Onassis Cardiac Surgery Center and Kapodistrian, University of Athens, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece.
First Cardiology Department, Hippokration Hospital, University of Athens, Athens, Greece.
Heart Fail Rev. 2019 Nov;24(6):977-987. doi: 10.1007/s10741-019-09805-1.
The number of breast cancer (BC) survivors has been increasing lately, due to the improvement in early detection strategies and oncological treatments. However, BC survivors are 3 times as likely to develop heart failure (HF) within 5 years of cancer diagnosis, and 7/100 of them will develop HF in a median follow-up of 8.5 years. Furthermore, HF in BC survivors has a worse prognosis compared to other causes of HF. Anthracyclines and trastuzumab have been proven to improve survival. However, they are also considered as the main causative factors of HF in BC survivors. Old patients, those with a pre-existing cardiovascular (CV) risk factors/disease, prior exposure to chemotherapy and radiotherapy are at increased risk. Serial evaluation of troponins and cardiac imaging parameters using echocardiography and cardiovascular magnetic resonance can significantly contribute to the early diagnosis of cardiac involvement before overt HF will develop. Assessment and immediate treatment of traditional CV risk factors is the first step for cardiotoxicity prevention. In BC survivors with known heart disease, the clinical stabilization is strongly recommended for cardiotoxicity prevention. Finally, in high-risk CV patients, primary prevention including cardioprotectants and/or CV drugs should be applied. According to recent studies, the early start of ACE inhibitors and β-blockers and the modification of anti-cancer treatment can prevent the decline in left ventricular ejection fraction. However, further multicenter studies are needed to establish both prevention and treatment protocols to successfully overcome HF development in BC survivors.
由于早期检测策略和肿瘤治疗的改进，最近乳腺癌（BC）幸存者的数量一直在增加。然而，BC 幸存者在癌症诊断后 5 年内发生心力衰竭（HF）的风险增加了 3 倍，在中位数为 8.5 年的随访中，有 7/100 的患者会发生 HF。此外，BC 幸存者中的 HF 与其他 HF 病因相比预后更差。蒽环类药物和曲妥珠单抗已被证明可改善生存。然而，它们也被认为是 BC 幸存者 HF 的主要致病因素。老年患者、有预先存在的心血管（CV）危险因素/疾病、先前暴露于化疗和放疗的患者风险增加。连续评估肌钙蛋白和心脏成像参数，使用超声心动图和心血管磁共振成像，可显著有助于在明显 HF 发生之前早期诊断心脏受累。评估和立即治疗传统的 CV 危险因素是预防心脏毒性的第一步。对于已知有心脏病的 BC 幸存者，强烈建议临床稳定以预防心脏毒性。最后，对于高 CV 风险患者，应应用包括心脏保护剂和/或 CV 药物的一级预防。根据最近的研究，早期开始使用 ACE 抑制剂和β受体阻滞剂以及修改抗癌治疗可以防止左心室射血分数下降。然而，需要进一步的多中心研究来建立预防和治疗方案，以成功克服 BC 幸存者 HF 的发展。
