Tajiri Kazuko, Aonuma Kazutaka, Sekine Ikuo
Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba.
Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Jpn J Clin Oncol. 2017 Aug 1;47(8):678-682. doi: 10.1093/jjco/hyx068.
Cardiac dysfunction that develops during or after completion of cancer therapy is a growing health concern that should be addressed in a multidisciplinary setting. Cardio-oncology is a new discipline that focuses on screening, monitoring and treating cardiovascular disease during and after cancer treatment. A baseline cardiovascular risk assessment is essential. For high-risk patients, a tailored and detailed plan for cardiovascular management throughout treatment and beyond should also be established. Anthracycline and/or trastuzumab-containing chemotherapy and chest-directed radiation therapy are well known cardiotoxic cancer therapies. Monitoring for the development of subclinical cardiotoxicity is crucial for the prevention of clinical heart failure. Detecting a decreased left ventricular ejection fraction after cancer therapy might be a late finding; therefore, earlier markers of cardiac injury are being actively explored. Abnormal myocardial strain and increased serum cardiac biomarkers (e.g. troponins and natriuretic peptides) are possible candidates for this purpose. An important method for preventing heart failure is the avoidance or minimization of the use of cardiotoxic therapies. Decisions must balance the anti-tumor efficacy of the treatment with its potential cardiotoxicity. If patients develop cardiac dysfunction or heart failure, they should be treated in accordance with established guidelines for heart failure. Cancer survivors who have been exposed to cardiotoxic cancer therapies are at high risk of developing heart failure. The management of cardiovascular risk factors and periodic screening with cardiac imaging and biomarkers should be considered in high-risk survivors.
癌症治疗期间或结束后出现的心脏功能障碍是一个日益受到关注的健康问题，应在多学科环境中加以解决。心脏肿瘤学是一门新学科，专注于在癌症治疗期间及之后筛查、监测和治疗心血管疾病。进行基线心血管风险评估至关重要。对于高危患者，还应制定一份贯穿治疗全程及之后的心血管管理定制化详细计划。含蒽环类药物和/或曲妥珠单抗的化疗以及胸部定向放射治疗是众所周知的具有心脏毒性的癌症治疗方法。监测亚临床心脏毒性的发生对于预防临床心力衰竭至关重要。在癌症治疗后检测到左心室射血分数降低可能为时已晚；因此，正在积极探索早期心脏损伤标志物。异常心肌应变和血清心脏生物标志物（如肌钙蛋白和利钠肽）升高可能是这方面的候选指标。预防心力衰竭的一个重要方法是避免或尽量减少使用具有心脏毒性的治疗方法。必须在治疗的抗肿瘤疗效与其潜在心脏毒性之间取得平衡。如果患者出现心脏功能障碍或心力衰竭，应按照既定的心力衰竭指南进行治疗。接受过具有心脏毒性的癌症治疗的癌症幸存者发生心力衰竭的风险很高。对于高危幸存者，应考虑管理心血管危险因素并定期进行心脏成像和生物标志物筛查。
