Circulation and JACC: Cardiovascular Imaging: Special Issues in Cardio-Oncology
Advances in cancer treatment have resulted in significant improvement in cancer-specific survival, transforming many once-fatal cancers into chronic disease. As longevity increases, cardiovascular (CV) disease is emerging as a leading cause of morbidity and mortality, with cancer survivors increasingly subject to late CV disease related to cancer therapies, compounded by the development of age-related CV risk factors. These CV diseases threaten to limit the tremendous gains achieved in cancer care, catalyzing the burgeoning field of cardio-oncology, a joint discipline between oncology and cardiology that is aimed at optimizing CV health in patients with cancer during and after cancer therapy. Circulation and JACC: Cardiovascular Imaging have dedicated special themed issues to cover important topics of this subspecialty. The articles in these issues have now been catalogued in the Cardio-Oncology Resources page from the Cardio-Oncology Clinical Topic Collection on ACC.org.
In the focused Circulation issue (August 14, 2018, volume 138, issue 7), a series of articles are presented on the interplay of CV disease and cancer, highlighting the growing body of evidence demonstrating shared risk factors and pathophysiologic mechanisms between cancer and CV disease. A paradigm-shifting discovery that clonal hematopoiesis of indeterminate potential, a premalignant state, contributes to CV risk, further broadens this perspective. Evidence from an experimental study suggests a causal link between heart failure and cancer via inflammatory and neurohormonal factors, proposing the hypothesis that heart failure is an oncogenic condition and a risk factor for incident cancer. A report uncovers that lower limb arterial thrombosis is a marker of occult cancer and an adverse prognostic factor for mortality in common cancers. A letter to the editor reports significant mortality associated with immune checkpoint inhibitor induced myositis, raising awareness of the risk of autoimmune disease associated with immunotherapy. These articles and others in this issue collectively provide insight into the biology of the interplay of CV disease and cancer, analyzing challenges and potential solutions to overcome cancer and CV disease.
CV imaging has played a central role in the practice of cardio-oncology. In this themed issue of JACC: Cardiovascular Imaging (August 2018, volume 11, issue 8), articles are presented on the value of imaging in cardio-oncology, its utility to identify subclinical cardiac dysfunction, and prevent or mitigate progression of cardiac injury. Multiple papers cover the use of echocardiography, including two-dimensional and three-dimensional, strain imaging, and cardiac magnetic resonance imaging for cardiotoxicity detection. The issue includes an educational tutorial with web-based videos illustrating how to accurately measure strain to help practitioners implement the new technology correctly. Several articles discuss current practices for cardiac monitoring during and after cancer therapy, addressing controversy with the existing monitoring guidelines, analyzing its limitations with proposals to fill the knowledge gaps. An original cardiac magnetic resonance-based investigation provides insight on the mechanism of anthracycline-induced myocardial dysfunction by demonstrating the role of cardiomyocyte atrophy and subclinical left ventricular dysfunction. Other articles cover the diagnosis and management of radiation-induced heart disease. An introduction is made to the first randomized, strain-guided intervention trial in cardio-oncology (SUCCOUR [Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes]), which is expected to provide data on the potential benefit of heart failure medications based on the detection of abnormal strain.1
- Negishi T, Thavendiranathan P, Negishi K, Marwick TH; SUCCOUR investigators. Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes: The SUCCOUR Trial. JACC Cardiovasc Imaging 2018;11:1098-105.
Keywords: Cardiotoxicity, Cardiotoxins, Risk Factors, Myocytes, Cardiac, Anthracyclines, Medical Oncology, Echocardiography, Ventricular Dysfunction, Left, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Heart Failure, Immunotherapy, Chronic Disease, Myositis, Autoimmune Diseases, Atrophy, Thrombosis, Hematopoiesis, Lower Extremity
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