bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality and major adverse cardiac events in women with breast cancer receiving radiotherapy: a 10-year cohort study of patients and population controls
Authors: Jacobs J , L'hoyes W , Lauwens L , Weltens C , Voigt J U , Wildiers H , Neven P , Herrmann J , Thijs L , Staessen J , Janssens S , Van Aelst L 
Published: October 2022

Abstract

Background
Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for recommending this interval is unclear and informed the objective of this study.

Objectives
Study cardiovascular event rates in the first decade following curative radiotherapy for breast cancer, the time frame before guidelines recommend screening.

Methods
We performed a monocentric, retrospective study enrolling all women with unilateral BC in 2007–2008, who received radiotherapy as part of their curative treatment. We compared event rates during 10 years follow-up with an age and risk factor-matched control population (FLEMENGHO population).

Results
We included 1095 BC patients (median age 55y, IQR: 47–66y). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality accounted for 107 (49.1%) and 22 (10.1%) deaths, respectively. The incidence of coronary artery disease was similar compared to age and risk-matched women [risk ratio 0.75 (95% CI 0.48–1.18)], yet heart failure (HF) [risk ratio 1.97 (95% CI 1.19–3.25)] and atrial fibrillation or flutter (AF) (risk ratio 1.82 (95% CI 1.07–3.08) occurred more often. Age [HR 1.040 (95% CI 1.012–1.069)], tumor grade [HR 1.646 (95% CI 1.103–2.458)], and neo-adjuvant treatment setting [HR 3.079 (95% CI 1.432–6.620)] were risk factors for mortality; hormonal therapy [HR 0.007 (95% CI 0.001–0.042)] proved protective. Risk factors for MACE were mean heart dose [HR 1.079 (95% CI 1.012–1.151], hormonal therapy, history of cardiovascular disease [HR 2.771 (95% CI 1.253–6.126)], and Mayo Clinic Cardiotoxicity Risk Score [HR 2.547 (95% CI 1.538–4.217)]. While mean heart dose [HR 1.141 (95% CI 1.017–1.282)] and cardiovascular history [HR 3.374 (95% CI 1.259–9.043] clearly associated with new onset HF, only a trend towards higher AF burden with increasing mean heart dose could be observed.

Conclusions
Ten-year mortality following curative treatment for unilateral BC was mainly cancer-related. HF and AF constituted significantly increased risks in the first decade following irradiation. Mean heart dose, pre-existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for early cardiac mortality and adverse events and should guide early dedicated cardio-oncological follow-up.

Funding Acknowledgement
Type of funding sources: None.
Coronary calcification is independently associated with major adverse cardiovascular events in men with recurrent prostate cancer while aortic calcification is not
Authors: Som A , Shaikh P , Deng A , Deych E , Zhang K 
Published: October 2022

Abstract

Background
Cardiovascular disease is an important cause of morbidity and mortality in men with prostate cancer. Coronary and aortic calcification have been associated with major adverse cardiovascular events (MACE) in the general population, and are readily seen on staging cancer positron emission tomography (PET)/computed tomography (CT) scans. The utility of vascular calcification on non-gated CT for cardiovascular risk assessment in men with prostate cancer is not known.

Purpose
We determined the association between coronary and aortic calcification on non-gated CT imaging and MACE in men with prostate cancer.

Methods
We studied 354 men who underwent indium-111 capromab pendetide PET/CT for recurrent prostate cancer at our institution between 2012–2016. Clinical data were obtained from the medical record. Coronary and aortic calcification were qualitatively assessed using a standardized scoring system. The primary outcome of MACE included myocardial infarction, stroke, coronary and/or peripheral revascularization, heart failure hospitalization, and all-cause mortality.

Results
Over 5 years of follow-up, 63 patients (18%) met the primary outcome. Vascular calcification was common in this cohort (median 68 years of age), with 214 patients (60%) having coronary calcification and 296 patients (84%) having aortic calcification. Older patients had greater coronary and aortic calcification, and also higher rate of MACE. In adjusted models for age and diabetes, coronary calcification was associated with higher rate of MACE (hazard ratio [HR] 2.1, interquartile range [IQR] 1.1–4.0, p=0.02) while aortic calcification was not (HR 2.7, IQR 0.8–9.0, p=0.12). Undifferentiated vascular calcification was not associated with MACE (p=0.24).

