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Knowing the true nature of the cardiovascular effects of androgen deprivation therapy in prostate cancer: We still have a way to go…
Complicações cardiovasculares da terapêutica de privação androgénica no cancro da próstata: ainda temos um caminho a percorrer para o seu correto diagnóstico…
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Endoscopy of the upper gastrointestinal tract, revealing the presence of blood clot at the proximal esophageal tract (red arrow) with erosion from a pulsative mass. B. Computed tomography angiography of aorta and thorax with intravenous contrast agent, axial view, depicting the presence of a saccular descending aortic aneurysm at the level of the tracheal carina, with mural thrombus (red arrow), and an aortoesophageal fistula blocked by a part of the thrombus, protruding into the esophagus lumen (yellow arrow). C. Computed tomography angiography of aorta and thorax, three dimensional reconstruction, depicting the presence of the descending aortic aneurysm. D. Computed tomography angiography of aorta and thorax with intravenous contrast agent, axial view, depicting the presence of a saccular descending aortic aneurysm at the level of the tracheal carina with the presence of air within the thrombus's layers (red arrows). E. Computed tomography angiography of aorta and thorax with intravenous contrast agent, sagittal view, depicting the aneurysm's mural thrombus (red arrow), protruding into the esophagus lumen (yellow arrow). F. Invasive angiography, showing the result of the thoracic endovascular aortic repair procedure with coverage of the aneurysm with endovascular stent graft (red arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dimitrios Afendoulis, Athanasios Kartalis, Nikolaos Papagiannis, Maria Moutafi, Petros Voutas, Ioannis Gklotsos, Dimitrios Siskos, Aristodimos Maratsos, Konstantinos Toutouzas" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Dimitrios" "apellidos" => "Afendoulis" ] 1 => array:2 [ "nombre" => "Athanasios" "apellidos" => "Kartalis" ] 2 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Papagiannis" ] 3 => array:2 [ "nombre" => "Maria" "apellidos" => "Moutafi" ] 4 => array:2 [ "nombre" => "Petros" "apellidos" => "Voutas" ] 5 => array:2 [ "nombre" => "Ioannis" "apellidos" => "Gklotsos" ] 6 => array:2 [ "nombre" => "Dimitrios" "apellidos" => "Siskos" ] 7 => array:2 [ "nombre" => "Aristodimos" "apellidos" => "Maratsos" ] 8 => array:2 [ "nombre" => "Konstantinos" "apellidos" => "Toutouzas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122002426?idApp=UINPBA00004E" "url" => "/08702551/0000004100000007/v1_202207030541/S0870255122002426/v1_202207030541/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255122002384" "issn" => "08702551" "doi" => "10.1016/j.repc.2020.06.024" "estado" => "S300" "fechaPublicacion" => "2022-07-01" "aid" => "1966" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2022;41:601.e1-601.e3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Androgen deprivation therapy mimicking acute coronary syndrome: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "601.e1" "paginaFinal" => "601.e3" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Terapia de privação de androgénio que imita uma síndrome coronária aguda: um relato de caso" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 332 "Ancho" => 1255 "Tamanyo" => 114097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">First electrocardiogram recorded at the emergency room.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sinus rhythm, heart rate: 56 beats/minute, QRS axis: -55°, ST depression of 1 mm on DII, aVF and from V3 to V5 and of 2 mm on V6, deep negative T waves in DI, DII, DIII, aVF, aVL and from V1 to V6 leads and prolonged QT interval (QT interval: 642 milliseconds, corrected QT interval by Bazzet formula: 623 milliseconds and corrected QT interval by Fridericia formula: 629 milliseconds).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yaniel Castro-Torres, Alexander Triana-Díaz, Ángel Alexander Cuellar-Gallardo, Arnaldo Rodríguez-León, Eduardo Rodríguez-González" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Yaniel" "apellidos" => "Castro-Torres" ] 1 => array:2 [ "nombre" => "Alexander" "apellidos" => "Triana-Díaz" ] 2 => array:2 [ "nombre" => "Ángel Alexander" "apellidos" => "Cuellar-Gallardo" ] 3 => array:2 [ "nombre" => "Arnaldo" "apellidos" => "Rodríguez-León" ] 4 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Rodríguez-González" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122002384?idApp=UINPBA00004E" "url" => "/08702551/0000004100000007/v1_202207030541/S0870255122002384/v1_202207030541/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Knowing the true nature of the cardiovascular effects of androgen deprivation therapy in prostate cancer: We still have a way to go…" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "603" "paginaFinal" => "604" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Júlia Cristina Toste" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Júlia Cristina" "apellidos" => "Toste" "email" => array:1 [ 0 => "jctoste@hospitaldaluz.