Cardiac Ejection Fraction
Trastuzumab associated with cardiotoxicity in elderly women with risk factors
Elderly women with breast cancer and a history of heart disease are at a particularly higher risk for heart problems when treated with trastuzumab for their disease, according to data from a recent study.
“Trastuzumab is a current standard of care in HER2-positive breast cancer patients,” Cesar Serrano, MD, clinical fellow at the Department of Medical Oncology Breast Cancer Centre at the Vall d’Hebron University Hospital in Barcelona, Spain, and colleagues wrote in their study. “Although well tolerated, concerns about cardiotoxicity have recently led to a push to identify patients at risk of developing treatment-related cardiac events.”
Story continues below
Serrano and colleagues analyzed data for 45 women aged 70 to 92 years who were treated with trastuzumab (Herceptin, Genentech) since 2005. According to their results, 26.7% of patients developed a treatment-related cardiac event; 17.8% developed asymptomatic left ventricular ejection fraction (LVEF) decline; and 8.9% developed symptomatic congestive heart failure. All patients who developed asymptomatic cardiac events recovered after treatment discontinuation. All but one patient who developed symptomatic congestive heart failure recovered in a median of 5 weeks.
Women with CV risk factors, like history of cardiac disease and diabetes, were more likely to have treatment-related cardiotoxicity: 33% of those with a history of heart disease vs. 9.1% of those without ( P =.017) and 33.3% of those with diabetes vs. 6.1% of those without ( P =.010).
“Approximately 70% of all newly diagnosed cancers occur in patients older than 65 and, given the expected increase in the absolute number of elderly patients over the coming decades in Western countries, there is an unmet need for information about the efficacy and safety of anti-cancer treatments in daily clinical practice,” Serrano said in a press release. “Data obtained in this report can serve to advise clinicians to be aware of symptomatic and asymptomatic cardiac dysfunction in elderly patients. We think that it is reasonable to refer elderly breast cancer patients to a cardiologist if one or more cardiovascular risk factors are present before or during treatment with trastuzumab. Moreover, a closer surveillance of early symptoms and cardiac function is highly recommended.
Cardiac Ejection Fraction - News
According to their results, 26.7% of patients developed a treatment-related cardiac event; 17.8% developed asymptomatic left ventricular ejection fraction (LVEF) decline; and 8.9% developed symptomatic congestive heart failure.
Explain that a risk model that includes factors other than left ventricular ejection fraction proved better at predicting sudden cardiac death among postmenopausal women with coronary artery disease.
More than a fourth of patients had clinically significant declines in left ventricular ejection fraction (LVEF) during treatment with the anti-HER2 antibody. Two-thirds of the episodes (8 of 12) were asymptomatic. Of the four patients who developed
the majority of 254 cardiac deaths among postmenopausal women with coronary artery disease (CAD), and the independent predictors of SCD improved its prediction when they were considered in addition to left ventricular ejection fraction (LVEF),
The researchers observed that a limitation of their study was that it did not control for CRT-D response or nonresponse because of a lack of information on NYHA class change, left ventricular ejection fraction, and QRS duration during the follow-up
Elsevier Global Medical News
Standard Beats Anesthesia EEG Technique for Preventing Surgery Awareness
BY MARY ANN MOON
Elsevier Global Medical News
Breaking News
A method of administering general anesthesia while monitoring EEG activity to track the patient’s level of consciousness proved to be no better than the standard anesthesia technique at preventing episodes of patient awareness during surgery, according to a study published in the Aug. 18 issue of the New England Journal of Medicine.
“The overall incidence of awareness was lower than anticipated, suggesting that both protocols were likely to have had efficacy, but the finding of fewer cases [with the standard approach than with the EEG method] was contrary to the expected result,” said Dr. Michael S. Avidan of the department of anesthesiology at Washington University, St. Louis, and his associates.
“Notwithstanding major advances in our understanding of consciousness and anesthesia, until we clarify fully the mechanisms and measurement of anesthetic-induced unconsciousness and amnesia, some patients are still likely to have this complication,” the researchers noted.
Unintended intraoperative awareness (defined as the experience and explicit recall of sensory perceptions during surgery) is estimated to occur in approximately 1% of at-risk patients, and can lead to posttraumatic stress disorder. Approximately 20,000-40,000 U.S. patients each year are estimated to experience such awareness while under general anesthesia.
Some factors that appear to raise the risk of unintended awareness while under general anesthesia are a history of the condition during previous surgery, aortic stenosis, pulmonary hypertension, end-stage lung disease, anticipation of difficult intubation, poor exercise tolerance, impaired cardiac ejection fraction, excess alcohol intake, and the use of benzodiazepines, opiates, or anticonvulsants.
The current standard method for monitoring intraoperative patient awareness doesn’t measure consciousness itself, but instead ensures that “enough” anesthetic is used by tracking the end-tidal anesthetic-agent concentration (ETAC). Maintaining this at 0.7 MAC (minimum alveolar concentration) or higher is thought to decrease the incidence of awareness during surgery.
An alternative method is the bispectral index (BIS), which uses a single EEG signal from a sensor on the patient’s forehead to calculate brain activity and produces a numerical readout on a scale from 0 (indicating the suppression of all brain activity) to 100 (indicating a fully awake state). Maintaining a target range of 40-60 on this scale is thought to both prevent awareness and allow reductions in the dose of anesthetic.