Кардиотоксичность – прямое неблагоприятное воздействие противораковых препаратов на функцию или структуру сердца, возникающее как во время лечения, так и через много лет после него. Проявления кардиотоксичности могут быть самыми различными: сердечная недостаточность, ишемическая болезнь сердца, кардиомиопатия, миокардит, перикардит и аритмии, в том числе фибрилляция предсердий (ФП). Частота выявления ФП в популяции онкологических пациентов, проходящих терапию, составляет 20–30%. Современные возможности дистанционного мониторинга электрокардиограммы обеспечивают своевременное выявление и лечение ФП у онкологических пациентов, в том числе назначение антикоагулянтов. В статье представлен клинический случай пациента 59 лет с плоскоклеточным раком нижней трети пищевода, у которого после 1-го курса полихимиотерапии по схеме TPF (доцетаксел, цисплатин, 5-фторурацил) выявлена ФП с помощью одноканального монитора электрокардиограммы в чехле смартфона.
Cardiotoxicity is the direct adverse effect of anticancer agents on the function or structure of the heart, occurring both during treatment and many years later. The manifestations of cardiotoxicity can be very different: heart failure, coronary heart disease, cardiomyopathy, myocarditis, pericarditis, and arrhythmias, including atrial fibrillation (AF). The incidence of AF in the cancer patient population during therapy is 20–30%. Current options of remote electrocardiogram monitoring ensure the timely detection and treatment of AF in cancer patients, including the administration of anticoagulants. The article presents a clinical case of a 59-year-old patient with squamous cell carcinoma of the lower third of the esophagus after the first course of the TPF polychemotherapy regimen (docetaxel, cisplatin, 5-fluorouracil) with AF detected using a single-channel electrocardiogram monitor in a smartphone case.
1. Xiao D, Li J, Liu Y, et al. Emerging trends and hotspots evolution in cardiotoxicity: A bibliometric and knowledge-Map analysis From 2010 to 2022. Front Cardiovasc Med. 2023;10:1089916. DOI:10.3389/fcvm.2023.1089916
2. Hajjar LA, Fonseca SMR, Machado TIV. Atrial fibrillation and cancer. Front Cardiovasc Med. 2021;8:590768. DOI:10.3389/fcvm.2021.590768
3. Jakobsen CB, Lamberts M, Carlson N, et al. Incidence of atrial fibrillation in different major cancer subtypes: A Nationwide population-based 12 year follow up study. BMC Cancer. 2019;19(1):1105. DOI:10.1186/s12885-019-6314-9
4. Lancellotti P, Marechal P, Donis N, Oury C. Inflammation, cardiovascular disease, and cancer: A common link with far-reaching implications. Eur Heart J. 2019;40(48):3910-2. DOI:10.1093/eurheartj/ehz645
5. Alexandre J, Salem JE, Moslehi J, et al. Identification of anticancer drugs associated with atrial fibrillation: analysis of the WHO pharmacovigilance database. Eur Heart J Cardiovasc Pharmacother. 2021;7(4):312-20. DOI:10.1093/ehjcvp/pvaa037
6. Herrmann J. Adverse cardiac effects of cancer therapies: Cardiotoxicity and arrhythmia. Nat Rev Cardiol. 2020;17(8):474-502. DOI:10.1038/s41569-020-0348-1
7. Ahmad J, Thurlapati A, Thotamgari S, et al. Anti-cancer drugs associated atrial fibrillation-an analysis of real-world pharmacovigilance data. Front Cardiovasc Med. 2022;9:739044. DOI:10.3389/fcvm.2022.739044
8. Riess H, Ay C, Bauersachs R, et al. Use of direct oral anticoagulants in patients with cancer: Practical considerations for the management of patients with nausea or vomiting. Oncologist. 2018;23(7):822-39. DOI:10.1634/theoncologist.2017-0473
9. Grymonprez M, De Backer TL, Bertels X, et al. Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study. Front Pharmacol. 2023;14:1125576. DOI:10.3389/fphar.2023.1125576
10. Ording AG, Horváth-Puhó E, Adelborg K, et al. Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: A Danish nationwide population-based cohort study. Cancer Med. 2017;6(6):1165-72. DOI:10.1002/cam4.1054
