Palmieri Vittorio, Vietri Maria Teresa, Montalto Andrea, Montisci Andrea, Donatelli Francesco, Coscioni Enrico, Napoli Claudio
Unit of Cardiac Surgery, Cardiovascular Department, Azienda Ospedaliera di Rilevanza Nazionale "San Sebastiano e Sant'Anna", 81100 Caserta, Italy.
Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80100 Naples, Italy.
Cancers (Basel). 2023 Apr 10;15(8):2224. doi: 10.3390/cancers15082224.
Anticancer treatments are improving the prognosis of patients fighting cancer. However, anticancer treatments may also increase the cardiovascular (CV) risk by increasing metabolic disorders. Atherosclerosis and atherothrombosis related to anticancer treatments may lead to ischemic heart disease (IHD), while direct cardiac toxicity may induce non-ischemic heart disease. Moreover, valvular heart disease (VHD), aortic syndromes (AoS), and advanced heart failure (HF) associated with CV risk factors and preclinical CV disease as well as with chronic inflammation and endothelial dysfunction may also occur in survivors of anti-carcer treatments.
Public electronic libraries have been searched systematically looking at cardiotoxicity, cardioprotection, CV risk and disease, and prognosis after cardiac surgery in survivors of anticancer treatments.
CV risk factors and disease may not be infrequent among survivors of anticancer treatments. As cardiotoxicity of established anticancer treatments has been investigated and is frequently irreversible, cardiotoxicity associated with novel treatments appears to be more frequently reversible, but also potentially synergic. Small reports suggest that drugs preventing HF in the general population may be effective also among survivors of anticancer treatments, so that CV risk factors and disease, and chronic inflammation, may lead to indication to cardiac surgery in survivors of anticancer treatments. There is a lack of substantial data on whether current risk scores are efficient to predict prognosis after cardiac surgery in survivors of anticancer treatments, and to guide tailored decision-making. IHD is the most common condition requiring cardiac surgery among survivors of anticancer treatments. Primary VHD is mostly related to a history of radiation therapy. No specific reports exist on AoS in survivors of anticancer treatments.
It is unclear whether interventions to dominate cancer- and anticancer treatment-related metabolic syndromes, chronic inflammation, and endothelial dysfunction, leading to IHD, nonIHD, VHD, HF, and AoS, are as effective in survivors of anticancer treatments as in the general population. When CV diseases require cardiac surgery, survivors of anticancer treatments may be a population at specifically elevated risk, rather than affected by a specific risk factor.
抗癌治疗正在改善癌症患者的预后。然而，抗癌治疗也可能通过增加代谢紊乱来提高心血管（CV）风险。与抗癌治疗相关的动脉粥样硬化和动脉粥样血栓形成可能导致缺血性心脏病（IHD），而直接心脏毒性可能诱发非缺血性心脏病。此外，与CV危险因素、临床前CV疾病以及慢性炎症和内皮功能障碍相关的瓣膜性心脏病（VHD）、主动脉综合征（AoS）和晚期心力衰竭（HF）也可能出现在抗癌治疗的幸存者中。
系统检索公共电子图书馆，研究抗癌治疗幸存者的心脏毒性、心脏保护、CV风险和疾病以及心脏手术后的预后。
CV危险因素和疾病在抗癌治疗幸存者中可能并不罕见。由于已有的抗癌治疗的心脏毒性已得到研究且通常是不可逆的，与新治疗相关的心脏毒性似乎更常是可逆的，但也可能具有协同作用。小样本报告表明，在普通人群中预防HF的药物在抗癌治疗幸存者中可能也有效，因此CV危险因素和疾病以及慢性炎症可能导致抗癌治疗幸存者需要进行心脏手术。目前缺乏大量数据来表明当前的风险评分是否能有效预测抗癌治疗幸存者心脏手术后的预后，并指导个性化决策。IHD是抗癌治疗幸存者中最常见的需要进行心脏手术的疾病。原发性VHD主要与放射治疗史有关。关于抗癌治疗幸存者中的AoS尚无具体报告。
尚不清楚针对癌症和抗癌治疗相关的代谢综合征、慢性炎症和内皮功能障碍（这些可导致IHD、非IHD、VHD、HF和AoS）的干预措施在抗癌治疗幸存者中是否与在普通人群中一样有效。当CV疾病需要进行心脏手术时，抗癌治疗幸存者可能是一个风险特别高的人群，而不是受特定危险因素影响的人群。
