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Chemotherapy and the heart: what the cardiologist must know

Basic Sciences, Pharmacology, Genomics and Cardiovascular Pathology


The great advances in chemotherapy have led to a significant improvement of cancer prognosis but have dramatically increased the incidence of cardiotoxicity.
At present, the secondary effects of cancer therapy that have been shown, of which some are potentially reversible (type II agents – mainly signalling inhibitors), others stable (type I agents – cytotoxic agents) and arising also after many years, are as follows: left ventricular dysfunction, hypertension, arrhythmias (acquired LQTs), myocardial ischemia and thrombotic manifestations.
The aim of this session was to enhance the knowledge of all cardiologists, even if not specifically trained in the field, on the general principle of cardiotoxicity from cancer therapy, the specific clinical implications, and the management criteria.
This could be a difficult task considering the rapidly growing number of new agents used in chemotherapy and the lack of large randomized trials. It is time to simplify the approach to the problem using a schematization of current knowledge, and to permit a rapid update of the new information.
Moreover, it is mandatory to know:

  1. the general principle of evaluation of eligibility of a patient for a specific chemotherapy (risk factors),
  2. what are the necessary useful investigations before, during and after chemotherapy (ECG for rhythm and conduction disturbances and for ischemia signs; Echo or other imaging tests (MRI) to assess left ventricular function at baseline and periodically; biochemical indices such as Troponin or NT-proBNP),
  3. what, if any, are the possible prevention measures against cardiotoxicity (ACE-Inhibitors, BetaBlockers),
  4. what are the follow-up criteria.

References


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Chemotherapy and the heart: what the cardiologist must know

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.