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Echocardiography Helps in Early Detection of Heart Damage for Cancer Patients

By MedImaging International staff writers
Posted on 25 Oct 2011

For cancer patients whose medical treatments could put them at risk for future cardiac problems, strain echocardiography can help physicians detect early signs of cardiac toxicity. More...

To help get this information out to those who need it, an American echocardiography society is preparing a guideline document outlining the best way to evaluate cancer patients, and has funded a research study to enhance identification of patients who are at risk.

In the past, when cancer treatments were not very effective and cancer was usually fatal, little attention was paid to the complications from treatment. With the advent of more successful new therapies for cancer that have raised survival rates, concerns about their long-term effects have now become paramount. “There are 2.2 million survivors of breast cancer in the US alone,” said Juan Carlos Plana, MD, codirector of cardio-oncology, Cleveland Clinic (Cleveland, OH, USA), “and heart disease, not cancer, is the biggest risk they face.”

When a patient is diagnosed with breast cancer, she (or he) is tested for the HER2 (human epidermal growth factor receptor 2) mutation, an aggressive form of cancer, which affects 20% to 25% of breast cancer patients, typically treated with Doxorubicin followed by Herceptin. Unfortunately, as many as one third of patients receiving these two drugs will develop cardiotoxicity, and some will progress to full-blown heart failure, which means they could potentially need mechanical devices or heart transplants in order to survive.

The introduction of strain echocardiography for early identification of cardiac problems is great news for those suffering from many forms of cancer. “The goal is not to stop cancer therapy, but to identify cardiotoxicity early and to protect the heart with medications so heart failure does not become a problem and the cancer treatment can be continued,” Dr. Plana explained. “Currently, 17% of patients receiving treatment for the most aggressive form of breast cancer have to stop therapy due to heart issues. The sensitivity of strain echo allows early detection so oncologists can treat their patients without fear of the downstream effects of the therapies.”

Dr. Plana, who is a fellow of the American Society of Echocardiography (ASE; Morrisville, NC, USA) and served as medical director of cardiac imaging at MD Anderson Cancer Center (Houston, TX, USA), now heads a newly-formed cardio-oncology center at the Cleveland Clinic, where every patient slated for a cancer therapy with the potential for toxicity receives an intensive left-ventricular mechanics protocol, which includes both three-dimensional (3D) echocardiography with contrast and strain imaging.

To highlight the benefits of these screenings, ASE has collaborated with the European Association of Echocardiography (Sophia Antipolis, France) and the American Society of Clinical Oncology (Alexandria, VA, USA) to organize a guideline-writing group, led by Dr. Plana. An earlier article written with ASE board of directors member Marielle Scherrer-Crosbie, MD, PhD, FASE, MCH, associate professor of medicine, Massachusetts General Hospital and Harvard Medical School (both based in Boston, MA, USA), and others for the American Journal of Cardiology, has already outlined exciting progress in this area.

ASE expects its new guideline to be available in 2012. To take the new clinical application for echocardiography one step further, the ASE Education and Research Foundation has also funded a career development award on the use of strain and 3D echocardiography to identify patients who are at high risk for developing heart complications even before they start chemotherapy treatment. The lead researcher, ASE member Timothy Tan, MBBS, PhD, clinical and research fellow, Massachusetts General Hospital and Harvard Medical School, hopes the research “will increase the understanding of heart failure associated with cancer treatment, potentially helping to decrease its morbidity and mortality.”

As the largest global organization for cardiovascular ultrasound imaging, the American Society of Echocardiography (ASE) is a leader and advocate, setting practice standards and guidelines. Comprised of over 15,000 physicians, sonographers, nurses, and scientists, ASE is a strong voice providing guidance, expertise, and education to its members with a commitment to improving the practice of ultrasound and imaging of the heart and cardiovascular system for better patient outcomes. The full text of ASE’s guidelines is available online (please see Related Links below).

Related Links:
American Society of Echocardiography
American Society of Echocardiography guidelines
Cleveland Clinic

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56 (87.976455688477): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (576.97296142578): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1291.036605835): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

59 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

60 (106.0962677002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

61 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

62 (79.154968261719): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (635.86235046387): SELECT fid FROM jos_deeppockets WHERE id=294737740 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737740 AND published='1' LIMIT 1

64 (53.882598876953): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

65 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

66 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

67 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

68 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

69 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294737740 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737740 AND published='1' LIMIT 1

70 (29.802322387695): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

71 (378.13186645508): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (437.02125549316): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (46.014785766602): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

106 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

107 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

110 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

111 (63.896179199219): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (638.96179199219): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (730.99136352539): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (479.93659973145): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (192.88063049316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

116 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

117 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

118 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

119 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

120 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

121 (96.797943115234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

122 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

123 (379.08554077148): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 20828.96232605): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

125 (551.93901062012): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737740 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737740 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 7467.0314788818): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (150.91896057129): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (42.200088500977): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (325.91819763184): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (78.916549682617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (29.802322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (504.0168762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (375.03242492676): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=214

139 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=214

140 (560.99891662598): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (544.07119750977): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

143 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

144 (!!!!! 9115.9343719482): TRUNCATE TABLE jos_trademed_module

145 (125.88500976562): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (66.995620727539): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (931.97822570801): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

150 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

151 (!!!!! 1255.0354003906): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

152 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

153 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

154 (32.901763916016): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737740 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737740 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (35.04753112793): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (38.862228393555): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

157 (53.167343139648): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (140.90538024902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

159 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737740 AND published='1' LIMIT 1

160 (46.968460083008): select jos_twitters.link from jos_twitters where cat=10

161 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

162 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

163 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

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