Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology

Abstract

Cardio-oncology is a new field of interest in cardiology that focuses on the detection, monitoring, and treatment of cardiovascular disease occurring as a side effect of chemotherapy and radiotherapy. Both cancer treatment modalities can cause cardiac dysfunction, a major cause of morbidity and mortality in the oncologic population. It is necessary to periodically monitor cancer patients under treatment, especially those receiving anthracyclines and trastuzumab (monoclonal antibody), using mainly 3D echocardiography to calculate left ventricular ejection fraction and to estimate myocardial deformation. Additionally, measuring various biomarkers, such as natriuretic peptides, could facilitate early identification and appropriate response to potential cardiotoxicity. In this regard, cardiological assessment before starting cancer treatment is essential and should be continued throughout, since cardiac dysfunction can occur at any time, even several years after therapy onset. High-risk individuals, in particular, should receive a detailed management plan designed in collaboration between an oncology and a cardiology specialist. If heart failure develops, even in the absence of overt clinical symptoms, standard heart treatment is to be followed and causal agent discontinued if possible. One important question is whether and when to stop cardiac medication in case of heart dysfunction reversal, after completion of cancer treatment. Further cardio-oncology evolution can lead to a deeper understanding of the adverse mechanisms and effects causing heart failure, as well as the development of personalized treatment regimens in order to limit cardiotoxicity.

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Abbreviations

ACE:

Angiotensin-converting enzyme

GLS:

Global longitudinal strain

HF:

Heart failure

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MRI:

Magnetic resonance imaging

VEGF:

Vascular endothelial growth factors

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Correspondence to Peggy M. Kostakou.

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Kostakou, P.M., Kouris, N.T., Kostopoulos, V.S. et al. Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology. Heart Fail Rev 24, 91–100 (2019). https://doi.org/10.1007/s10741-018-9731-y

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Keywords

  • Cardiotoxicity
  • Cancer
  • Heart failure
  • Echocardiography
  • Strain