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Echocardiography and biomarkers for the diagnosis of cardiotoxicity
Dominik Berliner1, Gernot Beutel2, Johann Bauersachs3
1Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. berliner.dominik@mh-hannover.de.
Abstract:
As a result of better treatment options for malignant cancer, the cardiovascular side effects of such therapies have increasingly come into focus in recent years. The new cardiological subspecialty of oncocardiology is developing strategies to prevent and/or detect those effects early in order to treat them in a timely and adequate manner. The diagnosis of cardiotoxic effects is based mainly on imaging and specific biomarkers. Echocardiography has become the main imaging technique due to its wide availability. In addition to quantitative determination of left ventricular function using two-dimensional methods, three-dimensional methods offer better precision and less variability in the detection of cardiac dysfunction. Furthermore, the analysis of the global longitudinal strain (GLS) reveals even subtle changes in left ventricular function and thus detects very early damage before left ventricular ejection fraction drops. Various biomarkers have been tested recently for their potential to detect cardiotoxicity. Cardiac troponins are currently the best investigated biomarkers and certainly have the highest impact. Due to contradicting results, the importance of natriuretic peptides has not yet been conclusively clarified. Results for myeloperoxidase are promising, as are the results for circulating microRNAs, which still mainly derive from experimental data. In this context, further studies still need to show the value of these in everyday clinical practice.
Insights
Oncology treatments can harm the heart. Oncocardiology uses advanced echocardiography (like 3D imaging and global longitudinal strain analysis) and biomarkers to detect and manage cancer therapy-related cardiac dysfunction early.
Area of Science:
- Cardiology and Oncology
- Cardio-oncology
- Cardiovascular Medicine
Background:
- Improved cancer treatments lead to increased focus on cardiovascular side effects.
- Cardio-oncology emerges to manage cancer therapy-related cardiac dysfunction.
- Early detection and treatment of cardiotoxicity are crucial for patient outcomes.
Purpose of the Study:
- To review current diagnostic strategies for cancer therapy-induced cardiotoxicity.
- To highlight the role of advanced echocardiography and biomarkers in early detection.
- To discuss the clinical utility of emerging biomarkers and imaging techniques.
Main Methods:
- Utilizing echocardiography, including 2D, 3D methods, and global longitudinal strain (GLS) analysis for assessing left ventricular function.
- Evaluating various biomarkers such as cardiac troponins, natriuretic peptides, myeloperoxidase, and circulating microRNAs for cardiotoxicity detection.
- Reviewing current literature and clinical practices in cardio-oncology.
Main Results:
- 3D echocardiography offers improved precision and reduced variability in detecting cardiac dysfunction compared to 2D methods.
- Global Longitudinal Strain (GLS) analysis detects subtle left ventricular function changes, indicating early cardiotoxicity before ejection fraction decline.
- Cardiac troponins are impactful biomarkers; natriuretic peptides' role is unclear; myeloperoxidase and microRNAs show promise but require further clinical validation.
Conclusions:
- Advanced echocardiographic techniques, particularly GLS, are vital for early cardiotoxicity detection in cancer patients.
- While cardiac troponins are established, further research is needed to confirm the clinical value of other biomarkers like natriuretic peptides, myeloperoxidase, and microRNAs.
- Integrated cardio-oncology approaches combining imaging and biomarkers are essential for timely management of cardiovascular side effects from cancer therapies.
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