Clinical cardiologist with special expertise in echocardiography. Since 1982 involved in the field of Cardio-oncology, with clinical expertise and scientific activity mostly in cardiac toxicity of antineoplastic drugs, primary and metastatic malignant cardiac tumors. Editor of the Manual of cardio-oncology (Springer). Member of of the Executive Committee of the Cardio-Oncology Toxicity (COT) Registry of the ESC
The variation in shape, in the global and regional function of the left ventricle (LV) was quanti... more The variation in shape, in the global and regional function of the left ventricle (LV) was quantitated by using Two-Dimensional Echocardiography (TDE) in 20 normal subjects (N) (17 males, 3 females, with a mean age of 21.2 years, age range 15 to 34) and compared to 20 patients with aortic regurgitation (AR) (14 males, 6 females with a mean age of 31 years, age range 16 to 51). The left ventricle was subdivided into two TDE short axis cross-sections at the papillary muscle (PM) and at the mitral valve (MV) level. Wall motion was assessed by the following indices; endocardial systolic fractional area change (FAC), wall thickening (Wth) and circumferential fiber shortening (S). The ejection fraction (EF), the diastolic (EID) and systolic eccentricity index (EIS), the end-diastolic volume (EDV), the end systolic volume (ESV) and the LV mass (M) were estimated using a 4 chamber apical view. Measurements of sectional cavity areas, muscle areas and endocardial perimeters were obtained twic...
An excessive alcohol intake has been reported as one of the possible causes or risk factors of &a... more An excessive alcohol intake has been reported as one of the possible causes or risk factors of 'alcoholic cardiomyopathy'. The possibility that this cardiomyopathy may improve or even reverse if the alcohol abuse has been terminated has been suggested, but unequivocal echocardiographic documentation of this improvement has never been described. This study reports the normalization of cardiac chamber dimensions and of variables of left ventricular function documented by M-mode and cross-sectional echocardiographic follow-up studies, after cessation of excessive consumption of alcohol, in three cases of alcoholic cardiomyopathy.
The cardiotoxicity of fluoropyrimidines (FP) [5-Fluorouracil and Capecitabine] is often reported ... more The cardiotoxicity of fluoropyrimidines (FP) [5-Fluorouracil and Capecitabine] is often reported as acute cardiac ischemia with rest typical angina, signs of ischemia at electrocardiogram (ECG), and ventricular kinetics abnormalities. However, silent ischemia, effort-related toxicity, and ventricular arrhythmias (VA) have been also described. The aim of this study is to report a consecutive series of 115 patients with FP cardiotoxicity observed in a single center both within clinical prospective studies and during the clinical routine. The clinical presentation widely varied as regards symptoms, ECG abnormalities, and clinical outcomes. We report also the strategies used to prevent cardiotoxicity in a subgroup of 35 patients who continued o rechallenged FP therapy after cardiotoxicity. In nearly half of the patients, the cardiotoxicity was triggered by physical effort. Typical angina was rare: the symptoms were absent in 51% of cases and were atypical in half of the other cases. ST-...
Background Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major ... more Background Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major arrhythmias) of 5-Fluorouracil, but this risk has never been investigated for its prodrug capecitabine. Patients and Methods One hundred and ninety-two consecutive patients undergoing capecitabine chemotherapy from December 1, 2010 through July 31, 2016 were prospectively evaluated. The baseline evaluation included electrocardiography (ECG) and echocardiography (2DE); a follow-up evaluation, including ECG and exercise stress testing (2DE in case of ECG abnormalities), was done after ≥10 days of treatment. Cardiotoxicity was suspected from ischemic ECG changes, new kinetic abnormalities at 2DE, Lown classification ≥2 ventricular arrhythmia, symptomatic arrhythmias, or positive stress test, and confirmed by a negative stress test after capecitabine washout. Results Cardiotoxicity was diagnosed in 32 patients (16.7%): six at rest and 26 during exercise. All 32 patients had ECG abnormalities...
