June 5, 2017
Two articles primarily researched and written by Oconee Heart and Vascular Services cardiologist Erick Avelar, MD, have been accepted for publication in peer-reviewed scientific journals.
The first article, entitled “Role of Imaging in Cardio-Oncology,” has been published in Current Treatment Options in Cardiovascular Medicine. The article reports on research into how cancer treatment affects the heart. Caitlin Strickland, RN, OHVC’s cardio-oncology nurse educator, is listed as one of Dr. Avelar’s co-authors. A summary of the article can be found at https://link.springer.com/article/10.1007/s11936-017-0546-2.
“Recent advances in cancer treatment and research have greatly improved survival rates for patients with cancer,” Dr. Avelar states in the article’s opinion statement. “However, many of these cancer survivors are developing cardiac disease – most commonly heart failure – as a result of this treatment.”
In the article, Dr. Avelar describes how various imaging systems and emerging techniques can assist in detecting early signs of cardiotoxicity, which is damage to the heart from cancer medications and/or radiation treatment. The theory is that early detection may reduce the number of cancer survivors who develop cardiac disease by allowing oncologists – cancer doctors – to fine-tune cancer treatment and to do so sooner.
The article compares the results of various imaging techniques – including echocardiography, MRI, CT, and nuclear medicine – with the goal of finding a way to detect heart problems earlier. It provides a comprehensive review of all imaging modalities now available to monitor heart function in cancer patients while they are receiving treatment.
In addition, Dr. Avelar describes the usefulness of cardiac MRI by also citing the data of his second article, published ahead of print. Cardiac MRI is a highly accurate and reproducible non-invasive imaging technique. Dr. Avelar finds that it has the ability to identify signs of heart trouble earlier than echocardiography or nuclear medicine, which are the standard methods of detection used now.
The second article, entitled “Effect of Adjuvant Chemotherapy on Left Ventricular Remodeling in Newly Diagnosed Primary Breast Cancer Women: A Pilot Prospective Longitudinal Cardiac Magnetic Resonance Imaging Study,” was accepted for publication in the Journal of Thoracic Imaging. Adjuvant therapy is additional treatment that is done after the main course of treatment. Its goal is to reduce the chances of cancer returning.
This article reports on prospective and original research using cardiac MRI to detect early signs of heart size changes (called heart remodeling) in women who are undergoing chemical and/or radiation therapy for breast cancer.
“One of the things that is lacking in the cardio-oncology field is to know the normal heart size and function response to cancer treatment,” Dr. Avelar said. “There could be benign changes to the heart related to cancer treatment. We don’t want to label benign changes as cardiotoxicity and alter treatment unnecessarily.”
Like primary cancer treatment, adjuvant chemotherapy can cause the heart to enlarge and weaken. Dr. Avelar recruited 20 patients with newly diagnosed breast cancer and followed them for a period of six months. They underwent cardiac MRI before cancer treatment, during treatment, two weeks after treatment, and finally, six months after treatment. The goal was to determine the normal heart response (remodeling) to cancer treatment, and if early detection of heart dysfunction (low left ventricle ejection fraction – a measure of the amount of blood actually pushed out by the heart) could be used to make changes in the woman’s treatment that would improve her length and quality of life.
The imaging findings indicate that the heart enlargement observed over time as well as the slight reduction in heart function were not associated with symptoms or biomarkers of heart failure. Future studies with a larger number of women and longer follow up are needed to determine the clinical significance of this pilot study, Dr. Avelar said.
“This pilot study is a good foundation that we can build on in order to determine with a longer follow up and a larger study population, whether the changes in heart size and function we observed are reversible, and whether they could lead to heart failure years from now,” he explained.
In addition to being a clinical cardiologist, Dr. Avelar is a Level 3 cardiac imaging reader who completed his training at Massachusetts General Hospital, Harvard Medical School. Dr. Avelar leads the Cardiac MRI/CT and Cardio-oncology programs at OHVC and St. Mary’s, and serves as an associate professor with the Augusta University/University of Georgia Medical Partnership in Athens. He sees outpatients at OHVC’s main clinic near Watkinsville and at its Walton County clinic in Monroe.
For more information about Oconee Heart and Vascular Center, please go to oconeeheart.com or visit the cardiology pages at stmarysathens.org.
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