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Life
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Cardio-oncology: From Basic Mechanisms and research to Clinical Practice
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Cardio-oncology: From Basic Mechanisms and research to Clinical Practice

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (17 June 2022) | Viewed by 11961

Special Issue Editors

Dr. Michal Laufer-Perl

E-Mail Website
Guest Editor
Department of Cardiology, Tel-Aviv Sourasky Medical Center, the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Interests: cardio-oncology; global longitudinal strain; heart failure; echocardiography; immune checkpoint inhibitors
Prof. Dr. Livia Kapusta

E-Mail Website
Guest Editor
1. Pediatric Cardiology Unit, Department of Pediatrics, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
2. Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
Interests: pediatric cardio oncology; late effects of childhood cancer

Special Issue Information

Dear Colleagues,

The advance in cancer therapies has led to a significant increase in survival rate, with over 16 million cancer survivors in the United States to date. However, the increase in survival has exposed the scope of side effects, which may lead to irreversible and potentially life-threating complications, as well as to the discontinuation of cancer therapy. Cardiotoxicity is considered the most significant side effect, with a major impact on morbidity and mortality. Although anthracyclines are still considered as the most familiar cardiotoxic drugs, we now know that the majority of cancer therapies have a potential cardiotoxic effect, including monoclonal antibodies against HER2, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, proteasome inhibitors, immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cell and mediastinal radiation.

New cardiac biomarkers and imaging techniques provide the ability for early subclinical diagnosis of cardiotoxicity and the prevention of its development. While the number of studies focusing on cardio-oncology is increasing, there is still no precise and clear guidelines for cardiac follow-up, and more importantly, no guidelines for the practical management of patients who developed cardiotoxicity. The present special issue, edited by Dr Michal Laufer-Perl and Professor Livia Kapusta, will focus on applying the results from basic mechanism and research to the clinical Practice"

Dr. Michal Laufer-Perl
Prof. Dr. Livia Kapusta
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiotoxicity
  • cardio-oncology
  • cardiac imaging
  • cardiac biomarkers
  • immunotherapy
  • radiation

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Published Papers (4 papers)

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Research

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11 pages, 1705 KiB  
Article
Immune Checkpoint Inhibitor-Induced Myocarditis vs. COVID-19 Vaccine-Induced Myocarditis—Same or Different?
by Lior Zornitzki, Ofer Havakuk, Zach Rozenbaum, Dana Viskin, Yaron Arbel, Nir Flint, Joshua Arnold, Barliz Waissengein, Ido Wolf, Shmuel Banai, Yan Topilsky and Michal Laufer-Perl
Life 2022, 12(9), 1366; https://doi.org/10.3390/life12091366 - 1 Sep 2022
Cited by 2 | Viewed by 2126
Abstract
Immune checkpoint inhibitor (ICI) and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis possibly share common mechanisms secondary to overactivation of the immune system. We aimed to compare the presenting characteristics of ICIs and COVID-19 vaccine-induced myocarditis. We performed a retrospective analysis of characteristics of [...] Read more.
Immune checkpoint inhibitor (ICI) and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis possibly share common mechanisms secondary to overactivation of the immune system. We aimed to compare the presenting characteristics of ICIs and COVID-19 vaccine-induced myocarditis. We performed a retrospective analysis of characteristics of patients diagnosed with either ICIs or COVID-19 vaccine-induced myocarditis and compared the results to a control group of patients diagnosed with acute viral myocarditis. Eighteen patients diagnosed with ICIs (ICI group) or COVID-19 vaccine (COVID-19 vaccine group)-induced myocarditis, and 20 patients with acute viral myocarditis (Viral group) were included. The ICI group presented mainly with dyspnea vs. chest pain and fever among the COVID-19 vaccine and Viral groups. Peak median high sensitivity Troponin I was markedly lower in the ICI group (median 619 vs. 15,527 and 7388 ng/L, p = 0.004). While the median left ventricular (LV) ejection fraction was 60% among all groups, the ICI group had a lower absolute mean LV global longitudinal strain (13%) and left atrial conduit strain (17%), compared to the COVID-19 vaccine (17% and 30%) and Viral groups (18% and 37%), p = 0.016 and p = 0.001, respectively. Despite a probable similar mechanism, ICI-induced myocarditis’s presenting characteristics differed from COVID-19 vaccine-induced myocarditis. Full article
(This article belongs to the Special Issue Cardio-oncology: From Basic Mechanisms and research to Clinical Practice)
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11 pages, 1134 KiB  
Article
Valvular Heart Disease following Anthracycline Therapy—Is It Time to Look beyond Ejection Fraction?
by David Zahler, Joshua H. Arnold, Tali Bar-On, Ari Raphael, Shafik Khoury, Zach Rozenbaum, Shmuel Banai, Yaron Arbel, Yan Topilsky and Michal Laufer-Perl
Life 2022, 12(8), 1275; https://doi.org/10.3390/life12081275 - 20 Aug 2022
Cited by 1 | Viewed by 1824
Abstract
The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were [...] Read more.
The association between anthracycline (ANT) and left ventricle (LV) dysfunction is well known; however, data regarding its direct effect on cardiac valve function is limited. We aimed to evaluate how ANT therapy affected valvular function in patients diagnosed with breast cancer. Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). Patients underwent echocardiography exams at baseline (T1), during ANT therapy (T2), and after completion within 3 months (T3) and 6 months (T4). A total of 141 female patients were included, with a mean age of 51 ± 12 years. From T1 to T4, we observed a significant deterioration in LV ejection fraction (60.2 ± 1.5 to 59.2 ± 2.7%, p = 0.0004) and LV global longitudinal strain (−21.6 (−20.0–−23.0) to −20.0 (−19.1–−21.1)%, p < 0.0001)), and an increase in LV end-systolic diameter (25 (22–27) to 27 (24–30) mm, p < 0.0001). We observed a significant increase in the incidence of new mitral regurgitation (MR) development (4 to 19%, p < 0.0001), worsening with concomitant trastuzumab therapy (6% to 31%, p = 0.003), and a trend for tricuspid regurgitation development (4% to 8%, p = 0.19). ANT therapy is associated with the development of a new valvular disease, mainly MR, which may imply the need for a valvular focus in the monitoring of cancer patients. Full article
(This article belongs to the Special Issue Cardio-oncology: From Basic Mechanisms and research to Clinical Practice)
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10 pages, 1002 KiB  
Article
Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement
by Milanthy Pourier, Remy Merkx, Jacqueline Loonen, Alyssa van Cleef, Chris de Korte, Louise Bellersen, Livia Kapusta and Annelies Mavinkurve-Groothuis
Life 2022, 12(3), 452; https://doi.org/10.3390/life12030452 - 19 Mar 2022
Cited by 5 | Viewed by 3065
Abstract
In echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events in CCS after previous measurement of [...] Read more.
In echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events in CCS after previous measurement of LVEF and myocardial strain. Echocardiography, including four-chamber view longitudinal strain (4CH-LS), of 116 anthracycline-treated CCS was obtained between 2005–2009 (index echocardiography). Follow-up was obtained at the late-effects clinic. Primary outcome was occurrence of cardiac events, defined as either symptomatic heart failure, life-threatening arrhythmias, LVEF < 40% or cardiac death, in CCS with normal versus abnormal index 4CH-LS. LVEF from subsequent echocardiograms was obtained to evaluate its natural course as a secondary outcome. After index echocardiography (median 13.1 years since childhood cancer diagnosis), our study added a median follow-up of 11.3 years (median last clinical contact 23.6 years since diagnosis). Only three CCS developed a cardiac event (6.2, 6.4 and 6.7 years after index echocardiography), resulting in a ten-year cumulative incidence of 2.7% (95%CI 0.9–8.2). All three CCS had a clearly reduced index 4CH-LS and relevant cardiovascular risk factors, whereas their index LVEFs were around the lower limit of normal. Index LVEF correlated with index 4CH-LS but mean long-term natural course of LVEF was comparable for CCS with abnormal versus normal index 4CH-LS. Absolute 10-year cumulative incidence of cardiac events in anthracycline-treated CCS during long-term follow-up was low. Sensitive echocardiographic measurements, such as 4CH-LS may be useful to tailor surveillance frequency in a selected group of CCS without cardiovascular disease. Full article
(This article belongs to the Special Issue Cardio-oncology: From Basic Mechanisms and research to Clinical Practice)
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Review

