Minneapolis Heart Institute® at Abbott Northwestern Hospital

Cardio-Oncology at MHI

Innovation SummitKasia Hryniewicz, MD

September 26th, 2015

• No disclosure

Why cardio-oncology?

Background• The advent of modern cancer therapy has

considerably improved the outcome of patients with cancer and, for the first time, has introduced "survivorship" as a theme in the management of cancer patients.

• These therapies may have cardiovascular consequences that may affect continued therapy of the cancer and cause short- and long-term morbidity or mortality.

Potential offenders

Trastuzumab (herecptin)

Cyclophosphamide

Busulfan

Melphalan

Carfilzomib

Adriamycin

Imatinib (Gleevec)Avastin (bevacizumab)

Cardiotoxicity• Cardiomyopathy• HTN• Acute coronary

syndrome/myocardial infarction• Thrombosis, • Electrocardiographic changes• Arrhythmias, • Myocarditis, pericarditis

Risk factors- age (> 50, > 65)- female gender- history of or pre-existing cardiovascular

disorders- mediastinal/chest radiation - cumulative dose - total dose administered during a day or a course- rate of administration - concurrent administration of cardiotoxic agents- prior anthracycline chemotherapy- electrolyte imbalances

Chemo-induced CM - prognosis

Diagnosis• Echo EF, diastolic function,

global longitudinal strain• Troponin• BNP• Cardiac MRI• Standard cardiac evaluation

Therapies• Prevention

- carvedilol- spironolactone- allopurinol- statin

• Treatment- standard HF therapy- dextrazoxane

Evolution of Cardio-Onc Clinic at MHI

1 MD,1 RN

Risk factor list

Reach out to

Minnesota Oncology

Prevention/

therapy and f/u

protocols

Imaging protocols (strain)

Cardio-Oncology Clinic at MHI

Kasia Hryniewicz, M.D.

Elizabeth Grey, M.D.

Mosi Bennett, M.D.

Michelle Vanhove, NP

Rebecca Giraldo, RN

Our philosophy• Physicians and NPs available to

see new referrals within 24 hours. • Education provided by nurse

coordinator at initial visit.• Close follow up including visits

and phone calls. • Efficient uptitration of

medications to allow the shortest time off chemotherapy“ We like to be bothered and we like to bother”

Standardized 2D echocardiogram

- Designated machine- All techs trained- All patients have longitudinal

strain measurements- All patients have 3D LV systolic

function assessment- Report generator updated to

include strain and 3D measurements

Our Stats• 117 patients• 90 (77%) women• Mean age 68 years (31-88)• Most common diagnosis breast

cancer (39%)

lymphoma (12%)

8/117 (7%) presented with low EF, able to restart chemotherapy after 4-6 weeks of HF treatment

When to refer? • Early!• Ideally before chemotherapy

started if any of the risk factors present

• If any decrement in LVEF during therapy

• Symptoms of heart failure and side effects of chemotherapy are very similar – refer when in doubt!

Future directions• Clinical trials

- stem cells in chemo induced CM (SENECA trial), starting this fall- Prevention and screening- Provider manual- Patient information booklet- Expanding to outreach clinics- NP involvement

Thank you!