissues.
- MeSH
- antibiotika antitumorózní aplikace a dávkování škodlivé účinky MeSH
- doxorubicin aplikace a dávkování škodlivé účinky MeSH
- kardiotoxicita diagnóza prevence a kontrola MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- nanočástice aplikace a dávkování MeSH
- nosiče léků aplikace a dávkování MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Despite the rising trend of cancer disease incidence more and more patients succeed in their fight with the disease. Innovative drugs bring cures or at least improvements to the patient's quality of life. Extensive application of anticancer therapy however brings about the increase of adverse effects of the therapy. Toxic damage of the myocardium remains one of the severest organ damage types with life-threatening consequences. In the last decade, in addition to the known cardio toxicity of traditional cytostatics, specialists have more and more often been facing cardio toxicity caused by targeted oncology therapies. As myocardium damage is hard to treat when the stage of clinical symptoms is reached, emphasis is laid on the timely diagnosing of this drug-related damage. Diagnostic procedures have been introduced for early detection of risk patients before the therapy has even commenced. Timely diagnosis of myocardium effects in the course of the conservative cancer therapy allows for adjustment of the oncology therapy and lifestyle and timely commencement of treatment of the affected myocardium. Echocardiograph is considered the basic procedure of patient monitoring during cancer therapy. MRI of the myocardium and CT cardiograph are limited by price and availability despite their uncontentious role in oncocardiology. Radionuclide ventriculography is considered the gold standard of assessment of the left ventricle function. It is well reproducible and widely available in oncology centres. Laboratory diagnostics of toxic damage of the myocardium focuses on cardinal troponins and natriuretic peptides. This examination performance in clinical practice is undemanding and its application in oncology practice increases.
- MeSH
- 3-jodobenzylguanidin MeSH
- antitumorózní látky * klasifikace škodlivé účinky MeSH
- antracykliny klasifikace škodlivé účinky MeSH
- bevacizumab škodlivé účinky MeSH
- biologická terapie škodlivé účinky MeSH
- cílená molekulární terapie klasifikace škodlivé účinky MeSH
- echokardiografie metody MeSH
- elektrokardiografie metody MeSH
- fluorouracil škodlivé účinky MeSH
- jednofotonová emisní výpočetní tomografie metody MeSH
- kardiotoxicita * diagnóza etiologie klasifikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- myokard patologie MeSH
- nádory farmakoterapie komplikace MeSH
- nemoci srdce diagnostické zobrazování diagnóza chemicky indukované MeSH
- radioisotopová ventrikulografie metody MeSH
- rizikové faktory MeSH
- sunitinib škodlivé účinky MeSH
- trastuzumab škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Klíčová slova
- kardioonkologie,
- MeSH
- antitumorózní látky * škodlivé účinky MeSH
- chronická myeloidní leukemie farmakoterapie MeSH
- dysfunkce levé srdeční komory diagnóza chemicky indukované MeSH
- inhibitory proteinkinas škodlivé účinky MeSH
- kardiotoxicita diagnóza etiologie prevence a kontrola MeSH
- kardiovaskulární nemoci * chemicky indukované prevence a kontrola MeSH
- lidé MeSH
- mezioborová komunikace MeSH
- nádory * farmakoterapie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Cardiotoxicity is a well-known and potentially serious complication of anticancer therapy. Anthracycline-based chemotherapy represents the greatest risk. Early detection of cardiotoxicity is crucial for applying preventive and supportive therapeutic strategies. METHODS AND RESULTS: Various methods have been recommended for monitoring of cardiotoxicity. In our conditions, echocardiography and electrocardiography are routinely used. However, this approach shows low sensitivity for the early prediction of cardiomyopathy when the possibilities of appropriate management could still improve the patient's outcome. Recently, biomarkers of cardiac injury have been investigated in the assessment of chemotherapy-induced cardiotoxicity. Cardiospecific biomarkers, such as cardiac troponins, show high diagnostic efficacy in the early subclinical phase of the disease before the clinical onset of cardiomyopathy. Increase in their concentrations correlates with disease severity. As for natriuretic peptides, some studies, including ours, have shown promising results. Definitive evidence of their diagnostic and prognostic role in this context is still lacking and natriuretic peptides have not been routinely used for monitoring of cardiotoxicity in clinical practice. Other perspective biomarkers of cardiotoxicity in oncology are under study, especially heart-type fatty acid-binding protein (H-FABP) and glycogen phosphorylase BB (GPBB). Our studies using GPBB have provided encouraging results. However, the available data are limited and their practical use in this context cannot be recommended until their clinical efficacy is clearly defined. CONCLUSIONS: This review covers the current status of biomarkers for the early detection of anthracycline-induced cardiotoxicity. The authors present in brief, their own experience with multiple biomarkers in the detection of cardiotoxicity.