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13 pages, 1218 KiB  
Review
Cardio-Oncology Rehabilitation—Present and Future Perspectives
by Boaz Elad, Manhal Habib and Oren Caspi
Life 2022, 12(7), 1006; https://doi.org/10.3390/life12071006 - 7 Jul 2022
Cited by 8 | Viewed by 3820
Abstract
Recent advances in cancer therapy have led to increased survival rates for cancer patients, but also allowed cardiovascular complications to become increasingly evident, with more than 40% of cancer deaths now being attributed to cardiovascular diseases. Cardiotoxicity is the most concerning cardiovascular complication, [...] Read more.
Recent advances in cancer therapy have led to increased survival rates for cancer patients, but also allowed cardiovascular complications to become increasingly evident, with more than 40% of cancer deaths now being attributed to cardiovascular diseases. Cardiotoxicity is the most concerning cardiovascular complication, one caused mainly due to anti-cancer drugs. Among the harmful mechanisms of these drugs are DNA damage, endothelial dysfunction, and oxidative stress. Cancer patients can suffer reduced cardiorespiratory fitness as a secondary effect of anti-cancer therapies, tumor burden, and deconditioning. In the general population, regular exercise can reduce the risk of cardiovascular morbidity, mortality, and cancer. Exercise-induced modifications of gene expression result in improvements of cardiovascular parameters and an increased general fitness, influencing telomere shortening, oxidative stress, vascular function, and DNA repair mechanisms. In cancer patients, exercise training is generally safe and well-tolerated; it is associated with a 10–15% improvement in cardiorespiratory fitness and can potentially counteract the adverse effects of anti-cancer therapy. It is well known that exercise programs can benefit patients with heart disease and cancer, but little research has been conducted with cardio-oncology patients. To date, there are a limited number of effective protective treatments for preventing or reversing cardiotoxicity caused by cancer therapy. Cardiac rehabilitation has the potential to mitigate cardiotoxicity based on the benefits already proven in populations suffering from either cancer or heart diseases. Additionally, the fact that cardiotoxic harm mechanisms coincide with similar mechanisms positively affected by cardiac rehabilitation makes cardiac rehabilitation an even more plausible option for cardio-oncology patients. Due to unstable functional capacity and fluctuating immunocompetence, these patients require specially tailored exercise programs designed collaboratively by cardiologists and oncologists. As the digital era is here, with the digital world and the medical world continuously intertwining, a remote, home-based cardio-oncology rehabilitation program may be a solution for this population. Full article
(This article belongs to the Special Issue Cardio-oncology: From Basic Mechanisms and research to Clinical Practice)
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