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Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Myocarditis III: Medical Management01:14

Myocarditis III: Medical Management

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Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
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Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Cardiomyopathy IV: Restrictive Cardiomyopathy01:29

Cardiomyopathy IV: Restrictive Cardiomyopathy

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Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
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Myocarditis I: Introduction01:21

Myocarditis I: Introduction

52
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
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Immune Checkpoint Inhibitors-Associated Cardiotoxicity.

Chenghui Li1, Sajjad A Bhatti2, Jun Ying3

  • 1Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

Cancers
|March 10, 2022
PubMed
Summary

Immune checkpoint inhibitors (ICIs) can cause cardiotoxicity, with ipilimumab and pembrolizumab showing higher risks than nivolumab. Arrhythmia and myocarditis are common cardiac events within a year of ICI treatment.

Keywords:
cardiac adverse eventscardiotoxicityimmune checkpoint inhibitorsreal-world database

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Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial in cancer therapy.
  • Limited data exists on ICI-associated cardiotoxicity variations across different cancer types and agents.
  • Understanding these differences is vital for patient safety and treatment optimization.

Purpose of the Study:

  • To investigate and compare the incidence and risk of cardiac adverse events (CAEs) associated with various ICI agents and classes.
  • To identify specific ICI treatments that may confer a higher risk of cardiotoxicity.

Main Methods:

  • A large population-based study analyzing data from 5518 cancer patients treated with ICIs.
  • Patients were grouped by their first ICI agent (ipilimumab, nivolumab, pembrolizumab, etc.) or class (PD-1, PD-L1, CTLA4 inhibitors).
  • A competing-risks regression model was used to analyze the time to first CAE within one year, adjusting for patient and cancer characteristics.

Main Results:

  • 12.5% of patients developed cardiotoxicity within 12 months of ICI initiation.
  • Arrhythmia (9.3%) and myocarditis (2.1%) were the most frequent CAEs.
  • Monotherapy with ipilimumab (aHR: 2.00) and pembrolizumab (aHR: 1.21) showed a significantly higher risk of CAEs compared to nivolumab.
  • Avelumab also suggested an elevated risk (aHR: 1.92), though not statistically significant.

Conclusions:

  • Ipilimumab and pembrolizumab monotherapy may increase the risk of cardiotoxicity compared to other ICI agents.
  • Further research is needed to confirm the risks associated with agents like avelumab and to elucidate mechanisms of ICI-induced cardiotoxicity.