Lozahic Caroline, Maddock Helen, Sandhu Hardip
Faculty Research Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.
Front Cardiovasc Med. 2021 Apr 23;8:634291. doi: 10.3389/fcvm.2021.634291. eCollection 2021.
Anti-cancer treatment regimens can lead to both acute- and long-term myocardial injury due to off-target effects. Besides, cancer patients and survivors are severely immunocompromised due to the harsh effect of anti-cancer therapy targeting the bone marrow cells. Cancer patients and survivors can therefore be potentially extremely clinically vulnerable and at risk from infectious diseases. The recent global outbreak of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its infection called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide health emergency, and on March 11, 2020, COVID-19 was declared a global pandemic by the World Health Organization (WHO). A high fatality rate has been reported in COVID-19 patients suffering from underlying cardiovascular diseases. This highlights the critical and crucial aspect of monitoring cancer patients and survivors for potential cardiovascular complications during this unprecedented health crisis involving the progressive worldwide spread of COVID-19. COVID-19 is primarily a respiratory disease; however, COVID-19 has shown cardiac injury symptoms similar to the cardiotoxicity associated with anti-cancer therapy, including arrhythmia, myocardial injury and infarction, and heart failure. Due to the significant prevalence of micro- and macro-emboli and damaged vessels, clinicians worldwide have begun to consider whether COVID-19 may in fact be as much a vascular disease as a respiratory disease. However, the underlying mechanisms and pathways facilitating the COVID-19-induced cardiac injury in cancer and non-cancer patients remain unclear. Investigations into whether COVID-19 cardiac injury and anti-cancer drug-induced cardiac injury in cancer patients and survivors might synergistically increase the cardiovascular complications and comorbidity risk through a "two-hit" model are needed. Identification of cardiac injury mechanisms and pathways associated with COVID-19 development overlapping with anti-cancer therapy could help clinicians to allow a more optimized prognosis and treatment of cancer survivors suffering from COVID-19. The following review will focus on summarizing the harmful cardiovascular risk of COVID-19 in cancer patients and survivors treated with an anti-cancer drug. This review will improve the knowledge of COVID-19 impact in the field of cardio-oncology and potentially improve the outcome of patients.
抗癌治疗方案可能因脱靶效应导致急性和长期心肌损伤。此外，由于针对骨髓细胞的抗癌治疗的严酷影响，癌症患者及其幸存者的免疫功能严重受损。因此，癌症患者及其幸存者在临床上可能极其脆弱，面临感染性疾病的风险。最近新型冠状病毒严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的全球爆发及其导致的2019冠状病毒病（COVID-19）迅速成为全球卫生紧急事件，2020年3月11日，世界卫生组织（WHO）宣布COVID-19为全球大流行。据报道，患有潜在心血管疾病的COVID-19患者死亡率很高。这凸显了在这场涉及COVID-19在全球范围内不断蔓延的前所未有的健康危机期间，监测癌症患者及其幸存者潜在心血管并发症的关键和重要性。COVID-19主要是一种呼吸道疾病；然而，COVID-19已表现出与抗癌治疗相关的心脏毒性相似的心脏损伤症状，包括心律失常、心肌损伤和梗死以及心力衰竭。由于微栓子和大栓子以及受损血管的显著流行，世界各地的临床医生已开始考虑COVID-19实际上是否可能既是一种血管疾病，也是一种呼吸道疾病。然而，促进COVID-19在癌症患者和非癌症患者中引起心脏损伤的潜在机制和途径仍不清楚。需要研究COVID-19心脏损伤与癌症患者及其幸存者中抗癌药物引起的心脏损伤是否可能通过“双打击”模型协同增加心血管并发症和合并症风险。识别与COVID-19发展重叠且与抗癌治疗相关的心脏损伤机制和途径，有助于临床医生对患有COVID-19的癌症幸存者进行更优化的预后和治疗。以下综述将重点总结COVID-19对接受抗癌药物治疗的癌症患者及其幸存者的有害心血管风险。本综述将增进对COVID-19在心脏肿瘤学领域影响的认识，并可能改善患者的治疗结果。