11. Angelini DE, Radivoyevitch T, McCrae KR, Khorana AA. Bleeding incidence and risk factors among cancer patients treated with anticoagulation. Am J Hematol. 2019;94(7):780-5. DOI:10.1002/ajh.25494
12. Wu VC, Wang CL, Huang YT, et al. Novel oral anticoagulant versus warfarin in cancerpatients with atrial fibrillation: An 8-year population-based cohort study. J Cancer. 2020;11:92-9. DOI:10.7150/jca.36468
13. Deng Y, Tong Y, Deng Y, et al. Non-vitamin K antagonist oral anticoagulants versus warfarin in patients with cancer and atrial fibrillation: A systematic review and meta-analysis. J Am Heart Assoc. 2019;8(14):e012540. DOI:10.1161/JAHA.119.012540
14. Cavallari I, Verolino G, Romano S, Patti G. Efficacy and safety of nonvitamin K oral anticoagulants in patients with atrial fibrillation and cancer: A study-level metaanalysis. Thromb Haemost. 2020;120(2):314-21. DOI:10.1055/s-0039-3400300
15. Sawant AC, Kumar A, McCray W, et al. Superior safety of direct oral anticoagulants compared to Warfarin in patients with atrial fibrillation and underlying cancer: A national veterans affairs database study. J Geriatr Cardiol. 2019;16(9):706-9. DOI:10.11909%2Fj.issn.1671-5411.2019.09.006
16. Shah S, Norby FL, Datta YH, et al. Comparative effectiveness of direct oral anticoagulants and warfarin in patients with cancer and atrial fibrillation. Blood Adv. 2018;2(3):200-9. DOI:10.1182/bloodadvances.2017010694
17. Melloni C, Dunning A, Granger CB, et al. Efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation and a history of cancer: Insights from the ARISTOTLE Trial. Am J Med. 2017;130(12):1440-48.e1. DOI:10.1016/j.amjmed.2017.06.026
18. Haverkamp HT, Fosse SO, Schuster P. Accuracy and usability of single-lead ECG from smartphones – A clinical study. Indian Pacing Electrophysiol J. 2019;19(4):145-9. DOI:10.1016/j.ipej.2019.02.006
19. Manetas-Stavrakakis N, Sotiropoulou IM, Paraskevas T, et al. Accuracy of artificial intelligence-based technologies for the diagnosis of atrial fibrillation: A systematic review and meta-analysis. J Clin Med. 2023;12(20):6576. DOI:10.3390/jcm12206576
20. Badheeb AM, Ahmed F, Alzahrani HA, et al. Cancer therapy-related cardiotoxicity: A comprehensive retrospective analysis at Najran Cancer Center, Saudi Arabia. Cureus. 2023;15(7):e41287. DOI:10.7759/cureus.41287
21. Costa IBSDS, Bittar CS, Fonseca SMR, et al. Brazilian cardio-oncology: The 10-year experience of the Instituto do Cancer do Estado de Sao Paulo. BMC Cardiovasc Disord. 2020;20(1):206. DOI:10.1186/s12872-020-01471-8
22. Brandão SR, Carvalho F, Amado F, et al. Insights on the molecular targets of cardiotoxicity induced by anticancer drugs: A systematic review based on proteomic findings. Metabolism. 2022;134:155250. DOI:10.1016/j.metabol.2022.155250
23. Jain D, Aronow W. Cardiotoxicity of cancer chemotherapy in clinical practice. Hosp Pract (1995). 2019;47(1):6-15. DOI:10.1080/21548331.2018.1530831
24. Alexandre J, Boismoreau L, Morice PM, et al. Atrial fibrillation incidence associated with exposure to anticancer drugs used as monotherapy in clinical trials. JACC CardioOncol. 2023;5(2):216-26. DOI:10.1016/j.jaccao.2022.11.019
25. Adhikari A, Asdaq SMB, Al Hawaj MA, et al. Anticancer drug-induced cardiotoxicity: Insights and pharmacogenetics. Pharmaceuticals (Basel). 2021;14(10):970. DOI:10.3390/ph14100970
26. Lobenwein D, Kocher F, Dobner S, et al. Cardiotoxic mechanisms of cancer immunotherapy – A systematic review. Int J Cardiol. 2021;323:179-87. DOI:10.1016/j.ijcard.2020.08.033
27. Moriyama S, Yokoyama T, Irie K, et al. Atrial fibrillation observed in a patient with esophageal cancer treated with fluorouracil. J Cardiol Cases. 2019;20(5):183-6. DOI:10.1016/j.jccase.2019.08.005
