Biomarker Discovery in Cardio-Oncology

Purpose of Review

In this article, we review current and emerging approaches to biomarker discovery to facilitate early diagnosis of cancer therapy-associated cardiovascular toxicity.

Recent Findings

Although small studies have demonstrated an association between established biomarkers of cardiac injury (troponins and brain natriuretic peptide) and acute or subacute cardiotoxicity, there is insufficient evidence to support their use in routine clinical care. Preclinical studies to define the molecular mechanisms of cardiotoxicity, as well as the use of unbiased “omics” techniques in small patient cohorts, have yielded promising candidate biomarkers that have the potential to enrich current risk stratification algorithms.

Summary

New biomarkers of cardiotoxicity have the potential to improve patient outcomes in cardio-oncology. Further studies are needed to assess the clinical relevance of molecular mechanisms described in animal models. Similarly, findings from “omics” platforms require validation in large patient cohorts before they can be incorporated into everyday practice.

     

Exercise and Cardio-Oncology Rehab

Current Treatment Options in Cardiovascular Medicine - To evaluate the evidence supporting the use of exercise training as a treatment strategy to reduce risk of cardiovascular disease (CVD) in...     

Cardio-Oncology: Role of Echocardiography

Current therapies for cancer have improved life expectancy of patients. Breast cancer and lymphoma survivors in up to 26% of cases can develop complications as a consequence of the chemotherapeutic and radiotherapeutic treatments. Echocardiography is a noninvasive method that can in all stages of cancer treatment perform a comprehensive evaluation and detect coronary, myocardial, valve and pericardial disease complications secondary to the therapeutic regimen used (radiotherapy and/or chemotherapy). Three-dimensional echocardiography derived left ventricular ejection fraction (LVEF) has an excellent correlation with cardiac magnetic resonance imaging and can be used to monitor LVEF; 2-dimensional speckle tracking echocardiography (2D-STE) derived strain and strain rate can detect changes in myocardial mechanics before changes in LVEF occur and can predict a future decrease in ejection fraction to less than 50% or of greater than 10% indicative of cardiotoxicity. Echocardiography should be used as the method of choice to evaluate serial changes in heart function, detect late side effects of treatment, and to identify patients at risk of a future decrease in LVEF.     

The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients

Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease. While there is limited evidence for the use of CT imaging in cancer patients, we will discuss the utility of cardiac CT in the detection and management of coronary artery disease, pericardial and valvular heart disease.