Samuel Younan, Babu Aswin, Karagkouni Foteini, Ismail Ayden, Choi Sunyoung, Boussios Stergios
Department of Cardiology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK.
GKT School of Medicine, King's College London, London SE1 9RT, UK.
Curr Issues Mol Biol. 2023 Oct 15;45(10):8337-8358. doi: 10.3390/cimb45100526.
Despite current advancements in chemotherapy, immunotherapy and targeted treatments, the potential for major adverse cardiovascular events, regardless of previous cardiac history, persists. Scoring systems, such as the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) risk assessment tool, can be utilized to evaluate several factors including prior cardiac history, risk factors and cardiac biomarkers to categorize patients into low, moderate, high, and very high-risk groups. Common cardiotoxicity complications include new or worsening left ventricular ejection fraction (LVEF), QT interval prolongation, myocardial ischaemia, hypertension, thromboembolic disease, cardiac device malfunction and valve disease. Baseline electrocardiogram (ECG) and transthoracic echocardiogram (TTE) are routinely performed for all patients commenced on cardiotoxic treatment, while other imaging modalities and biochemical markers have proven useful for monitoring. Management mainly includes early risk stratification and prompt identification of cardiovascular complications, with patient-specific surveillance throughout treatment. A multidisciplinary approach is crucial in determining the relationship between potential treatment benefits and cardiotoxicity, and whether the continuation of treatment is appropriate on a case-by-case basis. Early risk stratification, optimizing the patient's cardiovascular status prior to treatment, and prompt identification of suspected cardiotoxicity are key in significantly reducing risk. This article provides a comprehensive review of the various types of treatment-related cardiotoxicity, offering guidance on identifying high-risk patients, recognizing early signs of cardiotoxicity, and outlining appropriate treatment approaches and follow-up care for such cases.
尽管目前化疗、免疫疗法和靶向治疗取得了进展，但无论既往心脏病史如何，发生严重不良心血管事件的可能性依然存在。可以使用心力衰竭协会-国际心脏肿瘤学会（HFA-ICOS）风险评估工具等评分系统来评估包括既往心脏病史、风险因素和心脏生物标志物在内的多个因素，以便将患者分为低、中、高和极高风险组。常见的心脏毒性并发症包括新发或恶化的左心室射血分数（LVEF）、QT间期延长、心肌缺血、高血压、血栓栓塞性疾病、心脏装置故障和瓣膜疾病。对于所有开始接受心脏毒性治疗的患者，常规进行基线心电图（ECG）和经胸超声心动图（TTE）检查，而其他影像学检查方法和生化标志物已被证明对监测有用。管理主要包括早期风险分层和及时识别心血管并发症，并在整个治疗过程中进行个体化监测。多学科方法对于确定潜在治疗益处与心脏毒性之间的关系以及是否逐案继续治疗是否合适至关重要。早期风险分层、在治疗前优化患者的心血管状况以及及时识别疑似心脏毒性是显著降低风险的关键。本文全面综述了各种类型的治疗相关心脏毒性，为识别高危患者、识别心脏毒性的早期迹象以及概述此类病例的适当治疗方法和后续护理提供指导。
