Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Tratamiento óptimo de la insuficiencia cardiaca en pacientes con cáncer

174 views

Published on

Ponencia presentada por el Dr. José Luis López-Sendón Hentschel en el directo online ‘Módulo III - Estrategias de prevención y tratamiento de cardiotoxicidad: insuficiencia cardiaca e hipertensión’, realizado en la SEC el 21 de marzo de 2018

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Tratamiento óptimo de la insuficiencia cardiaca en pacientes con cáncer

  1. 1. Optimal treatment of heart failure today José López-Sendón Servicio de Cardiología Hospital Universitario La Paz. Madrid Conflict of inmterest: Research grants and honoraria from (research committees, clinical trials, personal, Institutional) Aspen, Astra-Zeneca, Bayer, Boehringer Ingelheim, Gilead, Lilly / Daiichi-Sankyo, Menarini, Merk, Novartis, Pfizer, Sanofi-Aventis, Servier, Tratamiento óptimo de la insuficiencia cardiaca en pacientes con cáncer
  2. 2. Optimal treatment of heart failure today • El problema. Necesidad de trabajo en equipo • Definición de IC por cardiotoxicidad • Tratamiento • Identificación precoz Tratamiento Insuficiencia Cardiaca en Cancer
  3. 3. Optimal treatment of heart failure todayTratamiento Insuficiencia Cardiaca en Cancer Insuficiencia cardiaca y Cancer • IC antes de Cancer • Aguda, al inicio de quimioterapia • Durante quimioterapia • Años post quimioterapia
  4. 4. Prevención de cardiotoxicidad. Nuevas promesas Long-term survivors of childhood cancer Comparison with siblings Oeffinger et al. NEJM 2006;355:1572 Tratamiento Insuficiencia Cardiaca en Cancer
  5. 5. Teamwork needed! Protocols to detect Ca Cardinale D et al JACC 2010;55:213
  6. 6. Optimal treatment of heart failure today Need to tem work • Some patiens arrive too late to the cardiologist • Some patients visit the cardiologist to often • Both are wrong, malpractice? • Not really but need of team work is clear Cancer and Heart Failure 2018Tratamiento Insuficiencia Cardiaca en Cancer
  7. 7. Optimal treatment of heart failure today • El problema. Necesidad de trabajo en equipo • Definición de IC por cardiotoxicidad • Tratamiento • Prevención Tratamiento Insuficiencia Cardiaca en Cancer
  8. 8. Optimal treatment of heart failure today Cardiopaty Risk Factors Asymptomatic LV Dysfunction Refractory HF Symptomatic HF BNP, biomarkers Symptoms Cardiac Imaging Risk Cancer and Heart Failure 2018Tratamiento Insuficiencia Cardiaca en Cancer
  9. 9. Optimal treatment of heart failure today Cardiopaty Risk Factors Asymptomatic LV Dysfunction Refractory HF Symptomatic HF Control risk factors(hipertensión, …) 2º prevention (estatins…) ACE-i If LVEF < 40 ACE-i BB Aldo B ARNI Ivabradine V asist devices Cancer and Heart Failure 2018Tratamiento Insuficiencia Cardiaca en Cancer
  10. 10. Optimal treatment of heart failure todayCancer and Heart Failure 2018 •Only higher Risk •Early, reversible myocardial damage (NMR) Edema, reversible myocardial damage •Highy sensitivity Troponin •Biomarkers •GLS •Other systolic VF parameters •HFpEF •HFmEF •Asymptomatic LVD (NMR more reliable) •Symptomatic LV dysfunction
  11. 11. Teamwork needed! Protocols to detect Ca Cardio-Oncology protocols in clinical practice CARDIOTOX REGISTRY Abnormal cardiac findings •85% HsTn •28% GLS •10% LVEF •4% Clinical HF •0% basal LVEF if no CV disease and normal ECG Cancer and Heart Failure 2018