282 Background: T is a mainstay in adjuvant therapy for HER2+ breast cancer (BC) patients (pts). ... more 282 Background: T is a mainstay in adjuvant therapy for HER2+ breast cancer (BC) patients (pts). Safety and efficacy of T in elderly patients are largely unknown. In HERA trial, NSABP B-31, NCCTG N9831 only 16% of pts were older than 60 years. Risk factors for T related cardiotoxicity are age (>50 y/o), hypertension, baseline LVEF (left ventricular ejection fraction <55%), previous antracycline therapy and BMI. Methods: Charts of pts >65 y/o with early HER2+ BC treated with T as adjuvant or neoadjuvant therapy at our institution were retrospectively reviewed. Primary endpoint was the evaluation of T cardiac toxicity and safety. Results: 22 elderly out of 172 pts (12%) were identified: 19 pts were treated only with surgery and adjuvant chemotherapy with concomitant or sequential T, 3 more pts also received neoadjuvant chemotherapy concomitant with T. According to Balducci’s criteria, fit, vulnerable and frail pts were 20, 2, 0 respectively. Median age was 69 y/o (range 65-76...
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy seri... more Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our labor... more We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our laboratory on 227 patients with pericardial diseases, in order to assess the capabilities and limits of echocardiography in this field. We observed 4 patients with congenital absence of the pericardium, 10 with of constrictive or infiltrative-adhesive pericarditis, 213 pericardial effusions, associated with left pleural effusion in 36 cases and with different kinds of intrapericardial masses in 33 cases. Through qualitative analysis of the echogenicity of such masses some aspects were singled out which may prove useful in identifying intrapericardial fat, as well as tumors. We also suggest new ways of using specific echocardiographic sections to differentiate left pleural effusions from pericardial effusions, and to identify very small pericardial effusions.
Journal of Cardiovascular Echography, Apr 10, 2020
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy seri... more Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
Most patients undergoing antineoplastic treatments with anthracyclines and trastuzumab—well known... more Most patients undergoing antineoplastic treatments with anthracyclines and trastuzumab—well known to be potentially cardiotoxic—have a cardiology follow-up planned by the oncologists. Any obvious side effects occurring during treatments administered in hospital or in the day hospital unit will be referred to the local cardiologist.
Although commonly thought of as two separate disease entities, cardiovascular diseases and cancer... more Although commonly thought of as two separate disease entities, cardiovascular diseases and cancer, the leading causes of death, possess various possible interactions, including a number of similar risk factors (e.g. obesity, diabetes, chronic inflammation). Each cardiologist should provide counseling for a correct lifestyle (diet, physical exercise, avoiding smoking and alcohol abuse); doing so, not only cardiovascular diseases, but also cancer could be prevented. Besides, intervention on diet, physical activity and smoking has been shown to be effective even in patients with known cancers. Many drugs used in cardiovascular prevention (i.e. aspirin, metformin, statins, and beta-blockers) have shown in vivo and in vitro promising pleiotropic properties, and, in observational studies, they were also effective in the prevention of some cancers, although this matter is controversial, emphasizing the need for interventional studies in the field of primary and secondary cancer prevention....
I controlli cardiologici (tipo di esame e tempistica) durante chemioterapia devono essere program... more I controlli cardiologici (tipo di esame e tempistica) durante chemioterapia devono essere programmati in base al tipo di cardiotossicità attesa, che è diversa per diversi farmaci (disfunzione ventricolare, ischemia cardiaca, tromboembo-lie, aritmie, ipertensione) ed è anche diversa, per uno stesso farmaco, in base al modo di somministrazione. In caso di riscontro di cardiotossicità è importante valutare l’intento della chemioterapia (curativa o adiuvante/neoadiuvante) prima di suggerirne l’interruzione. L’associazione di adeguate terapie cardiologiche e la programmazione di controlli cardiologici mirati può permettere di continuare alcune terapie salvavita anche in presenza di problemi cardiaci (preesistenti o iatrogeni).
Background/Aim: Cardiovascular risk factors (CVRFs) predict cardiotoxicity in cancer patients but... more Background/Aim: Cardiovascular risk factors (CVRFs) predict cardiotoxicity in cancer patients but their role in late cardiac toxicity is less clear. Patients and Methods: This was a retrospective analysis of patients treated with anthracyclines (A) and/or trastuzumab (T) and a correlation with early (≤5 years) or late (>5 years) cardiac toxicity, and baseline CVRFs and CVRFs at toxicity time. Results: A total of 610 patients were included, 422 with (Group A) and 188 without (Group B) baseline CVRFs. In group A toxicity incidence was 4.7% with all events during treatment or immediately after [mean onset time 0.7 years (range=0.2-1.6)]. Events rate was 3.2% in group B with all events after five years [mean time onset 6.9 years (range=5.2-7.5)]. All group B patients who developed late cardiac toxicity presented with CVRFs at the time of toxicity not reported before. Conclusion: CVRFs could predict late cardiac toxicity and their control should be part of the survivorship program.
