Department of Cardiology, The University of Texas MD Anderson Cancer Centre, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
School of Medicine &Public Health, Division of Cardiovascular Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
Nat Rev Cardiol. 2015 Sep;12(9):547-58. doi: 10.1038/nrcardio.2015.65. Epub 2015 May 12.
Patients with cancer can experience adverse cardiovascular events secondary to the malignant process itself or its treatment. Patients with cancer might also have underlying cardiovascular illness, the consequences of which are often exacerbated by the stress of the tumour growth or its treatment. With the advent of new treatments and subsequent prolonged survival time, late effects of cancer treatment can become clinically evident decades after completion of therapy. The heart's extensive energy reserve and its ability to compensate for reduced function add to the complexity of diagnosis and timely initiation of therapy. Additionally, modern oncological treatment regimens often incorporate multiple agents whose deleterious cardiac effects might be additive or synergistic. Treatment-related impairment of cardiac contractility can be either transient or irreversible. Furthermore, cancer treatment is associated with life-threatening arrhythmia, ischaemia, infarction, and damage to cardiac valves, the conduction system, or the pericardium. Awareness of these processes has gained prominence with the arrival of strategies to monitor and to prevent or to mitigate the effects of cardiovascular damage. A greater understanding of the mechanisms of injury can prolong the lives of those cured of their malignancy, but left with potentially devastating cardiac sequelae.
癌症患者可能会因恶性肿瘤本身或其治疗而出现不良心血管事件。癌症患者也可能患有潜在的心血管疾病，其后果往往因肿瘤生长或其治疗的压力而加剧。随着新的治疗方法的出现以及随后生存时间的延长，癌症治疗的晚期效应可能在治疗完成几十年后才会在临床上显现出来。心脏具有广泛的能量储备和代偿功能下降的能力，这增加了诊断和及时开始治疗的复杂性。此外，现代肿瘤治疗方案通常包含多种药物，其心脏毒性可能具有相加或协同作用。治疗相关的心肌收缩力损害可能是短暂的，也可能是不可逆的。此外，癌症治疗与危及生命的心律失常、缺血、梗死以及心脏瓣膜、传导系统或心包损伤有关。随着监测策略的出现，以及预防或减轻心血管损伤的影响的策略的出现，人们对这些过程的认识已经得到了提高。对损伤机制的更深入了解可以延长那些已经治愈恶性肿瘤但可能留下严重心脏后遗症的患者的生命。
