Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (Campus CVK), Berlin, Germany.
Department of Cardiology, Charité Universitätsmedizin Berlin (Campus CBF), Berlin, Germany.
Eur J Heart Fail. 2021 Jan;23(1):140-144. doi: 10.1002/ejhf.2071.
We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti-cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways. We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti-cancer therapies. The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients. We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio-oncology.
我们提出假设，晚期癌症也是一种心力衰竭综合征。它可以独立于抗癌治疗的心脏毒性作用或与之同时发生。这包括室性心律失常的风险增加。我们建议这些发展的病理生理联系包括由于组织动态平衡变化导致的广泛肌肉减少（即肌肉减少症），从而导致与心脏消耗相关的心肌病。心肌消耗导致心室壁变薄，增加心室壁应力，即使在没有心室扩张的情况下也是如此。此外，心律失常可能会通过影响电细胞和传导途径结构和功能的细胞消耗过程而得到促进。我们认为，在一些晚期癌症（而非终末期癌症）患者中，心力衰竭治疗或除颤器可能是相关的治疗选择。选择此类治疗的患者的关键要点可能是预期寿命、干预时的生活质量、症状负担以及对进一步抗癌治疗的影响。晚期癌症的死亡原因难以确定，并且癌症的事件定义尚未达成共识。呼吁对此进行临床研究。在针对癌症患者的心血管问题时，必须考虑更广泛的伦理问题。我们建议，集中精力评估癌症患者的心肌消耗和心律失常将预示着肿瘤心脏病学这一快速发展领域的进一步发展。