28. Peng H, Chen B, He S, et al. Efficacy and toxicity of three induction chemotherapy regimens in locoregionally advanced nasopharyngeal carcinoma: Outcomes of 10-year follow-up. Front Oncol. 2021;11:765378. DOI:10.3389/fonc.2021.765378
29. Diederichsen SZ, Haugan KJ, Brandes A, et al. Natural history of subclinical atrial fibrillation detected by implanted loop recorders. J Am Coll Cardiol. 2019;74(22):2771-81. DOI:10.1016/j.jacc.2019.09.050
30. Gognieva D, Vishnyakova N, Mitina Y, et al. Remote screening for atrial fibrillation by a federal cardiac monitoring system in primary care patients in Russia: Results from the Prospective Interventional Multicenter FECAS-AFS Study. Glob Heart. 2022;17(1):4. DOI:10.5334/gh.1057
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1. Xiao D, Li J, Liu Y, et al. Emerging trends and hotspots evolution in cardiotoxicity: A bibliometric and knowledge-Map analysis From 2010 to 2022. Front Cardiovasc Med. 2023;10:1089916. DOI:10.3389/fcvm.2023.1089916
2. Hajjar LA, Fonseca SMR, Machado TIV. Atrial fibrillation and cancer. Front Cardiovasc Med. 2021;8:590768. DOI:10.3389/fcvm.2021.590768
3. Jakobsen CB, Lamberts M, Carlson N, et al. Incidence of atrial fibrillation in different major cancer subtypes: A Nationwide population-based 12 year follow up study. BMC Cancer. 2019;19(1):1105. DOI:10.1186/s12885-019-6314-9
4. Lancellotti P, Marechal P, Donis N, Oury C. Inflammation, cardiovascular disease, and cancer: A common link with far-reaching implications. Eur Heart J. 2019;40(48):3910-2. DOI:10.1093/eurheartj/ehz645
5. Alexandre J, Salem JE, Moslehi J, et al. Identification of anticancer drugs associated with atrial fibrillation: analysis of the WHO pharmacovigilance database. Eur Heart J Cardiovasc Pharmacother. 2021;7(4):312-20. DOI:10.1093/ehjcvp/pvaa037
6. Herrmann J. Adverse cardiac effects of cancer therapies: Cardiotoxicity and arrhythmia. Nat Rev Cardiol. 2020;17(8):474-502. DOI:10.1038/s41569-020-0348-1
7. Ahmad J, Thurlapati A, Thotamgari S, et al. Anti-cancer drugs associated atrial fibrillation-an analysis of real-world pharmacovigilance data. Front Cardiovasc Med. 2022;9:739044. DOI:10.3389/fcvm.2022.739044
8. Riess H, Ay C, Bauersachs R, et al. Use of direct oral anticoagulants in patients with cancer: Practical considerations for the management of patients with nausea or vomiting. Oncologist. 2018;23(7):822-39. DOI:10.1634/theoncologist.2017-0473
9. Grymonprez M, De Backer TL, Bertels X, et al. Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study. Front Pharmacol. 2023;14:1125576. DOI:10.3389/fphar.2023.1125576
10. Ording AG, Horváth-Puhó E, Adelborg K, et al. Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: A Danish nationwide population-based cohort study. Cancer Med. 2017;6(6):1165-72. DOI:10.1002/cam4.1054
11. Angelini DE, Radivoyevitch T, McCrae KR, Khorana AA. Bleeding incidence and risk factors among cancer patients treated with anticoagulation. Am J Hematol. 2019;94(7):780-5. DOI:10.1002/ajh.25494
12. Wu VC, Wang CL, Huang YT, et al. Novel oral anticoagulant versus warfarin in cancerpatients with atrial fibrillation: An 8-year population-based cohort study. J Cancer. 2020;11:92-9. DOI:10.7150/jca.36468
13. Deng Y, Tong Y, Deng Y, et al. Non-vitamin K antagonist oral anticoagulants versus warfarin in patients with cancer and atrial fibrillation: A systematic review and meta-analysis. J Am Heart Assoc. 2019;8(14):e012540. DOI:10.1161/JAHA.119.012540
14. Cavallari I, Verolino G, Romano S, Patti G. Efficacy and safety of nonvitamin K oral anticoagulants in patients with atrial fibrillation and cancer: A study-level metaanalysis. Thromb Haemost. 2020;120(2):314-21. DOI:10.1055/s-0039-3400300
