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photo by briaN KohLbaCher CourteSy of CLeveLaND CLiNiC Some cancer patients can present several years later with cardiovascular problems which may require surgical attention. Dr. bruce Lytle, chairman of Cleveland Clinic's heart & vascular institute, specializes in surgery for these patients. Directors of the American Society of Echocardiography in June. He currently represents the United States on the Inter-American Society of Cardiology, Echocardiography Committee. Dr. Plana is also Chairman of the writing group of the expert consensus for the echocardiographic evaluation of patients during and after cancer therapy, a joint effort of the American Society of Echocardiography, the European Association of Cardiovascular Imaging and the American Society of Clinical Oncology. "The research that we have done in this platform will be put in a formal consensus document, endorsed by cardiologists and oncologists, which will be followed on both sides of the ocean," says Dr. Plana. 10 | Cleveland/Akron/Canton MD News The Cardio-Oncology Center Cleveland Clinic's Cardio-Oncology Center prov ides ca re to patients before, during and after cancer treatment. Before treatment, patients who are at risk for heart disease or are being treated for heart disease undergo evaluation. "We study the hearts of patients carefully before treatment is started using state-of-the-art technolog y, including 3-D and strain imaging," Dr. Plana explains. "During treatment, we continue to monitor them using these advanced tools. Depending on the chemotherapy regimen, we have different intervals for follow-up." Dr. Plana also evaluates patients who, during treatment, develop symptoms of cardiotoxicity — weakness or fatigue, swelling of the legs and feet, chest pain, irregular heartbeats and/ or dizziness. When an abnormality in strain is detected, cardioprotection measures are initiated. " Through clinical research, we have established specific thresholds that signal the need to initiate what we call cardioprotection regimens. These include the use of medications typically used for treatment of heart failure," he explains. "We make it easy for the heart to do its job with the hope that the heart can mend. And we've seen in our research that the heart actually does get better. We stop the progression of damage, so the patients don't end up with heart failure. Early detection is really important. Time is muscle in this condition, as well." For patients who had cancer treatment in the past and developed new or advanced cardiac problems, or those who had radiation therapy in the past a nd need surgica l or interventional treatments, Dr. Plana and his colleagues at the CardioOncology Center can help. The team includes specialists from the Sydell ■ MDNEWS.COM ■ JULY-AUGUST 2013 and Arnold Miller Family Heart & Vascular Institute and the Taussig Cancer Institute. "Some cancer patients, especially those who have had radiation therapy, can present several years down the line with problems in their valves, arteries or pericardium (the sac that covers the heart), which may need surgical attention. So we also have surgeons, including the Chairman of our Heart & Vascular Institute, Dr. Bruce Lytle, who specialize in surgery in these populations," says Dr. Plana. "We also have other surgeons, like Dr. Eric Roselli who specializes in the resection of tumors present in the heart or around the heart. And most recently, we teamed up with the Section of Preventive Medicine here within the Department of Cardiovascular Medicine. So our Cardio-Oncology Center is a tr ue exa mple of multidisciplinary collaboration." Dr. Plana recommends that patients who are going to receive breast cancer treatments toxic to the heart, or patients who have already received treatments, be evaluated. An interactive cardio-oncology assessment tool is available online to help referring physicians and their patients know if an evaluation at the Cardio-Oncology Center is warranted. It can be found at http://my.clevelandclinic.org/heart/ cardio-oncology-tool.aspx. "Surveillance of toxicity of chemotherapy is very important," says Dr. Pla na. " The hea r t gives us a window of opportunity. If you identify the toxicity within this window, we can stop disease progression." For more information about Cleveland Clinic's Cardio-Oncology Center, visit www.clevelandclinic.org/cardiooncology. To refer a patient, call Christine Cifranic, PA-C, MPAS, prog ram coordinator, at 216-636-4279. ■