Conclusions
Coronary calcification on non-gated CT scan is independently associated with MACE in men with recurrent prostate cancer while aortic calcification is not. The presence of coronary calcification should be included in staging PET/CT reports, and this information should prompt implementation of cardiovascular risk modification strategies.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This study was supported by the Mentors in Medicine Program, Department of Internal Medicine, Washington University School of Medicine.
Basal characteristics of the prospective spanish immunotherapy registry of cardiovascular toxicity: SIR-CVT
Authors: Zatarain-Nicolas E , Perez-Ramirez S , De Castro J , Martin-Garcia A , Del Barco E , Mesa Rubio D , De La Haba J , Martinez Monzonis M A , Aguin Losada S , Lozano Palencia T , Martinez-Banaclocha N , Gomez-Rubin M C , Cortez-Castedo P , Martin P , Lopez-Fernandez T 
Published: October 2022

Abstract

Background
The immune checkpoint inhibitors (ICI) have improved the prognosis of many cancers in the last years but concerning cardiovascular toxicity (CVtox) have been reported. Nowadays, specific surveillance protocols are lacking, and early diagnosis of toxicity may be challenging.

Purpose
To characterize the cardiovascular (CV) effects of immunotherapy and to seek for the mechanisms of CVtox of ICI in a protocolize surveillance program of cardio-oncology.

Methods
A multicentre national registry was developed by a research consortium of scientific societies of Cardiology and Oncology (SEC and SEOM) and the cardiovascular research centre (CNIC) in Spain (Figure 1). A total of 18 hospitals participate in recruiting since Q4 2021. A follow-up protocol was stablished with clinical, electrocardiographic (EKG), echocardiography, cardiac magnetic resonance (CMR) and laboratory assessment, including cardiac biomarkers, inflammatory panel and the expression of miR-721, a specific myocarditis biomarker. Toxicity management is performed at each institution following international guidelines.

Results
53 patients were currently included. Median age was 68 [59, 75] years-old, 79% were male. 83% had at least 1 CV-risk factor (75% smoking history, 20% diabetes mellitus, 50% hyperlipemia, 57% hypertension, 19% chronic kidney injury) and up to34% had previous CV disease. 93% had at least one dose of COVID19 vaccine. Dyspnoea was referred by 23% of patients, 28% have abnormal EKG findings and one-third (33%) abnormal cardiac biomarkers (median Troponin I-hs 5.30 [2.60, 11.00]; NT-proBNP 199 [68, 736]). Mean LVEF (60% [56.15, 66.78]) and GLS (−18 [−19.75, −16]) were within the normal range but 26% showed LGE at baseline. Cancer characteristics are summarized in Table 1.

Conclusion
Real-world SIR-CVT patients show a high CV risk profile and frequent pre-existing CV diseases before ICI treatment. The prospective follow-up of this cohort will help to develop personalized surveillance protocols according to baseline CVtox risk and to define different grades of cardiotoxicity.

Funding Acknowledgement
Type of funding sources: None.
The importance of cancer in the prediction of embolic and hemorrhagic risk in patients with atrial fibrillation
Authors: Lizancos Castro A , Raposeiras Roubin S , Abu-Assi Alnakeeb E , Dominguez Erquicia P , Parada Barcia J A , Ledo Pineiro A , Noriega Caro V , Gonzalez Garcia A , Iglesias Otero C 
Published: October 2022

Abstract

Introduction
Cancer is a prevalent disease and is associated with a two-fold greater risk of developing cardiovascular disease. Atrial fibrillation (AF) is a common cardiovascular comorbidity among oncologic patients and the co-occurrence of these two represents several clinical challenges. Many cancers interact with the coagulation system and the representation of this population in clinical trials with cardiovascular drugs is scarce. Thus the impact of cancer regarding clinical outcomes in patients with AF is unclear.

Purpose
The aim of this study was to assess how cancer influences the prediction ability of embolic and hemorrhagic risk in patients with AF.

Methods
The study population comprised 16,056 patients from a Spanish health area diagnosed with AF between 2014 and 2018 of whom 1,137 (7.1%) had a history of cancer. During a median follow-up of 4.9 years we assessed the relationship between cancer and bleeding and embolic events by competing risk analysis considering death a competing risk.

