Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Hamostaseologie. 2024 Aug;44(4):255-267. doi: 10.1055/a-2284-5855. Epub 2024 May 9.
Cardio-oncology, a burgeoning subspecialty, addresses the complex interplay between cardiology and oncology, particularly in light of increased cardiovascular (CV) disease mortality in cancer patients. This review provides a comprehensive overview of cardio-oncology with a focus on the therapies used in hematological malignancies. We explore the bidirectional relationship between heart failure and cancer, emphasizing the need for collaborative care. The review discusses risk stratification, highlighting the importance of baseline CV risk assessment and personalized surveillance regimens. Primary and secondary prevention strategies, including pharmacological interventions, are outlined. The review also delves into the cardiotoxicity associated with hematological cancer therapies, focusing on anthracyclines, Bruton kinase inhibitors, BCR-ABL tyrosine kinase inhibitors, CAR-T cell therapy, immune checkpoint inhibitors, multiple myeloma treatments, and hematopoietic stem cell transplantation. We then highlight the high risk of venous and arterial thromboembolisms in cancer patients and the challenges of anticoagulation management in cardio-oncology. Finally, the review touches on the importance of long-term follow-up and appropriate screening in cancer survivors at high risk of CV morbidity and mortality, based on their CV risk profile and the type and dose of cardiotoxic therapies they received such as anthracyclines or high radiation doses.
肿瘤心脏病学是一个新兴的亚专科,主要研究心脏病学和肿瘤学之间的复杂相互作用,特别是考虑到癌症患者心血管疾病死亡率的增加。这篇综述全面介绍了肿瘤心脏病学,重点介绍了血液系统恶性肿瘤的治疗方法。我们探讨了心力衰竭和癌症之间的双向关系,强调了协作治疗的必要性。综述还讨论了风险分层,强调了基线心血管风险评估和个性化监测方案的重要性。概述了一级和二级预防策略,包括药物干预。该综述还深入探讨了与血液系统癌症治疗相关的心脏毒性,重点关注蒽环类药物、布鲁顿酪氨酸激酶抑制剂、BCR-ABL 酪氨酸激酶抑制剂、CAR-T 细胞疗法、免疫检查点抑制剂、多发性骨髓瘤治疗和造血干细胞移植。然后,我们强调了癌症患者静脉和动脉血栓栓塞风险高的问题,以及肿瘤心脏病学中抗凝管理的挑战。最后,根据癌症幸存者的心血管风险状况和他们接受的心脏毒性治疗(如蒽环类药物或高剂量辐射)的类型和剂量,该综述强调了对心血管发病率和死亡率高风险的癌症幸存者进行长期随访和适当筛查的重要性。