George Youssef

The Prevention and Management of Cardiovascular Complications of Chemotherapy in Patients with Cancer

Cardiac toxicity of chemotherapeutic agents is a rapidly evolving area of increasing significance because of the increasing pool of long-term cancer survivors. The spectrum of cardiotoxicity with chemotherapeutic agents includes hypertension, QTc prolongation, acute cardiomyopathy, and bradyarrhythmias. The most common issue to arise has been cardiomyopathy with anthracyclines. Preventative strategies that have met with some success have included the use of less cardiotoxic analogs such as epirubicin and liposomal anthracycline preparations. The cardioprotectant agent dexrazoxane reduces cardiomyopathy but there are significant toxicity issues. Therefore, the main strategy for preventing cardiotoxicity remains careful monitoring with radionuclide angiography or echocardiography. The role of investigational markers of myocardial injury, such as troponin T or brain natriuretic peptide, remains of great interest. Management is according to conventional management of congestive heart failure.Trastuzumab is an antibody therapy directed against the human epidermal growth factor receptor-2 (HER2) receptor, which increases survival in patients with metastatic breast cancer and is under evaluation in the adjuvant setting. It also causes a decrease in left ventricular ejection fraction (LVEF) in a minority of patients. Incidence is increased if trastuzumab is given in conjunction with paclitaxel or anthracyclines. It differs from anthracycline cardiotoxicity in that it is not cumulative dose-dependent and often improves after withdrawal of treatment. Re-treatment with trastuzumab is often possible.Novel agents under development offer a different spectrum of toxicity to existing anticancer drugs and it appears likely that cardiovascular toxicity will be an important issue for many of these drugs, particularly those that target the tumor vasculature.

iConnect CKD - Virtual Medical Consulting: a web-based Chronic Kidney Disease, Hypertension and Diabetes Integrated Care Program.

Chronic kidney disease patients overwhelm specialist services and can potentially be managed in the primary care (PC). Opportunistic screening of high risk (HR) patients and follow‐up in PC is the most sustainable model of care. A ‘virtual consultation’ (VC) model instead of traditional face to face (F2F) consultations was used, aiming to assess efficacy and safety of the model.

Aortic valve laceration following coronary angiography and percutaneous coronary intervention

Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement.

883 BLOOD PRESSURE, FLUID VOLUME, VASCULAR AND VENTRICULAR FUNCTION IN CHRONIC KIDNEY DISEASE

Background: Hypertension (HT) is an early feature of renal disease, and is highly prevalent in patients with chronic kidney disease (CKD) of any stage. HT increases the risk of loss of residual renal function and is associated with increased cardiovascular morbidity and mortality in CKD patients. Fluid retention due to CKD is commonly attributed as a pathogenic cause of hypertension in this population. The aim of this study was to investigate relationships between fluid volume, vascular and ventricular function in different CKD stages. Methods: Patients with essential hypertension (EHT, n = 17), CKD stages 3b-5 (CKD, n = 53), renal transplantation (Tx, n = 31) and peritoneal dialysis (PD, n = 21) underwent ambulatory blood pressure monitoring, augmentation index (AI), cardiac echocardiogram and total body water (TBW) measurement. Results: There was no difference in medication use between groups. 24 hour average diastolic pressure was lower in CKD than EHT, PD and Tx (68 ± 1 vs 76 ± 3* vs 75 ± 3* vs 75 ± 2*mmHg, *p’ < 0.05). AI was lower in Tx than EHT and CKD (17 ± 2 vs 25 ± 2* vs 30 ± 3*, *p’ < 0.05) but not PD (19 ± 3). TBW was higher in CKD than Tx and PD (34 ± 2 vs 15 ± 3* vs 14 ± 4*L, *p’ < 0.05) but not EHT (27 ± 4L, NS). Left ventricular diastolic dysfunction (LVDD) was less prevalent in EHT than CKD, Tx and PD (33% vs 75%* vs 58%* vs 89%*, *p < 0.005) Conclusions: CKD is accompanied by an increase in TBW, AI and LVDD, even when blood pressure is well-controlled. TBW and AI may be reduced by Tx and PD, however, there is persisting LVDD.