Cardioncology Unit, European Institute of Oncology, Milan, Italy.
Semin Oncol. 2013 Apr;40(2):186-98. doi: 10.1053/j.seminoncol.2013.01.008.
Cardiotoxicity due to cancer treatment is of rising concern, for both cardiologists and oncologists, because it may have a significant impact on cancer patient management and outcome. The most typical manifestation of cardiotoxicity is a hypokinetic cardiomyopathy leading to heart failure. However, the spectrum of the toxic effects that can impair the cardiovascular system may also include acute coronary syndromes, hypertension, arrhythmias, and thromboembolic events. Patients undergoing cancer treatment are more vulnerable to cardiovascular injuries, and their risk of premature cardiovascular disease and death is higher than that of the general population. Prevention of cardiotoxicity remains the most important strategy, and several measures, including cardiac function monitoring, limitation of chemotherapy dose, use of anthracycline analogues and cardioprotectants, and early detection of myocardial cell injury by biomarkers, have been proposed. The response to modern heart failure therapy of cancer treatment-induced cardiomyopathy has never been evaluated in clinical trials, and currently there are no definitive guidelines. Although it is likely that medications used for other forms of cardiomyopathy, particularly angiotensin-converting enzyme inhibitors and β-blockers, may be highly effective, there is still some unjustified concern regarding their use in cancer patients. Specific guidelines that take cardiologic conditions of cancer patients into account are currently lacking and need to be developed.
由于癌症治疗导致的心脏毒性引起了心脏病专家和肿瘤学家的高度关注，因为它可能会对癌症患者的管理和预后产生重大影响。心脏毒性最典型的表现是导致心力衰竭的运动不能性心肌病。然而，可能损害心血管系统的毒性作用的范围还可能包括急性冠状动脉综合征、高血压、心律失常和血栓栓塞事件。接受癌症治疗的患者更容易受到心血管损伤，其过早发生心血管疾病和死亡的风险高于一般人群。预防心脏毒性仍然是最重要的策略，已经提出了几种措施，包括心脏功能监测、化疗剂量限制、使用蒽环类药物类似物和心脏保护剂，以及通过生物标志物早期检测心肌细胞损伤。癌症治疗引起的心肌病对现代心力衰竭治疗的反应从未在临床试验中得到评估，目前也没有明确的指南。尽管用于其他形式心肌病（特别是血管紧张素转换酶抑制剂和β受体阻滞剂）的药物可能非常有效，但在癌症患者中使用这些药物仍存在一些不合理的担忧。目前缺乏考虑癌症患者心脏状况的具体指南，需要制定这些指南。
