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癌症患者及幸存者癌症治疗相关心脏功能障碍和心力衰竭的预防。心力衰竭协会、欧洲心脏病学会预防心脏病学协会以及欧洲心脏病学会心脏肿瘤学委员会的临床共识声明。

Prevention of cancer therapy-related cardiac dysfunction and heart failure in cancer patients and survivors. A Clinical Consensus Statement of the Heart Failure Association, the European Association of Preventive Cardiology of the ESC, and the ESC Council of Cardio-Oncology.

作者信息

Rakisheva Amina, Farmakis Dimitrios, Attanasio Andrea, Genis Antoni Bayes, Cohen-Solal Alain, Gulati Geeta, Halle Martin, Hill Loreena, Fernandez Teresa Lopez, Lyon Alexander R, Moura Brenda, Santoro Ciro, Tocchetti Carlo Gabriele, van Linthout Sophie, Vassiliou Vassilios, Sener Yusuf Ziya, Bekbosynova Makhabbat, Metra Marco, Rosano Giuseppe, Piepoli Massimo

机构信息

City Cardiology Center, Almaty, Kazakhstan.

Heart Failure and Cardio-Oncology Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece.

出版信息

Eur J Heart Fail. 2025 Jul 18. doi: 10.1002/ejhf.3753.

Abstract

Despite advances in cancer treatments with significant improvement in patient outcomes, chemotherapy, targeted molecular therapies and radiotherapy may cause a range of cardiovascular complications, such as cancer therapy-related cardiac dysfunction (CTRCD), which represents a broad spectrum of possible presentation and aetiological link with the broad scope of various cancer therapies, including chemotherapy, targeted agents, immunotherapies, and radiation therapy, aiming at reducing the associated morbidity and mortality. However, practical guidelines on the primary prevention of CTRCD in high-risk patients, a key element in improving prognosis, are lacking in cancer patients and related evidence remains inconclusive. This Clinical Consensus Statement, authored by experts from the Heart Failure Association (HFA) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC), and the ESC Council of Cardio-Oncology, aims to discuss the definition and epidemiology of CTRCD, the implicated factors for risk stratification, and the appropriate early diagnostic pathways, while focusing on lifestyle modifications, and pharmacological interventions to reduce the incidence of CTRCD. In addition, a holistic cardio-oncology management approach is advised for prevention and long-term management.

摘要

尽管癌症治疗取得了进展,患者预后有了显著改善,但化疗、靶向分子疗法和放射疗法可能会引发一系列心血管并发症,如癌症治疗相关的心脏功能障碍(CTRCD),它涵盖了多种可能的表现形式,并且与包括化疗、靶向药物、免疫疗法和放射疗法在内的各种癌症治疗方法有着广泛的病因联系,旨在降低相关的发病率和死亡率。然而,癌症患者缺乏针对高危患者CTRCD一级预防的实用指南,而这是改善预后的关键因素,相关证据也尚无定论。本临床共识声明由欧洲心脏病学会(ESC)心力衰竭协会(HFA)、欧洲预防心脏病学协会(EAPC)以及ESC心脏肿瘤学委员会的专家撰写,旨在讨论CTRCD的定义和流行病学、风险分层的相关因素以及适当的早期诊断途径,同时重点关注生活方式的改变以及降低CTRCD发病率的药物干预措施。此外,建议采用全面的心脏肿瘤学管理方法进行预防和长期管理。

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