Results
After adjusting for age, sex, CHA2DS2-VASC score, HAS-BLED score and anticoagulation therapy, cancer was not associated with a higher risk of embolic events (sHR 0.73, 95% CI 0.41–1.26; p=0.256). Neither was an association between an increased rate of embolic events and cancer detected, overall (sHR 0.73, 95% CI 0.41–1.26), regarding active cancer, or any subgroup of cancer. However, cancer was associated with an increased risk of bleeding specifically in patients with active cancer (sHR 1.42, 95% CI 1.20–1.67) or prior radiotherapy (sHR 1.40, 95% CI 1.19–1.65). Both CHA2DS2-VASC and HAS-BLED scores showed a suboptimal performance to predict embolic and bleeding risk in non-anticoagulated patients with active cancer (c-statistic &lt;0.50). Discrimination and calibration ability of ATRIA and HEMORR2HAGES bleeding risk scores was also poor in patients with cancer (c-statistic &lt;0.6 and Brier score &gt;0.1). Moreover, the ratio between the increase in bleeding and decrease in embolic events in anticoagulated patients was similar in those with and without cancer (5.6 vs 7.8 bleeding events, p&lt;0.001).

Conclusion
Cancer was associated with an increased risk of bleeding but not an increased risk of embolic events. Neither the CHA2DS2-VASC nor the HAS-BLED scores showed a good performance for predicting embolic and hemorrhagic events in AF patients with active cancer. The embolic-hemorrhagic ratio profile of anticoagulation was similar in patients with and without cancer, and parallel to cancer-free patients, anticoagulation significantly reduced embolic events while increasing bleeding risk in oncological patients.

Funding Acknowledgement
Type of funding sources: None.
Effect of 1st line treatment on aortic inflammation as assessed by 18 FDG PET/CT in patients with Hodgkin and non-Hodgkin lymphoma
Authors: Solomou E , Terentes-Printzios D , Kafouris P , Pouli A , Sioni A , Giannouli S , Metaxas M , Angelopoulou M , Ioakimidis N , Aggeli C , Voulgarelis M , Tousoulis D , Tsioufis C , Anagnostopoulos C D , Vlachopoulos C 
Published: October 2022

Abstract

Background
Despite advances in the treatment of oncology patients, therapy-related side effects may lead to premature morbidity among cancer survivors. Inflammatory activation that has been linked to cardiovascular disease is particularly crucial for the pathogenesis of both Hodgkin (HL) and non-Hodgkin lymphoma (NHL).

Objectives
To assess the vascular effects of chemotherapy in patients with HL and NHL by 18-Fluorodeoxyglucose (FDG PET/CT) and to investigate possible interactions with systemic inflammation as assessed by circulating inflammatory markers.

Methods
Between July 2015 and July 2019, sixty-five consecutive patients (37 males, mean age 56±17.8 years) with histologically confirmed new diagnosis of either HL (n=33) or NHL (n=32), were prospectively studied. PET/CT imaging was performed at baseline, at an interim phase and after 1st line treatment. Aortic FDG uptake was assessed by measuring global aortic TBR. Serum interleukin-6 (IL6) and interleukin-1b (IL1b) were measured at each phase for all patients and served as circulating inflammatory markers.

Results
Patients with HL demonstrated significant reduction in aortic TBR after 1st line treatment (aortic TBRbaseline=1.98, aorticTBR3rdscan=1.75, p=0.001, F=8.335), which remained significant after adjustment for 10-year cardiovascular risk (Framingham risk score), dyslipidemia, hypertension and diabetes (p=0.002, F=7.664). In contrast, patients with NHL did not demonstrate a significant aortic inflammation response (aortic TBRbaseline = 2.13, aorticTBR3rd scan=2.015, p=0.596, F=0.527), Figure 1. Regarding inflammatory markers, after 1st line treatment IL6 levels were reduced significantly in both HL and NHL groups (IL6baseline HL=3.25, IL6 post 1st line treatment HL=0.448, p=0.00; IL6baseline NHL=0.475, IL6 post 1st line treatment NHL=0.144, p=0.001); IL1b levels did not change significantly in either group, Table 1.

Conclusions
We demonstrate for the first time that aortic inflammation as assessed by 18-FDG PET-CT is reduced in HL patients after 1st line treatment but not in NHL patients. These findings imply that different pathophysiological pathways and different therapies might affect the arterial bed in different ways in lymphoma patients. Further, a strong potential role of molecular imaging in cardio-oncology emerges, offering valuable information on disease prognosis and progression with a single examination.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Hellenic Society of Hypertension
High risk of cardiovascular disease in curatively treated patients with oesophageal cancer: a Danish cohort study
Authors: Soendergaard M , Nordsmark M , Nielsen K M , Valentin J B , Johnsen S P , Poulsen S H 
Published: October 2022

Abstract

Background
The cardiovascular disease (CVD) burden among patients with oesophageal cancer (EC) treated with curative intent is unclear.

