Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy.
PhD Course, Università Campus Bio-Medico di Roma, 00128 Rome, Italy.
Int J Mol Sci. 2022 Jul 26;23(15):8242. doi: 10.3390/ijms23158242.
Contemporary anticancer immunotherapy with chimeric antigen receptor T-cell (CAR-T) therapy has dramatically changed the treatment of many hematologic malignancies previously associated with poor prognosis. The clinical improvement and the survival benefit unveiled the risk of cardiotoxicity, ranging from minimal effects to severe cardiac adverse events, including death. Immunotherapy should also be proposed even in patients with pre-existing cardiovascular risk factors, thereby increasing the potential harm of cardiotoxicity. CAR-T therapy frequently results in cytokine release syndrome (CRS), and inflammatory activation is sustained by circulating cytokines that foster a positive feedback mechanism. Prompt diagnosis and treatment of CAR-T cardiotoxicity might significantly improve outcomes and reduce the burden associated with cardiovascular complications. Clinical and echocardiographic examinations are crucial to perform a tailored evaluation and follow-up during CAR-T treatment. This review aims to summarize the pathophysiology, clinical implications, and echocardiographic assessment of CAR-T-related cardiotoxicity to enlighten new avenues for future research.
嵌合抗原受体 T 细胞（CAR-T）疗法的当代癌症免疫疗法极大地改变了许多以前预后不良的血液系统恶性肿瘤的治疗方法。临床改善和生存获益揭示了心脏毒性的风险，从轻微影响到严重的心脏不良事件，包括死亡。即使在存在心血管危险因素的患者中，也应提出免疫疗法，从而增加心脏毒性的潜在危害。CAR-T 疗法经常导致细胞因子释放综合征（CRS），并且循环细胞因子的炎症激活促进了正反馈机制。及时诊断和治疗 CAR-T 心脏毒性可能会显著改善结果并降低与心血管并发症相关的负担。临床和超声心动图检查对于在 CAR-T 治疗期间进行针对性评估和随访至关重要。本综述旨在总结 CAR-T 相关心脏毒性的病理生理学、临床意义和超声心动图评估，为未来的研究开辟新途径。
