Markus S Anker1,2,3,4, Stephan von Haehling5, Andrew J S Coats6, Hanno Riess7, Jan Eucker8, Jan Porthun9, Javed Butler10, Mahir Karakas11,12, Wilhelm Haverkamp1, Ulf Landmesser3,4,13, Stefan D Anker1. 1. Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité University Medicine Berlin, Berlin, Germany. 2. Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany. 3. German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany. 4. Department of Cardiology (CBF), Charité University Medicine Berlin, Berlin, Germany. 5. Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany. 6. IRCCS San Raffaele Pisana, Rome, Italy. 7. Department of Hematology and Oncology, Charité - Campus Virchow-Klinikum (CVK), Berlin, Germany. 8. Department of Hematology and Oncology, Benjamin Franklin Campus, Charité University of Medicine Berlin, Berlin, Germany. 9. Norwegian University of Science and Technology, Campus Gjøvik (NTNU-Gjøvik), Norway. 10. Department of Medicine, University of Mississippi Medical Center, Jackons, MS, USA. 11. Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. 12. Partner Site Hamburg/Kiel/Lübeck, German Center for Cardiovascular Research, Hamburg, Germany. 13. Berlin Institute of Health (BIH), Berlin, Germany.
Abstract
AIMS: Many cancer patients die due to cardiovascular disease and sudden death, but data on ventricular arrhythmia prevalence and prognostic importance are not known. METHODS AND RESULTS: Between 2005 and 2010, we prospectively enrolled 120 unselected patients with lung, colon, or pancreatic cancer due to one of three diagnoses: colorectal (n = 33), pancreatic (n = 54), or non-small cell lung cancer (n = 33). All were free of manifest cardiovascular disease. They were compared to 43 healthy controls similar in age and sex distribution. Each participant underwent 24 h electrocardiogram recording and cancer patients were followed for up to 12.5 years for survival (median 21 months). Ninety-six cancer patients (80%) died during follow-up [5-year survival: 27% (95% confidence interval 19-35%)]. Non-sustained ventricular tachycardia (NSVT) was more frequent in cancer patients vs. controls (8% vs. 0%, P = 0.021). The number of premature ventricular contractions (PVCs) over 24 h was not increased in cancer patients vs. controls (median 4 vs. 9, P = 0.2). In multivariable analysis, NSVT [hazard ratio (HR) 2.44, P = 0.047] and PVCs (per 100, HR 1.021, P = 0.047) were both significant predictors of mortality, independent of other univariable mortality predictors including tumour stage, cancer type, potassium concentration, prior surgery, prior cardiotoxic chemotherapy, and haemoglobin. In patients with colorectal and pancreatic cancer, ≥50 PVCs/24 h predicted mortality (HR 2.30, P = 0.0024), and was identified in 18% and 26% of patients, respectively. CONCLUSIONS: Non-sustained ventricular tachycardia is more frequent in unselected patients with colorectal, pancreatic, and non-small cell lung cancer and together with PVCs predict long-term mortality. This raises the prospect of cardiovascular mortality being a target for future treatment interventions in selected cancers.
AIMS: Many cancerpatients die due to cardiovascular disease and sudden death, but data on ventricular arrhythmia prevalence and prognostic importance are not known. METHODS AND RESULTS: Between 2005 and 2010, we prospectively enrolled 120 unselected patients with lung, colon, or pancreatic cancer due to one of three diagnoses: colorectal (n = 33), pancreatic (n = 54), or non-small cell lung cancer (n = 33). All were free of manifest cardiovascular disease. They were compared to 43 healthy controls similar in age and sex distribution. Each participant underwent 24 h electrocardiogram recording and cancerpatients were followed for up to 12.5 years for survival (median 21 months). Ninety-six cancerpatients (80%) died during follow-up [5-year survival: 27% (95% confidence interval 19-35%)]. Non-sustained ventricular tachycardia (NSVT) was more frequent in cancerpatients vs. controls (8% vs. 0%, P = 0.021). The number of premature ventricular contractions (PVCs) over 24 h was not increased in cancerpatients vs. controls (median 4 vs. 9, P = 0.2). In multivariable analysis, NSVT [hazard ratio (HR) 2.44, P = 0.047] and PVCs (per 100, HR 1.021, P = 0.047) were both significant predictors of mortality, independent of other univariable mortality predictors including tumour stage, cancer type, potassium concentration, prior surgery, prior cardiotoxic chemotherapy, and haemoglobin. In patients with colorectal and pancreatic cancer, ≥50 PVCs/24 h predicted mortality (HR 2.30, P = 0.0024), and was identified in 18% and 26% of patients, respectively. CONCLUSIONS: Non-sustained ventricular tachycardia is more frequent in unselected patients with colorectal, pancreatic, and non-small cell lung cancer and together with PVCs predict long-term mortality. This raises the prospect of cardiovascular mortality being a target for future treatment interventions in selected cancers.
Authors: Lorenzo Stretti; Dauphine Zippo; Andrew J S Coats; Markus S Anker; Stephan von Haehling; Marco Metra; Daniela Tomasoni Journal: ESC Heart Fail Date: 2021-12-16
Authors: Annemarie Albrecht; Jan Porthun; Jan Eucker; Andrew J S Coats; Stephan von Haehling; Antonio Pezzutto; Mahir Karakas; Hanno Riess; Ulrich Keller; Ulf Landmesser; Wilhelm Haverkamp; Stefan D Anker; Markus S Anker Journal: Cancers (Basel) Date: 2021-05-12 Impact factor: 6.639