Hauwanga Wilhelmina N, McBenedict Billy, Amadi Emmanuel S, Dohadwala Taha K, Johnny Chukwuwike, Asaju Felix, Okafor Onyinye D, Jimoh Abdulmalik, Elumah Ada Andrea Oghenerukevwe, Onyinyinyechi Okam V, Petrus Dulci, Lima Pessôa Bruno
Family Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, BRA.
Neurosurgery, Fluminense Federal University, Niterói, BRA.
Cureus. 2024 Aug 6;16(8):e66258. doi: 10.7759/cureus.66258. eCollection 2024 Aug.
Cancer therapy advancements have improved survival rates but also introduced significant cardiotoxic risks. Cardiotoxicity, a critical adverse effect of cancer treatments such as doxorubicin, trastuzumab, and radiotherapy, poses substantial challenges. This systematic review synthesizes findings from studies on cardiotoxicity induced by cancer therapies, focusing on detection and management. Key predictors of chemotherapy-induced myocardial toxicity (CIMT) include advanced age, hypertension, hyperlipidemia, diabetes, and elevated N-terminal pro-B-type natriuretic peptide levels. Regular echocardiographic assessments, particularly of the left ventricular global longitudinal strain (LVGLS) and left ventricular ejection fraction (LVEF), are essential for early detection. The CardTox-Score, incorporating these risk factors, shows high sensitivity and specificity in predicting CIMT. Advanced imaging techniques and biomarkers play crucial roles in identifying at-risk patients before functional decline. Early biomarkers and imaging techniques such as LVGLS and LVEF are effective in diagnosing and managing cardiotoxicity, allowing timely interventions. Cardiology involvement in patient care significantly enhances adherence to cardiac monitoring guidelines and reduces cardiotoxicity risks. Management strategies emphasize regular cardiac monitoring, patient education, and the use of cardioprotective agents. A collaborative approach between cardiologists and oncologists is vital to assess cardiovascular risks, minimize vascular toxicity, and manage long-term adverse effects, ensuring the safety and efficacy of cancer therapies. This review underscores the importance of early detection and proactive management of cardiotoxicity in cancer patients to optimize treatment outcomes and improve quality of life.
癌症治疗的进展提高了生存率，但也带来了重大的心脏毒性风险。心脏毒性是多柔比星、曲妥珠单抗和放射治疗等癌症治疗的一种关键不良反应，带来了巨大挑战。本系统评价综合了关于癌症治疗引起的心脏毒性的研究结果，重点关注检测和管理。化疗引起的心肌毒性（CIMT）的关键预测因素包括高龄、高血压、高脂血症、糖尿病以及N末端B型利钠肽前体水平升高。定期进行超声心动图评估，尤其是对左心室整体纵向应变（LVGLS）和左心室射血分数（LVEF）的评估，对于早期检测至关重要。纳入这些风险因素的心脏毒性评分（CardTox-Score）在预测CIMT方面显示出高敏感性和特异性。先进的成像技术和生物标志物在功能下降之前识别高危患者方面发挥着关键作用。LVGLS和LVEF等早期生物标志物和成像技术在诊断和管理心脏毒性方面有效，能够及时进行干预。心脏病学参与患者护理可显著提高对心脏监测指南的依从性并降低心脏毒性风险。管理策略强调定期心脏监测、患者教育以及使用心脏保护剂。心脏病专家和肿瘤学家之间的协作方法对于评估心血管风险、最小化血管毒性以及管理长期不良反应至关重要，可确保癌症治疗的安全性和有效性。本综述强调了早期检测和积极管理癌症患者心脏毒性对于优化治疗结果和改善生活质量的重要性。