The variation in shape, in the global and regional function of the left ventricle (LV) was quanti... more The variation in shape, in the global and regional function of the left ventricle (LV) was quantitated by using Two-Dimensional Echocardiography (TDE) in 20 normal subjects (N) (17 males, 3 females, with a mean age of 21.2 years, age range 15 to 34) and compared to 20 patients with aortic regurgitation (AR) (14 males, 6 females with a mean age of 31 years, age range 16 to 51). The left ventricle was subdivided into two TDE short axis cross-sections at the papillary muscle (PM) and at the mitral valve (MV) level. Wall motion was assessed by the following indices; endocardial systolic fractional area change (FAC), wall thickening (Wth) and circumferential fiber shortening (S). The ejection fraction (EF), the diastolic (EID) and systolic eccentricity index (EIS), the end-diastolic volume (EDV), the end systolic volume (ESV) and the LV mass (M) were estimated using a 4 chamber apical view. Measurements of sectional cavity areas, muscle areas and endocardial perimeters were obtained twic...
An excessive alcohol intake has been reported as one of the possible causes or risk factors of &a... more An excessive alcohol intake has been reported as one of the possible causes or risk factors of &amp;amp;#39;alcoholic cardiomyopathy&amp;amp;#39;. The possibility that this cardiomyopathy may improve or even reverse if the alcohol abuse has been terminated has been suggested, but unequivocal echocardiographic documentation of this improvement has never been described. This study reports the normalization of cardiac chamber dimensions and of variables of left ventricular function documented by M-mode and cross-sectional echocardiographic follow-up studies, after cessation of excessive consumption of alcohol, in three cases of alcoholic cardiomyopathy.
The cardiotoxicity of fluoropyrimidines (FP) [5-Fluorouracil and Capecitabine] is often reported ... more The cardiotoxicity of fluoropyrimidines (FP) [5-Fluorouracil and Capecitabine] is often reported as acute cardiac ischemia with rest typical angina, signs of ischemia at electrocardiogram (ECG), and ventricular kinetics abnormalities. However, silent ischemia, effort-related toxicity, and ventricular arrhythmias (VA) have been also described. The aim of this study is to report a consecutive series of 115 patients with FP cardiotoxicity observed in a single center both within clinical prospective studies and during the clinical routine. The clinical presentation widely varied as regards symptoms, ECG abnormalities, and clinical outcomes. We report also the strategies used to prevent cardiotoxicity in a subgroup of 35 patients who continued o rechallenged FP therapy after cardiotoxicity. In nearly half of the patients, the cardiotoxicity was triggered by physical effort. Typical angina was rare: the symptoms were absent in 51% of cases and were atypical in half of the other cases. ST-...
Background Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major ... more Background Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major arrhythmias) of 5-Fluorouracil, but this risk has never been investigated for its prodrug capecitabine. Patients and Methods One hundred and ninety-two consecutive patients undergoing capecitabine chemotherapy from December 1, 2010 through July 31, 2016 were prospectively evaluated. The baseline evaluation included electrocardiography (ECG) and echocardiography (2DE); a follow-up evaluation, including ECG and exercise stress testing (2DE in case of ECG abnormalities), was done after ≥10 days of treatment. Cardiotoxicity was suspected from ischemic ECG changes, new kinetic abnormalities at 2DE, Lown classification ≥2 ventricular arrhythmia, symptomatic arrhythmias, or positive stress test, and confirmed by a negative stress test after capecitabine washout. Results Cardiotoxicity was diagnosed in 32 patients (16.7%): six at rest and 26 during exercise. All 32 patients had ECG abnormalities...
282 Background: T is a mainstay in adjuvant therapy for HER2+ breast cancer (BC) patients (pts). ... more 282 Background: T is a mainstay in adjuvant therapy for HER2+ breast cancer (BC) patients (pts). Safety and efficacy of T in elderly patients are largely unknown. In HERA trial, NSABP B-31, NCCTG N9831 only 16% of pts were older than 60 years. Risk factors for T related cardiotoxicity are age (>50 y/o), hypertension, baseline LVEF (left ventricular ejection fraction <55%), previous antracycline therapy and BMI. Methods: Charts of pts >65 y/o with early HER2+ BC treated with T as adjuvant or neoadjuvant therapy at our institution were retrospectively reviewed. Primary endpoint was the evaluation of T cardiac toxicity and safety. Results: 22 elderly out of 172 pts (12%) were identified: 19 pts were treated only with surgery and adjuvant chemotherapy with concomitant or sequential T, 3 more pts also received neoadjuvant chemotherapy concomitant with T. According to Balducci’s criteria, fit, vulnerable and frail pts were 20, 2, 0 respectively. Median age was 69 y/o (range 65-76...
