Opinion statement
Individuals who have ever been diagnosed with cancer are at increased risk for cardiovascular conditions during and after cancer treatment. Especially during cancer treatment, cardiovascular conditions can manifest in many ways, including peripheral or pulmonary edema. Edema can indicate volume overload affecting the heart even without other unequivocal evidence of apparent diastolic or systolic left ventricular dysfunction, particularly at rest. We propose a novel algorithm to streamline the diagnostic evaluation and cardiovascular classification for cancer patients with edema. We initially advise prompt evaluation with a chest X-ray and echocardiogram. We then suggest classification into one of five categories based on the timing of presentation of edema relative to cancer treatment, as well as echocardiography results and the presence or absence of hypertension or lymphatic causes of edema. This classification tool can then be utilized to guide further cardiovascular management suggestions. These concurrent syndromes presenting as edema may indicate the development or aggravation of undiagnosed diastolic dysfunction with or without hypertension, even if transiently present only while on cancer treatment.
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We are grateful to Abdulaziz Hamid from the Medical College of Wisconsin for reading the manuscript.
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This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Numbers UL 1TR001436 and KL 2TR001438. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
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Dr. Brown has ownership interest in Preventive Cardio-Oncology LLC, which had no direct control over this review manuscript or its content; all authors report no other potential competing interests.
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Summey, R., Aliani, R., McAlarnen, L.A. et al. Syndromes of Concurrent Hypertension, Diastolic Dysfunction, and Pulmonary or Peripheral Edema in Cardio-Oncology: Case Studies, Literature Review, and New Classification System. Curr. Treat. Options in Oncol. 24, 1917–1934 (2023). https://doi.org/10.1007/s11864-023-01141-9
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DOI: https://doi.org/10.1007/s11864-023-01141-9