Canale Maria Laura, Coviello Katia, Solarino Gianluca, Del Meglio Jacopo, Simonetti Federico, Venturini Elio, Camerini Andrea, Maurea Nicola, Bisceglia Irma, Tessa Carlo, Casolo Giancarlo
Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy.
Hematology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy.
Front Cardiovasc Med. 2022 Mar 1;9:801143. doi: 10.3389/fcvm.2022.801143. eCollection 2022.
Effective anticancer treatments have dramatically improved the outcome of patients with cancer, but cardiac toxicity reduces their clinical efficacy in a non-negligible percentage of patients. Sacubitril/valsartan is a new paradigm in the treatment of chronic heart failure, with a reduced ejection fraction due to the enhancement of natriuretic peptides' properties when coupled with a blocking effect on the angiotensin II type 1 (AT1) receptors. As with other clinical conditions of heart failure with potentially reversible declines in cardiac function, a wearable cardioverter defibrillator (WCD) is a valid tool for protection against sudden death until recovery occurs. We report a case series of four patients with chemotherapy-related acute cardiac failure with severely reduced cardiac function. They were successfully treated with sacubitril/valsartan while being protected from malignant arrhythmias using a wearable cardioverter defibrillator until the recovery of cardiac function. Sacubitril/valsartan was confirmed to be effective in anthracycline-related cardiac toxicity and the wearable cardioverter defibrillator should be considered as a support tool even in the oncology patient.
有效的抗癌治疗显著改善了癌症患者的预后，但心脏毒性在不可忽视比例的患者中降低了其临床疗效。沙库巴曲缬沙坦是慢性心力衰竭治疗的一种新范例，由于与1型血管紧张素II（AT1）受体阻断作用相结合时增强了利钠肽的特性，其射血分数降低。与其他心功能可能出现可逆性下降的心力衰竭临床情况一样，可穿戴式心脏复律除颤器（WCD）是一种有效的预防猝死的工具，直至心功能恢复。我们报告了一组4例化疗相关急性心力衰竭且心功能严重降低患者的病例系列。他们在使用可穿戴式心脏复律除颤器预防恶性心律失常的同时，成功接受了沙库巴曲缬沙坦治疗，直至心功能恢复。沙库巴曲缬沙坦被证实对蒽环类药物相关心脏毒性有效，即使在肿瘤患者中，可穿戴式心脏复律除颤器也应被视为一种支持工具。
