Abstract
This thesis comprises of two parts which report three component studies each involving cardio-oncology and transthyretin cardiac amyloidosis (ATTR-CA).The association between CVD and cancer is increasingly recognized. To further investigate CVD in patients with cancer and improve gaps in knowledge, we investigated the frequency and temporal relationships of CVD. We reported temporal trends of all CVD within 1 year of chemotherapy and risk factor association pre-chemotherapy and post-chemotherapy. We developed network-based methodology for unbiased cardiac risk stratification for cancer patients with CTRCD. Using this method, we identified 4 subgroups that had the most distinct survival rate among the overall cohort. In terms of CVD, the most common risk factor was found to be atrial fibrillation (AF) and this was further investigated diagnosis of AF relative to cancer diagnosis according to age and the associations between AF timing, CHA2DS2-VASc score, cancer therapeutics and mortality in selected oncology patients.
The second section of this thesis focuses on ATTR-CA, which is associated with CVD and is an evolving entity. ATTR-CA is increasingly recognized as a cause of heart failure in older patients. Cardiac scintigraphy with technetium-99m-pyrophosphate (99mTc-PyP) labelled bone-seeking tracers is used to non-invasively make the diagnosis of ATTR-CA based on the presence of ventricular uptake. Atrial uptake (AU) on 99mTc-PyP is currently not clinically reported. We investigated AU and the relative interaction with atrial fibrillation, ATTR-CA, and clinical outcomes. Using von Kossa staining (a phosphate binding dye) within histopathological samples of patients that confirm the presence of micro-calcifications with atrial and ventricular tissue. For the next chapter, I focused on aortic stenosis (AS) and investigated AV calcification in patients with and without ATTR-CA using propensity matching to compare.
In this thesis, I report a wide variety of findings and observations of CVD in cardio-oncology and ATTR-CA.
Thesis is embargoed until 31 July 2028.
| Date of Award | Jul 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Patrick Collier (Supervisor), Chris Watson (Supervisor) & David Grieve (Supervisor) |
Keywords
- Cardiovascular medicine
- cardio-onology
- cardiac amyloidosis