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy seri... more Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our labor... more We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our laboratory on 227 patients with pericardial diseases, in order to assess the capabilities and limits of echocardiography in this field. We observed 4 patients with congenital absence of the pericardium, 10 with of constrictive or infiltrative-adhesive pericarditis, 213 pericardial effusions, associated with left pleural effusion in 36 cases and with different kinds of intrapericardial masses in 33 cases. Through qualitative analysis of the echogenicity of such masses some aspects were singled out which may prove useful in identifying intrapericardial fat, as well as tumors. We also suggest new ways of using specific echocardiographic sections to differentiate left pleural effusions from pericardial effusions, and to identify very small pericardial effusions.
Journal of Cardiovascular Echography, Apr 10, 2020
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy seri... more Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
Most patients undergoing antineoplastic treatments with anthracyclines and trastuzumab—well known... more Most patients undergoing antineoplastic treatments with anthracyclines and trastuzumab—well known to be potentially cardiotoxic—have a cardiology follow-up planned by the oncologists. Any obvious side effects occurring during treatments administered in hospital or in the day hospital unit will be referred to the local cardiologist.
Although commonly thought of as two separate disease entities, cardiovascular diseases and cancer... more Although commonly thought of as two separate disease entities, cardiovascular diseases and cancer, the leading causes of death, possess various possible interactions, including a number of similar risk factors (e.g. obesity, diabetes, chronic inflammation). Each cardiologist should provide counseling for a correct lifestyle (diet, physical exercise, avoiding smoking and alcohol abuse); doing so, not only cardiovascular diseases, but also cancer could be prevented. Besides, intervention on diet, physical activity and smoking has been shown to be effective even in patients with known cancers. Many drugs used in cardiovascular prevention (i.e. aspirin, metformin, statins, and beta-blockers) have shown in vivo and in vitro promising pleiotropic properties, and, in observational studies, they were also effective in the prevention of some cancers, although this matter is controversial, emphasizing the need for interventional studies in the field of primary and secondary cancer prevention....
I controlli cardiologici (tipo di esame e tempistica) durante chemioterapia devono essere program... more I controlli cardiologici (tipo di esame e tempistica) durante chemioterapia devono essere programmati in base al tipo di cardiotossicità attesa, che è diversa per diversi farmaci (disfunzione ventricolare, ischemia cardiaca, tromboembo-lie, aritmie, ipertensione) ed è anche diversa, per uno stesso farmaco, in base al modo di somministrazione. In caso di riscontro di cardiotossicità è importante valutare l’intento della chemioterapia (curativa o adiuvante/neoadiuvante) prima di suggerirne l’interruzione. L’associazione di adeguate terapie cardiologiche e la programmazione di controlli cardiologici mirati può permettere di continuare alcune terapie salvavita anche in presenza di problemi cardiaci (preesistenti o iatrogeni).
Background/Aim: Cardiovascular risk factors (CVRFs) predict cardiotoxicity in cancer patients but... more Background/Aim: Cardiovascular risk factors (CVRFs) predict cardiotoxicity in cancer patients but their role in late cardiac toxicity is less clear. Patients and Methods: This was a retrospective analysis of patients treated with anthracyclines (A) and/or trastuzumab (T) and a correlation with early (≤5 years) or late (>5 years) cardiac toxicity, and baseline CVRFs and CVRFs at toxicity time. Results: A total of 610 patients were included, 422 with (Group A) and 188 without (Group B) baseline CVRFs. In group A toxicity incidence was 4.7% with all events during treatment or immediately after [mean onset time 0.7 years (range=0.2-1.6)]. Events rate was 3.2% in group B with all events after five years [mean time onset 6.9 years (range=5.2-7.5)]. All group B patients who developed late cardiac toxicity presented with CVRFs at the time of toxicity not reported before. Conclusion: CVRFs could predict late cardiac toxicity and their control should be part of the survivorship program.
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Papers by Chiara Lestuzzi