Carmine DePasquale

Left and right ventricular effects of anthracycline and trastuzumab chemotherapy: A prospective study using novel cardiac imaging and biochemical markers

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PREVALENCE AND CORRELATES OF ANAEMIA IN ESSENTIAL HYPERTENSION

1 Anaemia is an independent predictor of mortality in pro‐atherosclerotic conditions with impaired endothelial function, such as diabetes and chronic kidney disease. However, the prevalence of anaemia in hypertension, a condition characterized by endothelial dysfunction, is unclear. 2 Haemoglobin concentration, renal function and echocardiographic parameters of 187 consecutive patients (M : F 83 : 104; mean (±SD) age 58 ± 15 years) who underwent ambulatory blood pressure monitoring between 2005 and 2006 were assessed in a tertiary level university hospital. 3 The prevalence of normocytic anaemia in our cohort of hypertensive patients was 16% and was higher in patients with uncontrolled hypertension (20%) than among those with well‐controlled hypertension (4%; P = 0.03). Red cell indices (mean corpuscular volume, mean cell haemoglobin and mean cell haemoglobin concentration) did not differ between the groups. However, the haemoglobin concentration was progressively lower between patients with well‐controlled hypertension and uncontrolled hypertension (P = 0.007). Haematological parameters did not correlate to echocardiographic indices of left ventricular size and function. 4 Normocytic anaemia was highly prevalent in hypertensive patients. Poor blood pressure control was associated with lower haemoglobin concentration. This may indicate a higher cardiovascular risk in uncontrolled hypertension, as in other pro‐atherosclerotic conditions. Additional studies are needed to evaluate the effect of anaemia on morbidity and mortality in hypertensive patients.

Early cardiac changes following anthracycline chemotherapy in breast cancer: a prospective multi-centre study using advanced cardiac imaging and biochemical markers

Summary This prospective study is designed to identify novel ima- ging (utilizing cardiovascular magnetic resonance and advance echocardiography) and biochemical markers to detect early, sub-clinical cardiotoxicity following chemotherapy. Background Cardiac toxicity is an important long term side effect of anthracyline chemotherapy. We hypothesized that novel cardiovascular magnetic resonance (CMR) and echocar- diographic markers of myocardial function, oedema, and necrosis can detect early, subclinical cardiac toxicity in patients receiving anthracycline therapy for breast cancer. recovery fast-spin echo sequence (short-TI inversion recovery) was used in 3 short-axis views of the left ven- tricle. For assessment of myocardial oedema, the ratio of mean signal intensity (SI) of the myocardium was com- pared to that of skeletal muscle. Results In the study patients, the mean CMR LV end-systolic volume index (LVESVI) increased from baseline of 17.8 ± 6.2 to 20.3 ± 5.9 mL/m2 (p 1.9 as specified by Lake Louis criteria) in one or more short axis slices post chemotherapy. There was no new late gadolinium hyperenhancement to suggest focal myocar- dial necrosis/fibrosis in any patient following therapy.

Early and late left ventricular effects of breast cancer chemotherapy: a prospective multi-centre study using advanced cardiac imaging

Background Myocardial dysfunction is a recognized toxicity of anthracycline (A) and herceptin (H) chemotherapy. Whilst there is much current focus on the incidence and magnitude of myocardial dysfunction following the A/H regimen, whether these changes are mediated by reversible or irreversible myocardial injury remains unknown. We sought to determine rates of persistent LV dysfunction at 12 months (as defined by left ventricular ejection fraction (LVEF) decrease by 10% or below lower limits of normal) following A/H and explore the mechanism of myocardial dysfunction using advance cardiac imaging.

Contemporary breast cancer chemotherapy leads to persistent late right ventricular myocardial dysfunction: a prospective multi-centre study

Background Previous studies evaluating cardiac effects of chemotherapy have focussed on the left ventricle (LV) and largely been retrospective. Although right ventricle (RV) systolic dysfunction is an adverse prognostic marker in cardiomyopathy states, the RV effects of chemotherapy are not well defined. Methods

Myocardial perfusion is impaired in asymptomatic patients post renal transplantation

Background Cardiovascular disease is one of the commonest causes of mortality post-renal transplantation (RT), often in patients with no known cardiac disease. The cardiac phenotype in these patients is not clearly defined. Multi-parametric cardiovascular magnetic resonance (CMR) imaging enables concurrent assessment of myocardial function, perfusion and irreversible injury. We hypothesized that myocardial perfusion reserve would be impaired in asymptomatic post-renal transplant patients when compared with hypertensive controls. Methods Twenty-two asymptomatic R Tp atients (3 months to 5 years post-transplant) with, no known history of ischemic heart disease) and 12 hypertensive controls underwent

Quantitative analysis of paravalvular leak of transcatheter aortic valves using cardiac MR

Background There is extensive registry and clinical trial data demonstrating an increased incidence of paravalvular leak following transcatheter aortic valve implantation (TAVI) when compared with aortic valve replacement (AVR). Despite recent improvements in both hardware and software, echocardiographic measurement of aortic regurgitation (AR) largely remains qualitative in nature. Cardiovascular magnetic resonance (CMR) is able to directly quantify AR with high accuracy and reproducibility by using the technique of phase-contrast velocity mapping. We sought to compare CMR quantitative analysis of AR with concurrently collected echocardiographic measurements in patients undergoing both TAVI and open AVR.