The prognosis of cancer treatment depends on, among other aspects, the cardiotoxicity of chemotherapy. This research aims to create a feasible algorithm for the early diagnosis of antitumor therapy cardiotoxicity in breast cancer patients. The paper represents a protocol for a prospective cohort study with N 120 eligible participants admitted for treatment with anthracyclines and/or trastuzumab. These patients will be allocated into four risk groups regarding potential cardiotoxic complications. Patients will be examined five times every three months for six biomarkers: cardiac troponin I (cTnI), brain natriuretic peptide (BNP), C-reactive protein (CRP), myeloperoxidase (MPO), galectin-3 (Gal-3), and D-dimer, simultaneously with echocardiographic methods, including speckle tracking. The adjusted relative risk (aOR) of interrupting an entire course of chemotherapy due to cardiotoxic events will be assessed using multiple analyses of proportional Cox risks. The Cox model will also assess associations between baseline biomarker values and time to cardiotoxic events. Moreover, partly conditional survival models will be applied to determine associations between repeated assessments of changes in biomarkers from baseline and time to cancer therapy-related cardiac dysfunction. All models will be adjusted for cancer therapy regimen, baseline LVEF, groups at risk, baseline biomarker values, and age. The decision-tree and principal component analysis (PCA) methods will also be applied. Thus, feasible patterns will be detected.

As known, the clinical efficacy of chemotherapy is limited by the cardiotoxicity of drugs used. The study aimed to clarify cardiotoxic complications of chemotherapy from the Aktobe Medical Center database for 2018-2019. Material and methods: We performed a register study on essential parameters of the oncological process, drugs used, duration of chemotherapy, types of complications, and outcomes, including survival. Results: We found a total of 305 breast cancer cases. Chemotherapy was completed without complications in 65.9% of patients; treatment was interrupted due to complications - 10.5%; 6.2% of cardiovascular complications were identified. The two groups of patients, EchoCG + and EchoCG -, showed significant difference in the number of detected CV complications (p<.001) but no difference in the survival rate (p .814). The survival rate in patients with documented CV complications was 28.1 months vs. 34.3 months in the group without ones (p.005). The survival rate in those who completed the treatment without complications, was 34.9 months vs. 17.6 in individuals whose treatment was interrupted due to complications (p<.001). We performed a detailed review of four cases of cardiotoxicity with fatal outcomes. Conclusion: The analysis indicates the absence of a systematic approach to recording crucial information regarding cardiotoxicity. There is a lack of concordance in the actions of cardiologists and oncologists in the management of BC patients. The presence of lethal outcomes of chemotherapy with an established cause of cardiac death indicates the need to revise the cancer register management from the standpoint of cardio-oncology. In general, there is a need to develop local protocols for screening and monitoring patients undergoing cardiotoxic chemotherapy and radiation therapy.

A majority of modern antitumor pharmaceuticals are accompanied by cardiotoxicity. The study aims to present practical approaches to stratifying the baseline risk of antitumor therapies' cardiotoxicity in patients newly diagnosed with breast cancer started on anthracyclines and/or trastuzumab. Material and methods: Stratifying the risks of antitumor therapy was carried out according to the European Society of Cardiology recommendations. A therapist examined all patients for existing cardiovascular diseases and risk factors detection. The blood levels of glucose, cholesterol, creatinine, cardiac troponin I, and brain natriuretic peptide were determined. Electrocardiography and echocardiography with an assessment of the myocardium global longitudinal strain were performed. Results: In total, 128 breast cancer patients with a mean age of 54.3±11.0 years were included in the study. Of them, 84.4% had tumor stages I and II, and 21.1% were HER2-positive. Chronic heart failure and ischemic heart disease were detected in 2.3%. Among the risk factors, the most common were arterial hypertension (51.6%), obesity (29.7%), age 65-70 years (18%), significant smoking history (15.6%), and diabetes mellitus (11.7%). Elevated cardiac troponin I and brain natriuretic peptide baseline levels were present in 5.5% and 7.0% of patients, respectively. To a high-risk group for cardiotoxic complications, 7.8% were allocated, 35.7% were assigned to the moderate-risk group, and 54.7% had low risk. High/very high and moderate-risk patients (43.5%) were referred to a cardiologist. Cardioprotective treatment was started immediately in high/very high-risk patients. Conclusion: All revealed differences between the cardiovascular risk groups were related to age, cardiovascular system condition, and the severity of comorbid pathologies. The baseline stratification of patients into risk groups is a crucial step in preventing the cardiotoxicity of anticancer therapy. Comprehensive assessing the patient's condition before and during chemotherapy allows for avoiding the development of fatal cardiovascular complications in at-risk patients.

