Theofilis Panagiotis, Vlachakis Panayotis K, Oikonomou Evangelos, Drakopoulou Maria, Karakasis Paschalis, Apostolos Anastasios, Pamporis Konstantinos, Tsioufis Konstantinos, Tousoulis Dimitris
1st Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
3rd Department of Cardiology, Thoracic Diseases General Hospital Sotiria, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Biomedicines. 2024 Dec 21;12(12):2914. doi: 10.3390/biomedicines12122914.
Cancer therapy-related cardiac dysfunction (CTRCD) has emerged as a significant concern with the rise of effective cancer treatments like anthracyclines and targeted therapies such as trastuzumab. While these therapies have improved cancer survival rates, their unintended cardiovascular side effects can lead to heart failure, cardiomyopathy, and arrhythmias. The pathophysiology of CTRCD involves oxidative stress, mitochondrial dysfunction, and calcium dysregulation, resulting in irreversible damage to cardiomyocytes. Inflammatory cytokines, disrupted growth factor signaling, and coronary atherosclerosis further contribute to this dysfunction. Advances in cardio-oncology have led to the early detection of CTRCD using cardiac biomarkers like troponins and imaging techniques such as echocardiography and cardiac magnetic resonance (CMR). These tools help identify asymptomatic patients at risk of cardiac events before the onset of clinical symptoms. Preventive strategies, including the use of cardioprotective agents like beta-blockers, angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors have shown promise in reducing the incidence of CTRCD. This review summarizes the mechanisms, detection methods, and emerging treatments for CTRCD, emphasizing the importance of interdisciplinary collaboration between oncologists and cardiologists to optimize care and improve both cancer and cardiovascular outcomes.
随着蒽环类药物等有效癌症治疗方法以及曲妥珠单抗等靶向治疗的兴起，癌症治疗相关的心脏功能障碍（CTRCD）已成为一个重大问题。虽然这些疗法提高了癌症生存率，但其意外的心血管副作用可导致心力衰竭、心肌病和心律失常。CTRCD的病理生理学涉及氧化应激、线粒体功能障碍和钙调节异常，导致心肌细胞不可逆转的损伤。炎性细胞因子、生长因子信号传导中断和冠状动脉粥样硬化进一步加剧了这种功能障碍。心脏肿瘤学的进展使得通过使用肌钙蛋白等心脏生物标志物以及超声心动图和心脏磁共振成像（CMR）等成像技术对CTRCD进行早期检测成为可能。这些工具有助于在临床症状出现之前识别有心脏事件风险的无症状患者。包括使用β受体阻滞剂、血管紧张素转换酶抑制剂、盐皮质激素受体拮抗剂和钠-葡萄糖协同转运蛋白2抑制剂等心脏保护剂在内的预防策略在降低CTRCD发病率方面已显示出前景。本综述总结了CTRCD的机制、检测方法和新兴治疗方法，强调了肿瘤学家和心脏病学家之间跨学科合作对于优化治疗以及改善癌症和心血管疾病治疗效果的重要性。