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Hospital da Luz, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "NOVA Medical School, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Complicações cardiovasculares da terapêutica de privação androgénica no cancro da próstata: ainda temos um caminho a percorrer para o seu correto diagnóstico…" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The cornerstone of systemic treatment for prostate cancer is pharmacological or surgical androgen deprivation therapy (ADT):<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">For patients with metastatic prostate cancer, ADT is the primary method of treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">ADT is also used in combination with local treatment modalities to achieve better cancer control or as an effective salvage therapy in patients who do not respond to local therapy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">As many as 46% of men with prostate cancer receive ADT at some point during their treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">Pharmacological ADT refers to treatment with a gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Suppression of androgen signaling can also be accomplished with androgen receptor inhibitors or cytochrome P450 17A1 inhibitors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although ADT provides a means of effective cancer control, studies have raised concerns regarding the adverse effects of ADT on metabolism and subsequent cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The mechanisms through which ADT has been suspected to increase cardiovascular risk include increased fat mass, increased low-density lipoprotein and total cholesterol, increased triglycerides, and increased insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cardiovascular disease represents the most common comorbidity and cause of death among patients with prostate cancer.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> ADT had positive associations with cardiovascular events, cardiovascular death, and myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A number of studies have demonstrated that ADT is associated with fatal and nonfatal cardiovascular disease events that encompass ischemic heart disease, myocardial infarction, sudden cardiac death or ventricular arrhythmias, cerebrovascular accidents, peripheral artery disease, and venous thromboembolism.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Increased risk seems to occur regardless of whether the patient is administered short- or long-term ADT.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Epstein et al. reported that death from ischemic heart disease is the most common noncancer death in patients with prostate cancer on ADT.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors present a case that seems to be an example of acute myocardial infarction in an octogenarian patient on ADT with goserelin and bicalutamide. Goserelin is a GnRH agonist and bicalutamide an androgen receptor inhibitor.</p><p id="par0055" class="elsevierStylePara elsevierViewall">They show other lesser-known manifestations of ADT that include QT interval prolongation and changes in repolarization presenting in a patient with chest pain.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Repolarization abnormalities and QT interval prolongation have been described with goserelin administration<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and chest pain has been documented with bicalutamide.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">However, the question remains, despite the absence of coronary disease, as to whether the chest pain and inversion of T waves would correspond to ischemia or not.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The clinicians in this case decided to discontinue treatment with the drugs that caused the androgen deprivation and cardiac semiology regressed. However, we do not know what the subsequent attitude was. Did they switch to a GnRH antagonist?</p><p id="par0075" class="elsevierStylePara elsevierViewall">QT prolongation is a drug class effect due to androgen deprivation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Prolongation of QT interval represents a delay in ventricular repolarization, which may lead to ventricular tachyarrhythmias, including torsade de pointes (TdP). TdP can degenerate into ventricular fibrillation, leading to sudden death.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Looking at this clinical case of cardiovascular effects of ADT makes us think that there is still a way to go in the search for knowledge.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular effects of androgen deprivation therapy in prostate cancer: contemporary meta-analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.-R. Hu" 1 => "M.S. Duncan" 2 => "A.K. Morgans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/ATVBAHA.119.313046" "Revista" => array:3 [ "tituloSerie" => "Arterioscler Thromb Vasc Biol" "fecha" => "2020" "volumen" => "40" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Androgen deprivation therapy and cardiovascular risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Punnen" 1 => "M.R. Cooperberg" 2 => "N. 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Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JOP" "Revista" => array:4 [ "tituloSerie" => "J Oncol Pract" "fecha" => "2018" "volumen" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29648923" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Androgen deprivation therapy mimicking na acute coronary syndrome. A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Castro-Torres" 1 => "A. Triana-Díaz" 2 => "A.A. Cuellar-Gallardo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2022" "volumen" => "41" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Approach to initiating QT-prolonging oncology drugs in the ambulatory setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Lemos" 1 => "C. Kung" 2 => "V. 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