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Echocardiographic evaluation in cancer patients undergoing chemotherapy focus of recommendation papers
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The European Association of Echocardiography and the American Society of Echocardiography are collaborating to issue recommendations on the usefulness of serial echocardiographic evaluations and the potential effect of more advanced ultrasound technologies in cancer patients who are undergoing chemotherapy.
In recent years, several cancer therapies, such as anthracyclines, have been linked to potential adverse cardiac effects. Now, new-generation targeted therapies, such as trastuzumab (Herceptin, Genentech) for breast cancer, have also been associated with adverse effects on MI. Currently, 17% of patients have to stop cancer therapy because of CV involvement, according to information from the European Society of Cardiology.
“The early detection of cardiotoxicity is a critical issue in the clinical setting, in order to modulate appropriately and hopefully not interrupt chemotherapy,” Maurizio Galderisi, MD, FESC, chairman of the European Association of Echocardiography and medical director of the department of clinical and experimental medicine at Federico II University Hospital, Naples, Italy, told Cardiology Today. “The goal of this document is to highlight the technical advantages of cardiac imaging and, in particular, of echocardiography in identifying cardiotoxicity early.”
Echocardiography has emerged as the modality of choice for noninvasive evaluation of cardiac disease in patients with cancer. The tool is essential for the evaluation of left ventricular systolic and diastolic function, and pericardial and valvular heart disease. However, echocardiograms are only performed at the beginning of cancer therapy or as a consequence of the onset of cardiac signs and symptoms, in particular after the administration of recognized cardiotoxic drugs or radiation therapy.
According to Galderisi, the recommendation papers will represent the first guidelines issued on echocardiographic evaluation in patients with cancer who are undergoing chemotherapy. The goal of the European Association of Echocardiography (EAE) and the American Society of Echocardiography issuing the recommendations is to change the way echocardiography is used combined with cardiotoxicity and to indicate new research pathways.
“This is a first draft of recommendations and represents a true novelty,” Galderisi said in an interview. “Possible updates will be needed in relation to the advancement of cardiac imaging and ultrasound technology, and the increased knowledge of new chemotherapeutic agents and their mechanisms of action.”
Rosa Sicari, MD, PhD, FESC, of the Consiglio Nazionale delle Richerche Institute of Clinical Physiology and chairwoman of the EAE scientific committee, said, “The assessment of cardiac toxicity remains a critical issue in oncology.” According to Sicari, ejection fraction is not useful to detect early and subtle forms of cardiac dysfunction. “New tools are needed and the evidence should be built in the near future with appropriately designed studies and with the common efforts of oncologists, cardiologists and pharmacists. This document is not meant to fill the gap of knowledge but to provide the state of the art of ultrasound in this field and indicate new research pathways.”
The guidelines will be completed in 2012. – by Casey Murphy
Disclosure: Drs. Galderisi and Sicari report no relevant financial disclosures.