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Interaction of genetic predisposition, classic risk factors and pre-existing cardiovascular diseases in the development or progression of a cardiovascular disease as a result of cancer therapy (‘2nd hit’) or the cancer itself. CAD coronary artery disease, PAD peripheral artery disease, LV left ventricular
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The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 3...
Citations
... Exercise interventions, both AET (MCT and HIIT) and RT, during chemotherapy have been shown to be safe and applicable [155,156] and have the potential to improve CRF and prevent development of long-term HF [97,157,158] by affecting multiple molecular pathways. This should trigger the implementation of exercise training as an adjunct to standard cancer-related therapy in the form of cardio-oncological rehabilitation, which is not generally available despite "guideline recommendations" [8,[159][160][161][162]. More exercise trials are needed to elucidate the most appropriate training regimen to prevent and antagonize CTRCD, whose definition may require revision in the future to incorporate additional functional variables. ...
Purpose of the Review
Cancer therapy-related cardiac dysfunction (CTRCD) has been identified as a threat to overall and cancer-related survival. Although aerobic exercise training (AET) has been shown to improve cardiorespiratory fitness (CRF), the relationship between specific exercise regimens and cancer survival, heart failure development, and reduction of CTRCD is unclear. In this review, we discuss the impact of AET on molecular pathways and the current literature of sports in the field of cardio-oncology.
Recent Findings
Cardio-oncological exercise trials have focused on variations of AET intensity by using moderate continuous and high intensity interval training, which are applicable, safe, and effective approaches to improve CRF.
Summary
AET increases CRF, reduces cardiovascular morbidity and heart failure hospitalization and should thus be implemented as an adjunct to standard cancer therapy, although its long-term effect on CTRCD remains unknown. Despite modulating diverse molecular pathways, it remains unknown which exercise regimen, including variations of AET duration and frequency, is most suited to facilitate peripheral and central adaptations to exercise and improve survival in cancer patients.
... Abnormalities in blood flow can lead to cardiological and vasculature defects [27][28][29], as appropriate blood flow is essential for the development of the heart and other organs. This involves diagnosing and assessing the vascular network and its health, along with measuring blood flow rates to assess the condition of organ health. ...
Speckle patterns are a generic feature in coherent imaging techniques like optical coherence tomography (OCT). Although speckles are granular like noise texture, which degrades the image, they carry information that can be benefited by processing and thereby furnishing crucial information of sample structures, which can serve to provide significant important structural details of samples in in vivo longitudinal pre-clinical monitoring and assessments. Since the motions of tissue molecules are indicated through speckle patterns, speckle variance OCT (SV-OCT) can be well-utilized for quantitative assessments of speckle variance (SV) in biological tissues. SV-OCT has been acknowledged as a promising method for mapping microvasculature in transverse-directional blood vessels with high resolution in micrometers in both the transverse and depth directions. The fundamental scope of this article reviews the state-of-the-art and clinical benefits of SV-OCT to assess biological tissues for pre-clinical applications. In particular, focus on precise quantifications of in vivo vascular response, therapy assessments, and real-time temporal vascular effects of SV-OCT are primarily emphasized. Finally, SV-OCT-incorporating pre-clinical techniques with high potential are presented for future biomedical applications.
... Despite the remarkable progress made in treating childhood cancers, the therapies employed (particularly anthracyclines and radiation therapy) can inadvertently inflict damage on the entire cardiovascular system, predisposing survivors to an increased risk of, eg, heart failure, coronary artery disease, valvular heart disease, hypertension, and arrhythmia later in life. 1 Heart failure, a more commonly encountered long-term adverse event, is often linked to an inferior prognosis and quality of life, and contributes to a sig- ...
... Research has shown that compared to normal individuals, childhood cancer survivors have a 5-15 fold increased risk of congestive heart failure, and once diagnosed, the 5-year survival rate is less than 50% [10] . Tumor combined with cardiovascular disease or cardiovascular complications induced by anticancer treatment have become the main cause of incidence rate and mortality/non cancerous death of child cancer survivors [11][12][13][14] . Therefore, early identi cation of high-risk children, successful screening and early treatment of children with cardiac damage are of great signi cance. ...
Objective To explore the risk factors for anthracycline related acute cardiotoxicity (ACT) in pediatric patients with hematological tumors, and to construct a column chart risk prediction model.
Methods 184 children with hematological tumors in a tertiary hospital from January 2016 to December 2023 were selected as the research subjects. The children were divided into a model group (129 cases) and a validation group (55 cases) in a 7:3 ratio. The model group was used to construct a risk prediction model, while the validation group was used to verify the accuracy of the model's predictions. Using multiple logistic regression analysis to explore the independent influencing factors of anthracycline related acute ACT in children with hematological tumors, and further establishing a risk column chart prediction model using R software.
