Zusammenfassung
Fortschritte in der Chemotherapie neoplastischer Erkrankungen haben einerseits das Leben der Patienten verlängert, anderseits aber auch dazu geführt, dass die Nebenwirkungen der onkologischen Therapie für die betroffenen Patienten realisiert wurden. Zu den häufigsten Nebenwirkungen zählen die kardiovaskulären Komplikationen, die akut oder oft auch erst nach vielen Jahren zu Herzerkrankungen und zum Tod eines Patienten führen. Die Kardioonkologie beschäftigt sich mit der Prävention, Diagnostik und Behandlung der durch die Krebstherapie verursachten kardiovaskulären Erkrankungen. Neben der Herzinsuffizienz durch myokardiale Dysfunktion (Kardiotoxizität) zählen die koronare Herzerkrankung (KHK), die Herzklappenerkrankungen sowie die ventrikulären Arrhythmien infolge QT-Verlängerungen zu den wichtigsten kardiovaskulären Folgeerkrankungen der zytostatischen Therapie. Zudem kann es zu arterieller Hypertonie, thrombembolischen Ereignissen, pulmonaler Hypertonie, Vaskulopathien und Perikardkomplikationen kommen. Grundsätzlich wird zur Minimierung der kardiovaskulären Nebenwirkung potenziell kardiotoxischer Therapieverfahren eine strikte Einstellung kardiovaskulärer Risikofaktoren gefordert. Patienten mit eingeschränkter linksventrikulärer Funktion sollten bereits vor kardiotoxischer Chemotherapie durch Echokardiographie identifiziert werden. Eine Therapie mit Betablockern und ACE-Hemmern kann auch bei asymptomatischen Patienten indiziert sein, um Auswirkungen der Chemotherapie auf die myokardiale Dysfunktion zu minimieren. Eine prophylaktische Gabe von ACE-Hemmern und Betablockern während anthrazyklinhaltiger Chemotherapie kann bei herzgesunden Patienten erwogen werden.
Abstract
The numbers of survivors of cancer have increased as a consequence of advances in chemotherapy; however, the side effects of cancer treatment have become increasingly more important. The most frequent side effects include cardiovascular complications, which can lead to acute and delayed morbidity and mortality, often many years later. The discipline of cardio-oncology deals with the prevention, diagnostics and treatment of cardiovascular diseases caused by cancer therapy. The most important cardiovascular side effects of cytostatic therapy are heart failure due to myocardial dysfunction (cardiotoxicity), coronary artery disease, valvular disease and ventricular arrhythmia as a result of QT extension. In addition, arterial hypertension, thromboembolic events, pulmonary hypertension, vasculopathy and pericardial complications can also occur. Fundamentally, a strict limitation of risk factors is necessary to minimize the cardiovascular side effects of potentially cardiotoxic therapeutic procedures. Patients with impaired left ventricular function should be identified by echocardiographic examination prior to cardiotoxic chemotherapy. Treatment with beta blockers and angiotensin-converting enzyme (ACE) inhibitors can also be indicated in asymptomatic patients in order to minimize the effects of chemotherapy on myocardial dysfunction. Prophylactic administration of ACE inhibitors and beta blockers during anthracycline chemotherapy can be considered in patients free of cardiac disease.
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J. Hoog und S. Achenbach geben an, dass kein Interessenkonflikt besteht.
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Herz 2016 · 41:684–689. DOI 10.1007/s00059-016-4493-6
Online publiziert: 9. November 2016
Springer Medizin Verlag 2016
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Achenbach, S. Zusammenfassung des ESC Positionsdokuments „Krebsbehandlung und kardiovaskuläre Toxizität“. best practice onkologie 12, 264–270 (2017). https://doi.org/10.1007/s11654-017-0035-9
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DOI: https://doi.org/10.1007/s11654-017-0035-9