Purpose
To determine CVD incidence and all-cause mortality in patients with EC.

Material and methods
Danish national health registries were used to identify patients diagnosed with primary EC between 2008 and 2018. Each EC patient was matched with ten individuals from the general population. The primary endpoint was a CVD hospital contact (CVD-HC), either admission or outpatient contact. Secondary endpoints were all-cause mortality and five specific CVD endpoints evaluated separately: atrial fibrillation, ischemic heart disease, heart failure, perimyocarditis, and venous thromboembolism. Using registries, all endpoints were assessed up to ten years following the EC diagnosis.

Results
The study included 1,525 patients with EC matched to 15,250 individuals from the general population. Patients with EC had a post-diagnosis one-year adjusted hazard ratio (HR) of CVD-HCs of 6.1 (95% CI: 5.6 to 6.8) compared with the general population. During the next nine years, the risk of CVD-HC was comparable between the two cohorts with an adjusted HR of 1.0 (95% CI: 0.9 to 1.3) (Figure 1). Patients with EC, particularly those with prevalent CVD (29%) had a high risk of ischemic heart disease with a one-year HR of 6.2 (95% CI: 3.7 to 10.4). The risk of venous thromboembolism and atrial fibrillation was 14-fold and four-fold elevated within the first year after EC diagnosis compared to the general population. After EC diagnosis, all-cause mortality was, as expected, increased in patients with EC compared with the general population. However, prevalent CVD among patients with EC did not appear to be associated with higher all-cause mortality.

Conclusion
CVD morbidity was transiently increased in the first year following EC diagnosis compared with the general population. All-cause mortality risks were high but did not appear to be affected by prevalent CVD. The very high risk of CVD in curatively treated patients with EC calls for healthcare initiatives to advance preventive and post-treatment strategies.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Cancer SocietyCarpenter Jorgen Holm and Wife Elisa F. Hansen's Memorial Scholarship
Clinical and pathologic features of out-of-hospital cardiac arrest in pregnancy: insights from a state-wide registry
Authors: Paratz E , Rowe S , Van Heusden A , Thompson T , Morgan N , Smith K , James P , Pflaumer A , Connell V , Semsarian C , Ingles J , Parsons S , Stub D , Zentner D , La Gerche A 
Published: October 2022

Abstract

Background
Cardiovascular disease is the most common cause of indirect maternal mortality worldwide, and cardiac arrest occurs in up to 1 in 12,000 pregnancies.

Objective
To define rates, clinical and pathologic factors of out-of-hospital cardiac arrest (OHCA) in pregnant and post-partum females.

Methods
A prospective state-wide cardiac arrest registry combining ambulance, hospital and forensic data captured all OHCAs from 2019–2021. Clinical and pathological details for pregnant patients were identified.

Results
1,482 OHCAs occurred, including 376 females of child-bearing age of whom eight were pregnant or post-partum. OHCA incidence was lower in pregnant females compared to non-pregnant females of child-bearing age (5.2 OHCAs per 100,000 pregnant females vs 23.1 per 100,000 females of child-bearing age, p&lt;0.0001). Seven patients (87.5%) died, with five (62.5%) having a cardiac cause of OHCA (unascertained = 2, cardiomyopathy = 2 (1 hypertrophic), ischemic heart disease = 1). Two patients had pre-existing cardiac risk factors, but none had a cardiac diagnosis pre-arrest. Compared to in-hospital cardiac arrests (IHCAs) in pregnancy, OHCAs are more likely to have a cardiac cause (odds ratio 3.81) and lower maternal survival (odds ratio 0.09).

Conclusion
Maternal OHCA affects approximately 1 in 20,000 pregnancies with high maternal mortality rates. OHCA occurs at one-quarter the rate in non-pregnant females of child-bearing age. Approximately two-thirds of maternal OHCAs had an underlying cardiac cause, but low rates of cardiac diagnosis pre-arrest. OHCAs differ markedly from IHCAs in pregnant females, requiring ongoing evaluation as to specific causes and preventability.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF
Gestational diabetes, preeclampsia and the maternal heart
Authors: Thiru S , Ansari F , Cubbon R , Forbes K , Chowdhary A , Jex N , Kotha S , Morley L , Xue H , Kellman P , Greenwood J P , Plein S , Everett T , Scott E , Levelt E 
Published: October 2022

Abstract

Background
Gestational diabetes mellitus (GDM) and preeclampsia (pE) are both associated with an increased risk of cardiovascular mortality and morbidity, including an increased risk of developing heart failure in later life. Both conditions are increasing in prevalence; GDM affects up to 12% and pE affects 3–5% of pregnancies worldwide. Compromised cardiac energy production is an important contributor to most forms of heart disease. The changes in myocardial energetics in GDM and pE have not been characterised previously.

