Montisci Andrea, Palmieri Vittorio, Liu Jennifer E, Vietri Maria T, Cirri Silvia, Donatelli Francesco, Napoli Claudio
Division of Cardiothoracic Intensive Care, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy.
Department of Cardiac Surgery and Transplantation, Ospedali dei Colli Monaldi-Cotugno-CTO, Naples, Italy.
Front Cardiovasc Med. 2021 Sep 3;8:713694. doi: 10.3389/fcvm.2021.713694. eCollection 2021.
A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented.
由于治疗方法更加有效，癌症幸存者的数量一直在稳步增加。然而，化疗方案往往伴随着显著的毒性，心脏损伤成为一个突出的临床问题。许多机制导致化疗引起的心脏毒性：直接的心肌细胞损伤、心律失常的诱导、冠状动脉痉挛和加速的动脉粥样硬化。蒽环类药物是研究最多的具有心脏毒性的药物，是化疗引起心脏损伤的临床模型。对于因化疗相关心肌病而患有晚期心力衰竭（HF）的患者，当对最佳药物治疗无效时，机械循环支持或心脏移植是一种有效的治疗方法。在此，分析了癌症治疗引起心脏毒性的主要机制，重点关注在疾病过程中因急性心脏毒性、应激性心肌病以及化疗引起的心肌病患者的慢性心力衰竭急性发作而需要入住重症监护病房（ICU）的患者。在一部分患者中，心脏毒性可能是急性且危及生命的，导致明显的心源性休克。重症癌症患者的管理带来了独特的挑战，需要多学科方法。此外，目前没有病因治疗方法，只能采取支持性措施。
