Patients On Chemotherapy Who Have Heart Disease: Barry Ramo

4/9/2015
Cardio-Oncology for the Primary
Care Provider
as a result of the treatment.
Barry W. Ramo, MD,FACC
New Mexico Heart Institute
April 11, 2015
what is the least likely cause of
death for a patient who has
survived one cancer?
1. Cancer
2. Heart Disease
what is the most likely cause of
death for a patient who has
survived cancer?
1. Cancer
2. Heart Disease
Cancer patients are cured of
one life-threatening disease,
only to succumb to another —
heart failure —
1
4/9/2015
Cardiac Care of Patients with
Cancer
CV Evaluation, Risk Factors
Survival
Cancer
Diagnosis.
Cytotoxic Rx
Targeted XRT
Cardiac Care
• Cardiac
• CV
Toxicity
disease
• Strain
• Premature
,EF,Biomar
death
ker
• MRI
Primary Care Provider Role in Caring
for their Patients with Cancer
 Diagnosis
 During Therapy
 Post Therapy
Therapeutic and Cardiotoxic
Agents
Type 1
Anthrcyclines
Type 2
Herceptin
TARGETED THERAPY
• Tyrosine Kinase inhibitors
• VEGF Inhibitors
2
4/9/2015
Conflicting Goals
Maximize
therapeurtic
benefit
Kill the Prevent cancer
Cancer therapeutics
related cardiac
dysfunction
(CTRCD)
Detection of Early Toxicity
• Biomarkers: BNP, Troponin
• Left ventricular dysfunction
• Cardiac MR
Detection of Risk for Deterioration of Cardiac
Function after anthracyclines and Herceptin
• Predictors at 3 months
HS Troponin
Myocardial strain
• Not Predictive
• BNP
• Ejection Fraction
3
4/9/2015
Prevention of Cardiotoxicty
• Limited Data
• Beta Blocker, ACE-I combination in small
studies reduced LV dsyfunction Iib
recommendation
OVERDRIVE: EnalapriI + Carvedilol
With intensive Chemotherapy .
N=90
Mortality
6%
Mortality
22%
6.2%
33%
Cardiac Care of Patients with
Cancer
CV Evaluation, Risk Factors
Cardiac Care
Survival
Cancer
Diagnosis.
Cytotoxic Rx
Targeted XRT
•
•
•
Cardiac
Toxicity
Strain
,EF,Bioma
rker
MRI
• Late heart
failure
• HBP
• Optimize Risk
Factors
4
4/9/2015
Thank You
5