15. Sawant AC, Kumar A, McCray W, et al. Superior safety of direct oral anticoagulants compared to Warfarin in patients with atrial fibrillation and underlying cancer: A national veterans affairs database study. J Geriatr Cardiol. 2019;16(9):706-9. DOI:10.11909%2Fj.issn.1671-5411.2019.09.006
16. Shah S, Norby FL, Datta YH, et al. Comparative effectiveness of direct oral anticoagulants and warfarin in patients with cancer and atrial fibrillation. Blood Adv. 2018;2(3):200-9. DOI:10.1182/bloodadvances.2017010694
17. Melloni C, Dunning A, Granger CB, et al. Efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation and a history of cancer: Insights from the ARISTOTLE Trial. Am J Med. 2017;130(12):1440-48.e1. DOI:10.1016/j.amjmed.2017.06.026
18. Haverkamp HT, Fosse SO, Schuster P. Accuracy and usability of single-lead ECG from smartphones – A clinical study. Indian Pacing Electrophysiol J. 2019;19(4):145-9. DOI:10.1016/j.ipej.2019.02.006
19. Manetas-Stavrakakis N, Sotiropoulou IM, Paraskevas T, et al. Accuracy of artificial intelligence-based technologies for the diagnosis of atrial fibrillation: A systematic review and meta-analysis. J Clin Med. 2023;12(20):6576. DOI:10.3390/jcm12206576
20. Badheeb AM, Ahmed F, Alzahrani HA, et al. Cancer therapy-related cardiotoxicity: A comprehensive retrospective analysis at Najran Cancer Center, Saudi Arabia. Cureus. 2023;15(7):e41287. DOI:10.7759/cureus.41287
21. Costa IBSDS, Bittar CS, Fonseca SMR, et al. Brazilian cardio-oncology: The 10-year experience of the Instituto do Cancer do Estado de Sao Paulo. BMC Cardiovasc Disord. 2020;20(1):206. DOI:10.1186/s12872-020-01471-8
22. Brandão SR, Carvalho F, Amado F, et al. Insights on the molecular targets of cardiotoxicity induced by anticancer drugs: A systematic review based on proteomic findings. Metabolism. 2022;134:155250. DOI:10.1016/j.metabol.2022.155250
23. Jain D, Aronow W. Cardiotoxicity of cancer chemotherapy in clinical practice. Hosp Pract (1995). 2019;47(1):6-15. DOI:10.1080/21548331.2018.1530831
24. Alexandre J, Boismoreau L, Morice PM, et al. Atrial fibrillation incidence associated with exposure to anticancer drugs used as monotherapy in clinical trials. JACC CardioOncol. 2023;5(2):216-26. DOI:10.1016/j.jaccao.2022.11.019
25. Adhikari A, Asdaq SMB, Al Hawaj MA, et al. Anticancer drug-induced cardiotoxicity: Insights and pharmacogenetics. Pharmaceuticals (Basel). 2021;14(10):970. DOI:10.3390/ph14100970
26. Lobenwein D, Kocher F, Dobner S, et al. Cardiotoxic mechanisms of cancer immunotherapy – A systematic review. Int J Cardiol. 2021;323:179-87. DOI:10.1016/j.ijcard.2020.08.033
27. Moriyama S, Yokoyama T, Irie K, et al. Atrial fibrillation observed in a patient with esophageal cancer treated with fluorouracil. J Cardiol Cases. 2019;20(5):183-6. DOI:10.1016/j.jccase.2019.08.005
28. Peng H, Chen B, He S, et al. Efficacy and toxicity of three induction chemotherapy regimens in locoregionally advanced nasopharyngeal carcinoma: Outcomes of 10-year follow-up. Front Oncol. 2021;11:765378. DOI:10.3389/fonc.2021.765378
29. Diederichsen SZ, Haugan KJ, Brandes A, et al. Natural history of subclinical atrial fibrillation detected by implanted loop recorders. J Am Coll Cardiol. 2019;74(22):2771-81. DOI:10.1016/j.jacc.2019.09.050
30. Gognieva D, Vishnyakova N, Mitina Y, et al. Remote screening for atrial fibrillation by a federal cardiac monitoring system in primary care patients in Russia: Results from the Prospective Interventional Multicenter FECAS-AFS Study. Glob Heart. 2022;17(1):4. DOI:10.5334/gh.1057
Авторы
Д.Ф. Меситская*, А.С. Яснева, З.З. Фашафша, Ф.Ю. Копылов, Д.А. Андреев
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*aranid980@gmail.com
________________________________________________
Dinara F. Mesitskaya*, Anastasia S. Yasneva, Zaki Z. Fashafsha, Philipp Yu. Kopylov, Denis A. Andreev
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*aranid980@gmail.com