Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Curr Opin Cardiol. 2019 May;34(3):296-302. doi: 10.1097/HCO.0000000000000614.
The number of cancer survivors is increasing, and cardiovascular events are a significant cause of morbidity and mortality in these patients. Preexisting cardiovascular conditions as well as the development of cancer therapeutics-related cardiac dysfunction (CTRCD), in particular left ventricular dysfunction and heart failure, limit the options for cancer therapies for these patients and contribute to reduced cancer survival.
Recent guidelines and position statements from various cardiology and oncology societies provide an outline for the practicing physician for the management of CTRCD. However, this is largely based on data extrapolated from the general heart failure population (including patients without cancers) and is not based on strong evidence. There is now emerging evidence for the prevention and treatment of heart failure related to certain established chemotherapeutic drugs, whereas there is lack of trials for specific cardioprotective strategies to reduce cardiotoxicity of newer targeted cancer therapies.
In this article, we discuss the most recent literature for the management of asymptomatic left ventricular dysfunction and heart failure related to chemotherapy, from prevention to the use of goal-directed medical therapies as well as discuss the role for advanced heart failure treatment in this population.
癌症幸存者的数量正在增加，心血管事件是这些患者发病率和死亡率的重要原因。患者存在心血管疾病以及癌症治疗相关的心脏功能障碍（CTRCD），特别是左心室功能障碍和心力衰竭，限制了这些患者的癌症治疗选择，并导致癌症生存率降低。
来自不同心脏病学和肿瘤学会的最新指南和立场声明为临床医生提供了 CTRCD 管理的大纲。然而，这主要是基于从一般心力衰竭人群（包括没有癌症的患者）推断的数据，并且没有强有力的证据支持。现在有越来越多的证据表明可以预防和治疗与某些既定化疗药物相关的心力衰竭，而对于减少新型靶向癌症治疗的心脏毒性的特定心脏保护策略的试验却很少。
在本文中，我们讨论了与化疗相关的无症状左心室功能障碍和心力衰竭的最新文献，从预防到使用目标导向的药物治疗，以及讨论了在这一人群中使用晚期心力衰竭治疗的作用。
