Assoc. Prof Mitja Lainscak
Session number: 112Session title: Cardio-oncology: a new marriage of old partnersAuthors: Mitja Lainscak (Celje, Slovenia)
Cancer and heart failure (HF) share many risk factors and epidemiological features. With better management, both can evolve into a chronic phase that calls for specific diagnostic and therapeutic strategies. Best practice for chemo/radiotherapy-induced cardiac damage remains to be established, but classical history, ECG, imaging (left ventricular ejection fraction by echocardiography), and troponins (also in combination with myeloperoxidase) should currently be pursued in clinical practice.
After assessment of patient risk and management of side effects, close follow-up is warranted, particularly in survivors of malignancy in childhood, in whom cardiac manifestations can develop up to 30 years after chemotherapy. Once cardiac function is reduced, neurohormonal antagonists (ACE inhibitors and beta blockers) are effective in improving cardiac function. Furthermore, the same agents demonstrated a benefit for the prevention of a chemotherapy-induced reduction in cardiac function. Mineralocorticoid receptor antagonists have not yet been tested in these clinical scenarios, while there is very limited evidence in favor of statins. To cope with these challenges, intense collaboration between the oncologist and the cardiologist is crucial. Suggested key fields of research include pathophysiological mechanisms of cardiac injury, cardiac imaging, preventive strategies and therapeutic targets.
The other side of the coin, namely malignancy in patients with heart failure was not in the spotlight of this session. Nonetheless, in view of the outcome influenced by cancer burden and deaths, reciprocal collaboration is also warranted.
The Heart Failure Association is apparently the first international association to formally acknowledge the importance of collaboration through a Committee on Cardio-Oncology. Deliverables for patient management, irrespective of primary diagnosis, are eagerly awaited.
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