Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA.
Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
Curr Heart Fail Rep. 2020 Apr;17(2):43-55. doi: 10.1007/s11897-020-00453-3.
Cancer treatment-related cardiotoxicity (CTRC) represents a significant cause of morbidity and mortality worldwide. The purpose of our review is to summarize the epidemiology, natural history, and pathophysiology of cardiotoxicity-related to cancer treatment. We also summarize appropriate screening, surveillance, and management of CTRC. While cardiotoxicity is characteristically associated with anthracyclines, HER2-B antagonists, and radiation therapy (XRT), there is growing recognition of toxicity with immune checkpoint inhibitors (ICI), tyrosine kinase inhibitors, and proteasome inhibitors.
Patients at risk for cardiotoxicity should be screened based on available guidelines, generally with serial echocardiograms. The role of medical heart failure (HF) therapies is controversial in patients with asymptomatic left ventricular dysfunction but may be considered in some instances. Once symptomatic HF has developed, treatment should be in accordance with ACC/AHA guidelines. The goal in caring for patients receiving cancer treatment is to optimize cardiac function and prevent interruptions in potentially lifesaving cancer treatment.
癌症治疗相关的心脏毒性(CTRC)是全世界发病率和死亡率的重要原因。我们综述的目的是总结癌症治疗相关心脏毒性的流行病学、自然史和病理生理学。我们还总结了适当的筛查、监测和 CTRC 的管理。虽然心脏毒性通常与蒽环类药物、HER2-B 拮抗剂和放射治疗(XRT)有关,但人们越来越认识到免疫检查点抑制剂(ICI)、酪氨酸激酶抑制剂和蛋白酶体抑制剂也具有毒性。
有心脏毒性风险的患者应根据现有指南进行筛查,通常采用连续超声心动图。在无症状左心室功能障碍的患者中,使用心力衰竭(HF)的医学治疗存在争议,但在某些情况下可能会考虑使用。一旦出现有症状的 HF,应根据 ACC/AHA 指南进行治疗。在治疗接受癌症治疗的患者时,目标是优化心脏功能并防止中断潜在的救命癌症治疗。