  12. 12. Teamwork needed! Protocols to detect Ca Spanish congress of cardiology 2014 High sensitive assays allow detection of more patients with positive Tn at all timepoints Baseline 21 D 3 M 6 M hs-cTnT 8,3 % 17,2 % 53,5 % 36,9 % c-TnI 0 % 3,1 % 25 % 19,2 % hs-cTnT at 6 months c-TnI at 6 months LVEF 42% 24 % GLS 36% 30 % Patients with positive troponin values and without cardiotoxicity in ECHO Cardio-Oncology protocols in clinical practiceCancer and Heart Failure 2018
  13. 13. Optimal treatment of heart failure today • El problema. Necesidad de trabajo en equipo • Definición de IC por cardiotoxicidad • Tratamiento • Identificación precoz Tratamiento Insuficiencia Cardiaca en Cancer
  14. 14. Optimal treatment of heart failure today Prevention of Heart Failure • Statins, Betablockers, Ace-i • Dexrazosane Inconclusive data Cancer and Heart Failure 2018
  15. 15. Optimal treatment of heart failure todayESC Guide 2016 Heart Failure ESC HF-Guide 2016
  16. 16. Optimal treatment of heart failure today Drug treatmetn of HFrEF Indications Controls All patients Alternative / intolerant to ACEi All patients All patients Sinus HR ≥ 70 ACE-i ARB ß-blockers Aldosterone-i Ivabradine TA, Cr, K+ , Na+ TA, Cr, K+ , Na+ TA, FC Cr, K + , Na + FC Fluid retentionDiuretics TA, Cr, K + , Na + Substitutes ACEi/ARBs If persisting symptomsLCZ 696 TA, Cr, K + , Na + Cancer and Heart Failure 2018
  17. 17. Optimal treatment of heart failure today • El problema. Necesidad de trabajo en equipo • Definición de IC por cardiotoxicidad • Tratamiento • Identificación precoz Tratamiento Insuficiencia Cardiaca en Cancer
  18. 18. Optimal treatment of heart failure todayCancer and Heart Failure 2018 Annals of Oncology 2012; 23:156-166
  19. 19. Optimal treatment of heart failure todayCancer and Heart Failure 2018
  20. 20. Teamwork needed! Protocols to detect Ca • Cancer • Potentially toxic chemotherapy • Thoracic radiotherapy • Previous cardiotoxicity • CV disease • Any abnormal ECHO • Smoker • High cholesterol (Col LDL > 115) • Hypertension (>BP<140/90 mm Hg) • Diabetes (Glucose > 126; HbA1C > 6,5) • Renal dysfunction CrCl < 60 ml/min • Use of verapamil, diltiazem, antiarrhythmics… • CV Symptoms (dyspnoea, angina, syncope, palpitations) • Suspected PVD (Leg pain walking, other) • High TnT • Abnormal ECG Any Yes Cardio-Oncology Consult Follow guidelines / local protocols for each setting yesNo History CV Risk Factors Symptoms Tests yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo yesNo First Visit
  21. 21. Teamwork needed! Protocols to detect Ca • Previous cardiotoxicity • CV disease • Any abnormal ECHO • CV Risk factors • Suspected CV disease • TnT in each chemo cycle • ECG at the end of treatment • ECG at the end of follow-up • ECHO at the end of treatment • Echo at the end of Follow-up • Echo every 5 years Any Yes Cardio-Oncology Consult Follow guidelines / local protocols for each setting YesNo Follow-up YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo YesNo Cardio-Oncology protocols in clinical practice
  22. 22. Optimal treatment of heart failure today Conclusion • Cardiotoxicidad término más amplio que insuficiencia cardiaca • Trabajo en equipo para identificación precoz • Protocolos de seguimiento locales según medios • Tratamiento IC idéntico al de otras cardiopatías Tratamiento Insuficiencia Cardiaca en Cancer

×