Results Age, Targeted therapy, TC, and LDL-H were independent risk factors for anthracycline related acute ACT in children with hematological tumors (all P<0.05), while the combination of dexamethasone and dexamethasone was an independent protective factor for anthracycline related acute ACT in children with hematological tumors (P<0.05). A column chart prediction model was constructed using the above influencing factors as indicators. The area under the working characteristic curve (AUC) of the subjects in the model group was 0.804 [95% CI (0.725, 0.869), P<0.001]. The results of the Hosmer Lemeshow goodness of fit test were χ²=9.448, P=0.306, AUC in the validation group was 0.738 [95% CI (0.635,0.848), P<0.001], and the results of the Hosmer Lemeshow goodness of fit test were χ²=9.448, P=0.306. When the threshold probability of the clinical decision curve is between 0.01 and 0.92, the clinical net benefit is higher.
Conclusion: The risk prediction model for anthracycline related acute ACT in children with hematological tumors constructed in this study has good predictive value and clinical applicability. It can help medical staff screen high-risk populations, take timely and effective intervention measures, and achieve maximum survival benefits.
... Although cardio-oncology has been introduced as a subdiscipline to investigate cardiotoxic effects of cancer itself and associated therapies [113,164], the deleterious consequences of tumor therapy extend far beyond the cardiovascular all the way to the skeletal system [172,177,188]. Alterations in oxygen uptake, delivery, extraction, and utilization can occur from mouth to mitochondrion " leading to a variation of clinical symptoms (Fig. 1)". ...
Cardiovascular diseases and cancer are the leading causes of death in the Western world and share common risk factors. Reduced cardiorespiratory fitness (CRF) is a major determinant of cardiovascular morbidity and cancer survival. In this review we discuss cancer- induced disturbances of parenchymal, cellular, and mitochondrial function, which limit CRF and may be antagonized and attenuated through exercise training. We show the impact of CRF on cancer survival and its attenuating effects on cardiotoxicity of cancer-related treatment. Tailored exercise programs are not yet available for each tumor entity as several trials were performed in heterogeneous populations without adequate cardiopulmonary exercise testing (CPET) prior to exercise prescription and with a wide variation of exercise modalities. There is emerging evidence that exercise may be a crucial pillar in cancer treatment and a tool to mitigate cardiotoxic treatment effects. We discuss modalities of aerobic exercise and resistance training and their potential to improve CRF in cancer patients and provide an example of a periodization model for exercise training in cancer.
... It can be said that cancer and cardiovascular disease are two sides of the same coin [1]. Both cancer therapy and treatment options for CAD have improved significantly over the past two decades, leading to life extension [2,3]. Nevertheless, a coincidence of both disease areas leads to increased morbidity and mortality; however, patients with hematologic malignancies (HM) were not analyzed in detail in this regard [4]. ...
Background:
The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood.
Objective:
The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE).
Results:
Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001.
Conclusion:
Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.
... In the decade leading up to the much anticipated release of the 2022 ESC Cardio-Oncology guidelines, cardio-oncology consensus statements or guidelines of limited scope were released by the American Society of Echocardiography and European Association of Cardiovascular Imaging [7], Canadian Cardiovascular Society [8], ESC [9], ASCO [10], and the European Society of Medical Oncology [11], among others [12,13] (Fig. 1). The 2022 ESC Cardio-Oncology guidelines represented a monumental effort developed by the ESC Cardio-Oncology Task Force involving 30 international experts from 13 different countries and included multidisciplinary collaboration with the European Hematology Association, European Society for Therapeutic Radiology and Oncology, and the International Cardio-Oncology Society [1]. ...
While expert opinion is an important tool in the development of clinical practice guidelines (CPGs), it must be used judiciously and balanced with the available evidence. In this review, we carefully examine the role of balancing evidence and expert opinion in the context of the 2022 European Society of Cardiology (ESC) Cardio-Oncology guidelines, including the factors that influence the weight given to expert opinion and potential impact on health care systems adhering to specific guideline recommendations.
In an attempt to be all-encompassing, the 2022 ESC guidelines risk diluting important recommendations with low-quality recommendations lacking consensus. Adherence to, as well as deviation from, guidelines may have important unintended consequences to stakeholders.
The 2022 ESC guidelines should be viewed as a catalyst for the cardio-oncology community to generate higher quality evidence to address existing gaps in knowledge while also recognizing the current constraints in providing care to patients with cancer.
... Der pädiatrische Aspekt wird darin insgesamt wenig berücksichtigt. Das zuletzt publizierte Konsensuspapier der deutschen Fachgesellschaften enthält allerdings ein spezielles pädiatrisches Kapitel [8]. Ziel dieses Positionspapiers ist es, die Aufmerksamkeit der Kinderkardiologen und -onkologen, aber auch der Erwachsenenkardiologen und -onkologen im Hinblick auf dieses Thema zu erhöhen. ...
... Tab.8 Kardiales Screening in der Nachsorge in Abhängigkeit von der Toxizität[20] Bezieht sich auf die Strahlendosis, die das Herz treffen konnte (bei Bestrahlung von Brust, Bauch oder Wirbelsäule, Ganzkörperbestrahlung) EKG (einschließlich Bestimmung des QTc-Intervalls); zu Beginn des Follow-up, Wiederholung je nach klinischer Notwendigkeit schwach graduiert wurden. Das Risiko für eine Schädigung wird ebenfalls in hoch, moderat und niedrig eingeteilt. ...
