Background: The use of modern high-efficient cancer chemotherapy treatment in 5-35% of cases is accompanied by cardiotoxic effect varying from asymptomatic electrocardiography (ECG) changes to the development of acute coronary syndrome (ACS) and heart failure (CHF) that significantly impair the patients’ life expectancy.
Purpose: Assessment of the feasibility of cardiopaging using due to improve the effectiveness of cardiotoxic effect diagnostics in cancer patients.
Methods: Remote management effectiveness was assessed in cardio-oncological patients with heart failure (CHF) (22 patients: 12 men, 10 women, 52.6±5.5 y.o., NYHA 2.04±0.25, ejection fraction 48.6±6.5%). Patients were included in the study from 2 to 12 months after the chemotherapy start with 6 months follow-up period. Cardiopaging was performed on the principle of autotransmitting mobile devices and Internet application ECG Dongle. Asynchronous telecardiologic platform "CardioCloud" was used for information storage and analysis, telemedicine counseling. In CHF/chemotherapy group standard therapy was administered considering the patients’ clinical status. ECG was registered 5 times a week. ECG was registered in addition in the case of any clinical symptoms present or according to the patients’ desire. ECG registration duration was 10-20 minutes. ECG data were analyzed by an external doctor (an employee of the Cardiology Research Institute). Analysed data included mean heart rate, any rhythm or conduction disorders, dynamics of ST changes, QT duration. If necessary, medication was prescribed.
Results. Within 6 months not previously documented ECG changes were remotely registered in all CHF/chemotherapy patients. Among them sinus tachycardia was predominant (88%). Against the background of sinus tachycardia ventricular extrasystole of various gradations (38%), supraventricular extrasystole (24%), transient tachy-dependent bundle-branch blockages (9%) were registered. Atrial fibrillation paroxysms were observed in 2 patients. In 55% of patients complicated ECG disorders were registered in the form of sinus tachycardia and supraventricular rhythm disorders (extrasystole, episodes of atrial fibrillation) combination, and sinus tachycardia, ventricular extrasystole and ST depression. The majority pf detected violations were symptomatic (65%), in other cases patients did not complain. Within the framework of office counseling 7 (70%) patients had arterial hypertension (AH) of I-III degree. ß-blockers and ACE inhibitors were prescribed to correct the identified violations and AH.
Conclusions. Remote dynamic management of cancer patients with chemotherapy including ECG registration (=5 times/week, 10-20 min) on the base of mobile cardiopaging combined with doctors’ counseling is a sufficiently effective and accessible method of cardiotoxicity phenomenon diagnostics. The main advantage of the method is the possibility of early pharmacological correction in asymptomatic cardiovascular disorders.