Best Practices in Cardio-Oncology: Part 1

Authors:
Chang HM, Moudgil R, Scarabelli T, Okwuosa TM, Yeh ET.
Citation:
Cardiovascular Complications of Cancer Therapy. Best Practices in Diagnosis, Prevention, and Management: Part 1. J Am Coll Cardiol 2017;70:2536-2551.

The following are key points to remember from this best practices article on cardiovascular complications of cancer therapy, part 1 of 2:

  1. Contemporary cancer chemotherapy has successfully cured many cancers and converted a terminal illness to chronic disease.
  2. However, cancer therapy can also cause myocardial damage, induce endothelial dysfunction, and alter cardiac conduction. Thus, it is important for practicing cardiologists to be knowledgeable about the diagnosis, prevention, and management of cardiovascular complications of cancer therapy.
  3. Patients undergoing chemotherapy should have careful clinical evaluation and assessment of cardiovascular risk factors, such as coronary artery disease, diabetes, and hypertension. These risk factors should be managed according to the American College of Cardiology/American Heart Association guidelines.
  4. The anthracycline class of chemotherapy drugs is known to cause cardiotoxicity in a dose-dependent manner. Recent understanding of the molecular mechanism of anthracycline cardiotoxicity suggests an approach to prevent this dreaded complication.
  5. Trastuzumab when used in conjunction with anthracycline usually results in significant cardiotoxicity, which can be prevented by avoiding concurrent use of these drugs.
  6. An echocardiogram is the most important tool for serial evaluation of the heart during cancer therapy. Ejection fraction should be determined using biplane method of discs, according to the American Society of Echocardiography guideline. If the endocardial border is not distinct, ultrasonic contrast should aid in endocardial border definition and subsequent volume calculations.
  7. Cancer treatment, including radiation therapy and chemotherapy, are associated with accelerated development of coronary artery disease (CAD) and/or acute coronary syndrome (ACS). Cancer itself can also create a prothrombotic state that promotes the development of ACS. Thus, chest pain in cancer patients needs to be investigated promptly.
  8. 5-fluorouracil and vascular endothelial growth factor signaling pathway (VSP) inhibitors can cause cardiac ischemia, especially in patients with pre-existing CAD. Ischemia workup is indicated before therapy in high-risk patients.
  9. Life-saving interventions for ACS should not be denied to cancer patients with chemotherapy-induced thrombocytopenia.
  10. With the number of cancer survivors expanding quickly, the time has come for cardiologists to work closely with cancer specialists to prevent and treat cancer therapy-induced cardiovascular complications.

Clinical Topics: Acute Coronary Syndromes, Cardio-Oncology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Acute Coronary Syndrome, Anthracyclines, Cardiotoxicity, Chest Pain, Chronic Disease, Coronary Artery Disease, Diabetes Mellitus, Diagnostic Imaging, Echocardiography, Heart Failure, Hypertension, Myocardial Ischemia, Neoplasms, Risk Factors, Secondary Prevention, Stroke Volume, Survivors, Thrombocytopenia, Ultrasonics, Vascular Endothelial Growth Factor A


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