In Austria, the number of newly diagnosed cancers is round 40,000, with a yearly mortality of 20,000 patients with a main diagnosis of cancer. The Austrian cardiologists usually examine patients with diagnosed cancer in an outpatient setting as needed during therapies, e.g. for echocardiography, or at the university clinics if further treatment is necessary.
Several years ago, the Cardio-Oncology group of the Medical University of Vienna (leader Prof. J. Bergler-Klein) established two prospective clinical registries, to enable to treat and continuously follow oncologic patients with cardiac abnormalities, on a regular outpatient clinical basis. One of the registers includes patients who suffer from primary cardiac diseases, such as ischemic heart disease or valve diseases and receive anticancer treatment, or patients with cardiotoxicity as a consequence of the oncologic therapy. The second registry includes adult patients who have survived a childhood-cancer, and need cardiovascular care and follow-up screening. Measuring several biomarkers in more than 500 patients with heart failure, the heart failure group of the University Clinic in Vienna summarized the findings, that cancer itself may induce elevation of cardiac biomarkers, such as hs Troponine T or NT-proBNP, even before the start of anticancer treatment. The elevations of these biomarkers were strongly correlated with all-cause death, suggesting a direct effect of malignancies on heart structure and function (1).
Performing translational animal experiments, our experimental group of the Department of Cardiology has revealed, that in contrast with the general view of clinical cardiotoxicity, elevated cardiac markers were measured in all study animals (2), even with few cardiac symptoms, which underlines and urges the increasing evidence, that all patients with anticancer therapies should be treated early and preventively, possibly before the first signs of cardiotoxicity are developed (3).
Due to the increasing cardio-oncology activities at congresses in Austria, awareness is rising in the Austrian cardiology and oncology communities. The University cardiology clinics e.g. in Graz are increasingly performing outstanding scientific projects (4-6). The Austrian Society of Cardiology and the Austrian working groups for heart failure or echocardiography are undertaking efforts to further transport the importance of cardiac care in cancer patients along with the current and evolving recommendations (7-9).
Jutta Bergler-Klein, MD, Prof. of Med., FESC, FHFA
Mariann Gyöngyösi, MD, Prof. of Med., FESC
Dept. of Cardiology, Medical Univ. of Vienna, Austria
Waehringer Guertel 18-20, 1090 Vienna, Austria
- Pavo N, Raderer M, Hülsmann M, Neuhold S, Adlbrecht C, Strunk G, Goliasch G, Gisslinger H, Steger GG, Hejna M, Köstler W, Zöchbauer-Müller S, Marosi C, Kornek G, Auerbach L, Schneider S, Parschalk B, Scheithauer W, Pirker R, Drach J, Zielinski C, Pacher R. Cardiovascular biomarkers in patients with cancer and their association with all-cause mortality. Heart. 2015;101:1874-80.
- Bergler-Klein J, Spannbauer A, Zlabinger K, Macejovska D, Maurer G, Gyongyosi M. Identification of proto-oncogenes and genes responsible for myocardial fibrosis and diastolic dysfunction after anticancer treatment under experimental conditions. EuroEcho-Imaging 2015. Rapid fire abstract presentation.
- Gyöngyösi M, Lukovic D, Zlabinger K, Spannbauer A, Gugerell A, Pavo N, Traxler D, Pils D, Maurer G, Jakab A, Riesenhuber M, Pircher A, Winkler J, Bergler-Klein J. Liposomal doxorubicin attenuates cardiotoxicity via induction of interferon-related DNA damage resistance. Cardiovascular Research 2019, in press
- Schneider C, Wallner M, Kolesnik E, Herbst V, Mächler H, Pichler M, von Lewinski D, Sedej S, Rainer PP. The Anti-Cancer Multikinase Inhibitor Sorafenib Impairs Cardiac Contractility by Reducing Phospholamban Phosphorylation and Sarcoplasmic Calcium Transients. Sci Rep. 2018;8(1):5295
- Wallner M, Khafaga M, Kolesnik E, Vafiadis A, Schwantzer G, Eaton DM, Curcic P, Köstenberger M, Knez I, Rainer PP, Pichler M, Pieske B, Lewinski DV. Istaroxime, a potential anticancer drug in prostate cancer, exerts beneficial functional effects in healthy and diseased human myocardium. Oncotarget. 2017;8(30):49264-49274
- Rainer P, Doleschal B, Kirk JA, Sivakumaran V, Saad Z, Groschner K, Maechler H, Hoefler G, Bauernhofer T, Samonigg H, Hutterer G, Kass D, Pieske B, von Lewinski D, Pichler M. Sunitinib causes dose-dependent negative functional effects on myocardium and cardiomyocytes. BJU Int 2012;110:1455-62
- Ameri P, Canepa M, Anker MS, Belenkov Y, Bergler-Klein J, Cohen-Solal A, Farmakis D, López-Fernández T, Lainscak M, Pudil R, Ruschitska F, Seferovic P, Filippatos G, Coats A, Suter T, Von Haehling S, Ciardiello F, de Boer RA, Lyon AR, Tocchetti CG; Heart Failure Association Cardio-Oncology Study Group of the European Society of Cardiology. Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge. Eur J Heart Fail. 2018;20(5):879-887
- Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC; Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2013;14(8):721-40
- Bergler-Klein J. Right from the heart: survivors of childhood cancer and the right ventricle. Eur Heart J Cardiovasc Imaging. 2016;17(7):742-3