Department of Cardiovascular Diseases, Vita Salute University and San Raffaele Hospital, Milan, Italy.
Department of Cardiovascular Diseases, Vita Salute University and San Raffaele Hospital, Milan, Italy, and Prevention and Rehabilitation Unit, Fondazione Don Gnocchi, Parma, Italy.
Front Biosci (Landmark Ed). 2017 Jun 1;22(10):1760-1773. doi: 10.2741/4570.
Many of the patients undergoing chemotherapy or radiotherapy for cancer are at increased risk of developing cardiovascular diseases. Recent evidence suggests that cardiac dysfunction and subsequent heart failure are mainly due to vascular toxicity rather than only to due to myocyte toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by epicardial coronary artery disease. In fact, in the last decades, it has been found that myocardial ischemia may occur as a consequence of structural or functional dysfunction of the complex network of vessels, which cannot be seen by a coronary angiography: the coronary microcirculation. Nowadays many diagnostic and therapeutic options are available both in coronary microvascular dysfunction and cardio-oncology. Aim of this review is to suggest future theranostic implications of the relationship between cardiotoxicity in oncology and coronary microvascular dysfunction, showing common pathophysiologic mechanisms, proposing new diagnostic approaches and therapeutic options for cardioprotection.
许多正在接受癌症化疗或放疗的患者发生心血管疾病的风险增加。最近的证据表明，心脏功能障碍和随后的心力衰竭主要是由于血管毒性，而不仅仅是由于心肌毒性。然而，并非所有癌症治疗的血管毒性都可以用心外膜冠状动脉疾病来解释。事实上，在过去几十年中，人们发现心肌缺血可能是由于复杂血管网络的结构或功能障碍引起的，而冠状动脉造影无法观察到这一点：冠状动脉微循环。如今，在冠状动脉微血管功能障碍和肿瘤心脏病学中，有许多诊断和治疗选择。本文旨在探讨肿瘤相关性心脏毒性与冠状动脉微血管功能障碍之间的关系，并提出未来的治疗建议，展示共同的病理生理机制，为心脏保护提出新的诊断方法和治疗选择。
