Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.
Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.
ESC Heart Fail. 2022 Jun;9(3):1666-1676. doi: 10.1002/ehf2.13879. Epub 2022 Apr 1.
As the world population grows older, the co-existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio-Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications.
We enrolled 231 consecutive patients referred to our Cardio-Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month-survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow-up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04).
Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments.
随着世界人口老龄化，癌症和心血管合并症同时存在的情况越来越常见，这使得这些患者的治疗管理变得更加复杂。在这里，我们描述了意大利南部一个大型心血管肿瘤学中心的情况，该中心描述了不同类型的患者，并讨论了心血管并发症治疗管理方面的挑战。
我们招募了 231 例连续患者，这些患者于 2015 年 1 月至 2020 年 2 月期间被转诊至我们的心血管肿瘤学中心。根据他们首次就诊时的化疗状况，将患者分为三种不同类型。1 型患者为首次接受肿瘤治疗的患者，2 型患者已开始接受肿瘤治疗，3 型患者已完成癌症治疗。在观察期间，2 型患者发生心血管事件（46.2%比 1 型患者的 12.3%和 3 型患者的 17.9%）和停止肿瘤治疗（5.1%比 1 型患者的无）的发生率最高。在 48 个月的随访期间，2 型患者的生存率显著降低（32.1%比 1 型患者的 16.7%和 3 型患者的 17.9%），当我们在三组患者中都关注首次心血管评估时心血管风险因素不受控制或有明显心血管疾病的患者时，这一现象更为明显。然而，这些患者从我们的心血管评估中获益最大，正如在随访期间射血分数的微小但显著改善所证明的那样（2 型 b：从 50[20；67]增加到 55[35；65]；P=0.04）。
开始肿瘤治疗方案但没有进行准确的基线心血管评估的患者由于抗肿瘤治疗而面临发生心脏并发症的重大风险。