Zusammenfassung
Kinder und Jugendliche überleben eine Krebsdiagnose und erfolgreiche Krebstherapie länger als Erwachsene. Damit gewinnen Spätfolgen der Behandlung, wie kardiotoxische Langzeitwirkungen, zunehmend an Relevanz. Häufig werden im Rahmen der onkologischen Therapie Anthrazykline eingesetzt, deren akute und chronische Kardiotoxizität bekannt sind. Sie kommen bei Kindern in etwa 60 % der Krebstherapien zur Anwendung und sind zurzeit die Chemotherapeutika mit dem quantitativ höchsten Risiko für eine Kardiotoxizität. Weitere neuere Medikamente und die Bestrahlung sind ein zusätzliches, z. T. unbekanntes Risiko für Herz und Gefäße. Dies betrifft über die Kardiomyopathie hinaus auch das Auftreten von system- und pulmonalarterieller Hypertonie. Zunehmend besser charakterisiert wird das Risiko kardiovaskulärer Spätfolgen durch eine Strahlentherapie.
Einige der unerwünschten Nebeneffekte werden erst im Laufe der Zeit – lange nach der initialen Behandlung der Patienten – auftreten. Die Spätfolgen am Herzen können zunächst klinisch verborgen bleiben, obwohl schon eine subklinische linksventrikuläre systolische Dysfunktion besteht. Die manifeste Herzinsuffizienz folgt später. Dann jedoch sind die Patienten nicht mehr in der Betreuung der Kinder- und Jugendmediziner, haben das Erwachsenenalter erreicht und sollten durch Mediziner für Erwachsene versorgt werden. Eine strukturierte Transition nach der onkologischen Therapie ist somit essenziell.
In den letzten Jahren sind einige Positionspapiere oder Leitlinien zum Thema Kardioonkologie veröffentlicht worden. Der pädiatrische Aspekt wird darin insgesamt wenig berücksichtigt. Ziel dieses Positionspapiers ist es, die Aufmerksamkeit der Kinderkardiologen und -onkologen, aber auch der Erwachsenenkardiologen und -onkologen im Hinblick auf dieses Thema zu erhöhen. Dazu werden Risikofaktoren für eine kardiovaskuläre Toxizität der verschiedenen Erkrankungen und Therapieprotokolle dargestellt sowie der Stand der Kenntnis zur Vermeidung von Toxizität und manifester Herzinsuffizienz beschrieben. Art und Durchführung der kardiologischen Diagnostik und Nachsorge stellen den Mittelpunkt dar.
... Такой подход предполагает не только улучшение результатов противоопухолевого лечения, но и необходимость дальнейшего совершенствования принципов сопроводительной терапии, поскольку токсичность таргетных препаратов, включая сердечно-сосудистые события, все же отличается своеобразием [4]. Сердечно-сосудистые события, занимающие лидирующее место среди осложнений противоопухолевого лечения, не теряют своей актуальности как проблема и продолжают регистрироваться в клинических исследованиях, направленных на одобрение новых методов лекарственной терапии [5,6]. В табл. 1 суммированы данные, отражающие наиболее часто встречающиеся сердечно-сосудистые побочные эффекты иммунотерапии гематологических опухолевых заболеваний. ...
In clinical oncology in general, tumor treatment is closely related to a highly relevant issue of chemotherapy-induced adverse events. Among side effects, cardiovascular toxicity occupies the foremost place. The strategy of controlling the cardiovascular complications associated with antitumor drug and cell therapies presupposes an early diagnosis of changes in the heart muscle and blood vessels at the stage of subclinical manifestations of adverse events. The present literature review provides the analysis of data on immunotherapy side effects in hematological malignancies with a focus on cardiovascular complications. The review comprehensively discusses the characteristics of cardiovascular complications associated with immune checkpoint inhibitors, CAR-T cell products, bispecific antibodies as well as immunomodulatory and antiangiogenic drugs.
... Disease-and therapy-related monitoring for CTR-CVD, early cardio-protective measures, and long-term surveillance of the cancer survivors are cornerstones of contemporary cardio-oncology care. 2,3 On the one hand, substantial evidence about the precise frequency of CTR-CVD is available for many conventional cancer therapies (e.g. anthracyclines), and the current European Society of Cardiology (ESC) guidelines for these drugs are increasingly precise. ...
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The registry data presented by Mahmood et al.⁹ demonstrate that CAR T-cell recipients experience severe cardiac events (SCEs) at significant rates. In these patients, cardiovascular risk factors and cardiovascular disease [atrial fibrillation and heart failure including a decline in left ventricular ejection fraction (LVEF)] were significantly more frequent. CAR T-cell infusion exerts direct and indirect effects on the cardiovascular system (via cytokines, activated monocytes/macrophages, and/or directly from T cells). SCEs presented as heart failure, cardiogenic shock, and myocardial infarction, together with increased biomarkers. SCEs in turn were associated with overall and non-relapse mortality.