Purpose
We sought to assess if women with GDM and women with pE in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function or tissue characteristics.

Methods
Thirty-eight healthy pregnant (HP) women, thirty women with GDM and fifteen women with pE were recruited, matched for age and ethnicity. Participants underwent phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance for assessment of myocardial energetics (phosphocreatine to ATP ratio (PCr/ATP)), tissue characteristics, biventricular volumes and ejection fractions, left ventricular (LV) mass, global longitudinal strain (GLS) and mitral in-flow E/A ratio.

Results
The biochemical characteristics and multiparametric MR results are given in Table 1.
The women in the GDM and the pE groups had higher body-mass index. There was a stepwise increase in the systolic and diastolic BP from the HP to the GDM to the pE group. There was no difference in NTproBNP concentrations between the groups. The gestational weight gain was higher in women with GDM and pE compared to the HP group.
The women in the GDM and the pE groups showed similar reductions in myocardial PCr/ATP ratios compared to HP group (Figure 1a), accompanied by lower LV end-diastolic volumes and higher LV mass (Figure 1b) and enhanced LV concentricity in both groups (Figure 1c). While LV ejection fractions were similar across the groups, the GLS was reduced in women with GDM and in women with pE (Figure 1d).

Conclusions
We show here for the first time that despite no prior diagnosis of diabetes or hypertension, women with GDM or pE manifest impaired myocardial contractility and higher LV mass, associated with reductions in myocardial energetics. These findings may aid our understanding of the long-term cardiovascular risks associated with these conditions.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust
Hypertensive disorders in pregnancy increase subsequent risk of ischaemic cardiovascular events: genetic evidence from a Mendelian randomisation study
Authors: Rayes B , Ardissino M , Slob E , Johnson M , Ng F S 
Published: October 2022

Abstract

Background
Hypertensive disorders in pregnancy are major causes of maternal and foetal morbidity and have also been associated with long-term maternal risk of cardiovascular diseases. Whilst many retrospective and prospective cohort studies have explored this relationship, it is difficult to make causal inferences from observational studies due to potential residual confounding and bias. Leveraging genetic data predisposing to exposures and outcomes in instrumental variable analysis, Mendelian randomisation (MR) can provide valuable information for causal inference. The aim of this study is to use MR to investigate the relationship between hypertensive disorders in pregnancy and cardiovascular diseases.

Methods
Uncorrelated single nucleotide polymorphisms (SNPs) were selected as instrumental variables from the FinnGen consortium summary statistics for the exposures of any hypertensive disorder in pregnancy, and its two subgroups of gestational hypertension, and pre-eclampsia or eclampsia. Genetic association estimates for outcomes were extracted from GWAS studies of 122,733 for coronary artery disease, 34,217 cases for ischaemic stroke, 47,309 cases for heart failure and 60,620 cases for atrial fibrillation. All studies included patients predominantly of European ancestry. Primary analysis was conducted using inverse-variance weighted MR.

Results
Hypertensive disorders in pregnancy were associated with increased risk of coronary artery disease (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08–1.43; p=0.002); and this association was evident for both gestational hypertension (OR= 1.08; 95% CI: 1.00–1.17; p=0.040) and pre- or eclampsia (OR=1.06; 95% CI: 1.01–1.12; p=0.030). Hypertensive disorders in pregnancy were also associated with increased risk of ischaemic stroke (OR=1.27; 95% CI: 1.12–1.44; p=2.87x10–4). Neither gestational hypertension nor pre-eclampsia were independently associated with increased risk of ischaemic stroke, though effect estimates were consistent in direction. No associations were noted between the three hypertensive disorders in pregnancy and the outcomes of heart failure or atrial fibrillation.

Conclusions
Our findings provide genetic evidence that supports a likely causal association between hypertension in pregnancy and increased risk of coronary artery disease and stroke. This is consistent with observational evidence and supports the classification of hypertensive disorders in pregnancy as risk factors for cardiovascular disease.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council GEPSI 946647 for EAWSBritish Heart Foundation RG/16/3/32175 for FSN