Adão Rui, de Keulenaer Gilles, Leite-Moreira Adelino, Brás-Silva Carmen
Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Rev Port Cardiol. 2013 May;32(5):395-409. doi: 10.1016/j.repc.2012.11.002. Epub 2013 Apr 24.
Cardiotoxicity is one of the most significant adverse effects of cancer treatment, and is responsible for considerable morbidity and mortality. Among the effects of chemotherapeutic agents on the cardiovascular system, the most frequent and serious is heart failure with ventricular systolic dysfunction. Other toxic effects include hypertension, thromboembolic disease, pericardial disease, arrhythmias and myocardial ischemia. For several decades, cancer therapy-induced cardiomyopathy was almost exclusively associated with the use of cumulative doses of anthracyclines, which cause permanent damage at the cellular level. However, new therapeutic agents, such as the monoclonal antibody trastuzumab, induce transient reversible myocyte dysfunction which is unrelated to the dose used. Early identification of potential cardiovascular injury, accurate diagnosis of cardiotoxic events and implementation of appropriate monitoring plans are essential in patients with cancer. Close cooperation between cardiologists and oncologists is thus crucial, in order to balance the risks and benefits of cardiotoxic anticancer therapy. In this article we review the various responses to cardiotoxic cancer treatments and their relationship with the main antineoplastic drugs used in clinical practice. In addition, we discuss the main guidelines on detection and monitoring of cardiotoxicity in patients with cancer.
心脏毒性是癌症治疗最严重的不良反应之一，可导致相当高的发病率和死亡率。在化疗药物对心血管系统的影响中，最常见且严重的是伴有心室收缩功能障碍的心力衰竭。其他毒性作用包括高血压、血栓栓塞性疾病、心包疾病、心律失常和心肌缺血。几十年来，癌症治疗引起的心肌病几乎仅与累积剂量蒽环类药物的使用有关，这类药物会在细胞水平造成永久性损伤。然而，新型治疗药物，如单克隆抗体曲妥珠单抗，会引起短暂可逆的心肌细胞功能障碍，这与所用剂量无关。对于癌症患者，早期识别潜在的心血管损伤、准确诊断心脏毒性事件以及实施适当的监测计划至关重要。因此，心脏病专家和肿瘤学家之间密切合作至关重要，以便平衡具有心脏毒性的抗癌治疗的风险和益处。在本文中，我们综述了对具有心脏毒性的癌症治疗的各种反应及其与临床实践中使用的主要抗肿瘤药物的关系。此外，我们讨论了癌症患者心脏毒性检测和监测的主要指南。