Введение. Рак молочной железы является чувствительным к определенным схемам химиотерапии, которые оказывают агрессивное действие на сердце и сосуды. Выделяют антрациклин - опосредованную необратимую кардиотоксичность первого типа и трастузумаб - опосредованную обратимую кардиотоксичность второго типа. Определение сывороточных биомаркеров является альтерантивным подходом для ранней оценки дисфункции миокарда. Цель: анализ прогностической значимости тропонина для раннего выявления кардиотоксических осложнений антрациклина и/или трастузумаба у больных раком молочной железы. Стратегия поиска. Поиск осуществлялся в базах данных Pubmed, Web of Science, Scopus, eLIBRARY. Критериями для включения исследований в обзор были: рандомизированные клинические и проспективные исследования, датированные 2010 - 2020 гг.Использовались ключевые слова по следующим разделам: патология: «breast cancer», «breast»; лечение: «antracycline» «trastuzumab», «chemotherapy»; биомаркеры: «troponin», «troponin I», «troponin T», «high sensitive troponin»; осложнения химиотерапии: «cardiotoxicity», исследования: «controlled trial», «randomized controlled trial», «controlled clinical trial», «clinical trial». Отбор исследований производился методом триангуляции. Всего в обзор вошли 27 полнотекстовых исследований, полностью соответствующих критериям поиска. В списке литературы указаны также работы, не соответствовавшие критериям поиска, но иллюстрирующие актуальность темы. Результаты. Повышение уровня тропонина является признаком развития сердечной дисфункции с неблагоприятным прогнозом, особенно при продолжающемся росте уровня тропонина. Прирост уровня тропонина и интеграл прироста от базового уровня являются более надежными предикторами, чем абсолютное значение тропонина. Выводы.Пациенты с РМЖ, получающие терапию антрациклинами и последующую терапию таргетными препаратами имеют наибольшый риск развития кардиотоксических осложнений. Мониторирование уровня тропонина имеет прогностический потенциал и должно проводиться всем пациентам. Панель биомаркеров с включением тропонина может быть более полезной для раннего обнаружения дисфункции миокарда. ntroduction. Breast cancer is sensitive to some schemes of chemotherapy known to be aggressive towards the cardiovascular system. There is anthracycline-mediated irreversible cardiotoxicity of the first type and trastuzumab-mediated reversible cardiotoxicity of the second type. The use of serum biomarkers capable of detecting myocardial injury before symptoms appear is an alternative approach to early diagnosis of the chemotherapy cardiotoxic complications. Aim: analyze the prognostic value of troponin for the early detection of cardiotoxic complications caused by anthracycline and/or trastuzumab in breast cancer patients. Search strategy: The search was carried out across the databases Pubmed, Web of Science, Scopus, e-LIBRARY. Criteria for inclusion in the review were: randomized controlled trials and prospective studies dated 2010–2020. The keywords were used according to the following sections: pathology: "breast cancer", "breast"; treatment: «anthracyclines», «trastuzumab», «chemotherapy»; biomarkers: «troponin», «troponin I», «troponin T», «high sensitive troponin»; complications of chemotherapy: "cardiotoxicity", studies: "controlled trial", "randomized controlled trial", "controlled clinical trial", "clinical trial". The selection of studies was carried out by the triangulation method. In total, the review included full-text 27 studies that completely met the search criteria. The list of references also contains researches that did not meet the search criteria, but illustrating the relevance of the topic. Results. An increase in troponin levels may signify the development of cardiac dysfunction with a poor prognosis, especially if troponin levels continue to rise. The increase in the hs-troponin and the integral of the increase are more reliable predictors than the absolute value of troponin. Сonclusions. Breast cancer patients receiving anthracyclines and subsequent targeted chimiotherapy have the highest risk of cardiotoxic complications. Troponin level monitoring has predictive potential and should be considered to all patients receiving chemotherapy. Troponin and the combination of several markers may turn out to be more sensitive in predicting...

This publication presents a clinical case of infectious endocarditis in an adult male aged 60, with manifestation of the disease in the form of spondilodiscitis. The presented observation demonstrates the development of onset of infectious endocarditis of bacterial spondylodiscitis in the adult patient. For a long time the patient’s intensive pain in the lumbar region could not be connected with infective endocarditis. According to the results of the examination the changes in the spine were not evaluated as an onset of IE. Dynamic observation and control MRT study allowed for the conclusion about bacterial spondilodiscitis in our patient with IE and to connect these two processes. In such clinical cases, MRT of the spine or positron emission tomography combined with computed tomography using a radiopharmaceutical 18F-fluorodeoxyglucose (F-FDG- PET / CT) of the whole body is recommended. In the case of a specific spondilodiscitis, the continuation of antibacterial therapy is determined by signs of inflammatory activity on F-FDG-PET / CT or MRT of the spine.

Background/Objectives: The HFA-ICOS baseline cardiovascular risk classification was developed to standardize pretreatment risk stratification before potentially cardiotoxic cancer therapy, but its external performance across diverse populations remains incompletely characterized. We prospectively evaluated its performance in women with breast cancer receiving anthracycline-containing therapy in Central Asia. Methods: This prospective single-center external validation study used data from the PREDICATE cohort (ISRCTN12628444). Participants were classified at baseline as being at low, moderate, high, or very high cardiovascular risk according to the HFA-ICOS classification before treatment and outcome ascertainment; the high- and very-high-risk categories were pooled for analysis because of small numbers. Participants underwent serial cardiovascular surveillance, including echocardiographic assessment of left ventricular ejection fraction and global longitudinal strain, together with serial cardiac biomarker measurements. The primary outcome was cancer therapy-related cardiac dysfunction (CTRCD), defined according to the 2022 ESC cardio-oncology criteria. Results: The analysis included 108 participants. CTRCD occurred in 43 of 108 participants (39.8%). The observed proportion of participants who developed CTRCD increased from 30.0% in the low-risk group to 47.5% in the moderate-risk group and 75.0% in the high/very-high-risk group (p = 0.026). Kaplan–Meier analysis demonstrated significant separation of CTRCD-free survival across HFA-ICOS risk categories (log-rank χ² = 10.12; p = 0.006). Compared with the low-risk group, the hazard of CTRCD was higher in the moderate-risk group (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.13–4.13) and high/very-high-risk group (HR, 3.59; 95% CI, 1.42–9.11). Discrimination was modest (area under the curve, 0.630; 95% CI, 0.530–0.724). Conclusions: The HFA-ICOS classification demonstrated a clear ordinal gradient in CTRCD risk and significant time-to-event separation but showed limited discrimination at the individual-patient level. It may guide initial risk stratification but should be complemented by longitudinal cardiovascular surveillance rather than used as a stand-alone predictor.