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Cardiotoxicity is a well-recognized complication of chemotherapeutic agents. Cardiotoxicity encompasses multiple effects including subclinical injury, overt left ventricular (LV) dysfunction, and congestive heart failure (HF). The development of cardiotoxicity has important implications both during and subsequent to cancer therapy. Cardioprotective strategies include primary prevention and secondary prevention in those high-risk patients with subclinical cardiotoxicity. This review focuses on cardioprotective agents used in conjunction with cancer therapy. Radiation-induced heart disease and the treatment of cardiotoxicity are beyond the scope of this review.

Primary Prevention in Patients Without Cardiotoxicity or Dysfunction

Table 1: Selected Publications: Primary Prevention in Patients Without Cardiac Dysfunction

Dexrazoxane

Dexrazoxane, an intravenous iron chelator, is the only pharmacologic agent that is approved by the Food and Drug Administration to prevent cardiotoxicity in patients receiving anthracyclines. 15 In the United States, it is approved for use in women with metastatic breast cancer who have received a cumulative dose of 300 mg/m 2 and who will continue to receive doxorubicin to maintain tumor control; it is not approved by the Food and Drug Administration for use in pediatric patients. Among adults with advanced breast cancer receiving anthracyclines, dexrazoxane, as compared with placebo, reduced both asymptomatic LV dysfunction and clinical congestive HF. 16-18 A single study demonstrated an increased risk of dexrazoxane-associated secondary malignancy in pediatric Hodgkin's disease, but this finding has not been replicated in other studies. 19-21

Beta-Blockers and Renin-Angiotensin Inhibitors

Both randomized and observational data suggest a cardioprotective role for beta-blockers and renin-angiotensin inhibitors (ACEi and ARBs) in patients receiving chemotherapy. 4-10 For example, three recent randomized trials tested whether primary prevention using these agents during chemotherapy can reduce cardiotoxicity and preserve LVEF. 1-3

The OVERCOME (Prevention of Left Ventricular Dysfunction with Enalapril and Carvedilol in Patients Submitted to Intensive Chemotherapy for the Treatment of Malignant Hemopathies) trial randomized patients with hematologic malignancies to receive or not receive (control) a combination of enalapril and carvedilol; 80% (72 out of 90) received anthracyclines prior to or during the study. 1 At 6 months, there was no change in LVEF in the intervention group but a reduction of LVEF in the control group, resulting in an absolute difference between groups of –3.1% by echocardiography and –3.4% by cardiac magnetic resonance. The PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial randomized patients with breast cancer receiving anthracyclines +/– trastuzumab using a 2x2 factorial design to metoprolol or candesartan versus placebo. 2 Candesartan, but not metoprolol, preserved baseline LVEF; LVEF declined –0.8% in the candesartan group versus –2.6% in the placebo group. Similarly, the MANTICORE 101 (Multidisciplinary Approach to Novel Therapies in Cardiology Oncology Research) study randomized early stage human epidermal growth factor receptor-positive breast cancer patients 1:1:1 to perindopril, bisoprolol, or placebo prior to the initiation of trastuzumab. 3 Bisoprolol, but not perindopril, prevented the decline in LVEF compared with placebo; however, the primary endpoint of prevention of LV remodeling based on LV end-diastolic volume index was not met.

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Besides the radio and GPS, you can also use the Columbus infotainment GPS system to control your vehicle settings using the Car button on the control panel without needing a display. The Columbus infotainment GPS system has:

Updates that are available for infotainment GPS Columbus.

In addition to a radio and satnav, through the Amundsen infotainment satnav it is possible to control the car’s settings using the Car button on the control panel, without the necessity of a Maxi DOT display. Properties of the Amundsen navigation system:

Updates available for Amundsen infotainment navigation:

The new generation of the Bolero infotainment system provides expanded options for operating your radio, telephone and now also car systems, without the necessity of a Maxi DOT display. Support for image formats enables viewing of images from an SD card or USB and showing the logos of stored radio stations on the display. Properties of the Bolero infotainment system:

Updates available for Bolero infotainment navigation

The new generation of the Swing infotainment radio provides expanded options for operating your radio, telephone and now also car systems, without the necessity of a Maxi DOT display. A Swing infotainment radio contains: 5” resistant colour touchscreen TFT display Reception of AM/FM frequency bands and DAB Aux-In, USB with Apple connectivity SD card slot Bluetooth®

Updates available for Swing infotainment radio:

What can you update?

GPS data undergo constant changes (e.g. new roads, renaming of roads and renumbering of houses), so after a certain time they are not up-to-date and navigating to your designation can be inaccurate or incorrect. We therefore recommend regular updates to navigation data.

Your SKODA infotainment system includes other software as well. Regular updates will make sure it stays at top functionality, which will make your travels both safer and convenient.

Updating Bluetooth ensures that your mobile device matches up to the ŠKODA infotainment system without any problems. (Note: If your device works flawlessly, there is no reason to update it. In case of problems, please update to newer version.)

Update your Radio station logos regularly and you will always have the latest logos for your favorite regional and national radio stations as well as new broadcasting stations.

Regularly updating the MirrorLink® function guarantees compatibility with the latest applications on your mobile device.

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