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Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer

BACKGROUND: Medical castration, gonadotropin‐releasing hormone agonists, and antiandrogens have been widely applied as a treatment for prostate cancer. Sex steroid hormones influence cardiac ion channels. However, few studies have examined the proarrhythmic properties of medical castration. METHODS...

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Autores principales: Hasegawa, Kanae, Ito, Hideaki, Kaseno, Kenichi, Miyazaki, Shinsuke, Shiomi, Yuichiro, Tama, Naoto, Ikeda, Hiroyuki, Ishida, Kentaro, Uzui, Hiroyasu, Ohno, Seiko, Horie, Minoru, Yokoyama, Osamu, Tada, Hiroshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174268/
https://www.ncbi.nlm.nih.gov/pubmed/33599136
http://dx.doi.org/10.1161/JAHA.120.017267
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author Hasegawa, Kanae
Ito, Hideaki
Kaseno, Kenichi
Miyazaki, Shinsuke
Shiomi, Yuichiro
Tama, Naoto
Ikeda, Hiroyuki
Ishida, Kentaro
Uzui, Hiroyasu
Ohno, Seiko
Horie, Minoru
Yokoyama, Osamu
Tada, Hiroshi
author_facet Hasegawa, Kanae
Ito, Hideaki
Kaseno, Kenichi
Miyazaki, Shinsuke
Shiomi, Yuichiro
Tama, Naoto
Ikeda, Hiroyuki
Ishida, Kentaro
Uzui, Hiroyasu
Ohno, Seiko
Horie, Minoru
Yokoyama, Osamu
Tada, Hiroshi
author_sort Hasegawa, Kanae
collection PubMed
description BACKGROUND: Medical castration, gonadotropin‐releasing hormone agonists, and antiandrogens have been widely applied as a treatment for prostate cancer. Sex steroid hormones influence cardiac ion channels. However, few studies have examined the proarrhythmic properties of medical castration. METHODS AND RESULTS: This study included 149 patients who underwent medical castration using gonadotropin‐releasing hormones with/without antiandrogen for prostate cancer. The changes in the ECG findings during the therapy and associations of the electrocardiographic findings with malignant arrhythmias were studied. The QT and corrected QT (QTc) intervals prolonged during the therapy compared with baseline (QT, 394±32 to 406±39 ms [P<0.001]; QTc, 416±27 to 439±31 ms [P<0.001]). The QTc interval was prolonged in 119 (79.9%) patients during the therapy compared with baseline. In 2 (1.3%) patients who had no structural heart disease, torsade de pointes (TdP) and ventricular fibrillation (VF) occurred ≥6 months after starting the therapy. In patients with TdP/VF, the increase in the QTc interval from the pretreatment value was >80 ms. However, in patients without TdP/VF, the prevalence of an increase in the QTc interval from the pretreatment value of >50 ms was 11%, and an increase in the QTc interval from the pretreatment value >80 ms was found in only 4 (3%) patients. CONCLUSIONS: Medical castration prolongs the QT/QTc intervals in most patients with prostate cancer, and it could cause TdP/VFs even in patients with no risk of QT prolongation before the therapy. An increase in the QTc interval from the pretreatment value >50 ms might become a predictor of TdP/VF. Much attention should be paid to the QTc interval throughout all periods of medical castration to prevent malignant arrhythmias.
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spelling pubmed-81742682021-06-11 Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer Hasegawa, Kanae Ito, Hideaki Kaseno, Kenichi Miyazaki, Shinsuke Shiomi, Yuichiro Tama, Naoto Ikeda, Hiroyuki Ishida, Kentaro Uzui, Hiroyasu Ohno, Seiko Horie, Minoru Yokoyama, Osamu Tada, Hiroshi J Am Heart Assoc Original Research BACKGROUND: Medical castration, gonadotropin‐releasing hormone agonists, and antiandrogens have been widely applied as a treatment for prostate cancer. Sex steroid hormones influence cardiac ion channels. However, few studies have examined the proarrhythmic properties of medical castration. METHODS AND RESULTS: This study included 149 patients who underwent medical castration using gonadotropin‐releasing hormones with/without antiandrogen for prostate cancer. The changes in the ECG findings during the therapy and associations of the electrocardiographic findings with malignant arrhythmias were studied. The QT and corrected QT (QTc) intervals prolonged during the therapy compared with baseline (QT, 394±32 to 406±39 ms [P<0.001]; QTc, 416±27 to 439±31 ms [P<0.001]). The QTc interval was prolonged in 119 (79.9%) patients during the therapy compared with baseline. In 2 (1.3%) patients who had no structural heart disease, torsade de pointes (TdP) and ventricular fibrillation (VF) occurred ≥6 months after starting the therapy. In patients with TdP/VF, the increase in the QTc interval from the pretreatment value was >80 ms. However, in patients without TdP/VF, the prevalence of an increase in the QTc interval from the pretreatment value of >50 ms was 11%, and an increase in the QTc interval from the pretreatment value >80 ms was found in only 4 (3%) patients. CONCLUSIONS: Medical castration prolongs the QT/QTc intervals in most patients with prostate cancer, and it could cause TdP/VFs even in patients with no risk of QT prolongation before the therapy. An increase in the QTc interval from the pretreatment value >50 ms might become a predictor of TdP/VF. Much attention should be paid to the QTc interval throughout all periods of medical castration to prevent malignant arrhythmias. John Wiley and Sons Inc. 2021-02-18 /pmc/articles/PMC8174268/ /pubmed/33599136 http://dx.doi.org/10.1161/JAHA.120.017267 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Hasegawa, Kanae
Ito, Hideaki
Kaseno, Kenichi
Miyazaki, Shinsuke
Shiomi, Yuichiro
Tama, Naoto
Ikeda, Hiroyuki
Ishida, Kentaro
Uzui, Hiroyasu
Ohno, Seiko
Horie, Minoru
Yokoyama, Osamu
Tada, Hiroshi
Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title_full Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title_fullStr Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title_full_unstemmed Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title_short Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer
title_sort impact of medical castration on malignant arrhythmias in patients with prostate cancer
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174268/
https://www.ncbi.nlm.nih.gov/pubmed/33599136
http://dx.doi.org/10.1161/JAHA.120.017267
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