The diagnosis of acute coronary syndrome (ACS) in patients with cancer constitutes a therapeutic challenge. We aimed to assess the clinical presentation and management of ACS as well as 1-year survival in patients hospitalized for cancer. This retrospective study included patients hospitalized between 2012 and 2018 in a nonacademic center. The inclusion criteria were diagnosis of active cancer and ACS recognized using standard criteria. Patients were assessed with respect to invasive or conservative ACS strategy. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiovascular mortality during 1-year follow-up. We screened 25,165 patients, of whom 36 (0.14%) had ACS (mean [SD] age, 71.9 [9.8] years). The most common presentation was non–ST-segment elevation myocardial infarction (61% of patients). Coronary angiography was performed in 47% of patients, while 53% were treated conservatively. Overall, the primary endpoint occurred in 67% of patients and secondary endpoint in 28% during follow-up. The predictors of better outcome in a univariate analysis were invasive strategy, lack of metastases, aspirin use, and no cardiogenic shock. Invasive treatment and aspirin use remained significant predictors of better survival when adjusted for the presence of metastases (hazard ratio [HR] 0.37, confidence interval [CI] 0.15–0.92 and HR 0.39, CI 0.16–0.94, respectively) and ineligibility for cancer treatment (HR 0.37, CI 0.15–0.93 and HR 0.30, CI 0.12–0.73, respectively). The incidence of ACS in cancer patients is low but 1-year mortality rates are high. Guideline-recommended management was frequently underused. Our results suggest that invasive approach and aspirin use are associated with better survival regardless of cancer stage and eligibility for cancer treatment.

Cardiovascular disease and cancer coexist and lead to exertional dyspnea. The aim of the study was to determine the prognostic significance of cardiac comorbidities, ECG and baseline echocardiography in lung cancer patients with varying degrees of reduced performance status. This prospective study included 104 patients with histopathologically confirmed lung cancer, pre-qualified for systemic treatment due to metastatic or locally advanced malignancy but not eligible for thoracic surgery. The patients underwent a comprehensive cardio-oncological evaluation. Overall survival negative predictors included low ECOG 2 (Eastern Cooperative Oncology Group) performance status, stage IV (bone or liver/adrenal metastases in particular), pleural effusion, the use of analgesics and among cardiac factors, two ECG parameters: atrial fibrillation (HR = 2.39) and heart rate >90/min. (HR = 1.67). Among echocardiographic parameters, RVSP > 39mmHg was a negative predictor (HR = 2.01), while RVSP < 21mmHg and RV free wall strain < −30% were positive predictors (HR = 0.36 and HR = 0.56, respectively), whereas RV GLS <−25.5% had a borderline significance (HR = 0.59; p =0.05). Logistical regression analysis showed ECOG = 2 significantly correlated with the following echocardiographic parameters: increasing RVSP, RV GLS, RV free wall strain and decreasing ACT, FAC (p < 0.05). Selected echocardiographic parameters may be helpful in predicting poor performance in lung cancer patients and, supplemented with ECG evaluation, broaden the possibilities of prognostic evaluation.

Patients and methods The study group will include 200 patients with newly diagnosed BC, recruited prior to commencing oncological treatment. The follow-up will last 12 months. The inclusion criteria are as follows: informed consent, age of 18 years or older, new diagnosis of BC, planned anticancer therapy, life expectancy exceeding 12 months, and stable condition enabling performance of planned tests, regardless of cancer stage. The exclusion criteria include pregnancy, history of atrial fibrillation (AF), and lack of the patient's or family's ability to use a smartphone necessary for ECG telemonitoring. The study was approved by a local bioethics committee. Prior to randomization, each patient will undergo laboratory testing (N-terminal pro-B-type natriuretic peptide, troponin, C-reactive protein, hemoglobin A 1c , lipid profile) and baseline measurements including BP, heart rate, weight, height, waist circumference, and echocardiography. Patients will then be randomized in a 1:1 ratio either to an intervention arm or a standard-care arm.

Many factors contribute to mortality in lung cancer, including the presence of concomitant cardiovascular disease. In the treatment of early stage of lung cancer, the presence of comorbidities and occurence of cardiotoxicity may be prognostic. The effect of cardiotoxicity of radiotherapy and chemoradiotherapy on overall survival has been documented. Acute arterial and venous thromboembolic events seem to correlate with the degree of the histological malignancy, its clinical advancement, and even with optimal cardiac treatment, they may influence the survival time. In the case of high-grade and advanced lung cancer stage especially in an unresectable stadium, the prognosis depends primarily on the factors related to the histopathological and molecular diagnosis. Electrocardiographic and echocardiographic abnormalities may be prognostic factors, as they seem to correlate with the patient's performance status as well as tumor localization and size.

Advanced lung cancer causes damage to lung tissue and the alveolar–capillary barrier, leading to changes in pulmonary circulation and cardiac function. This observational study included 75 patients with inoperable lung cancer. Two echocardiographic assessments were performed: one before the initiation of systemic anticancer therapy and another after the first radiological evaluation of the efficacy of anticancer treatment. In retrospective analysis, diagnosis of early cancer progression was associated significantly (p < 0.05) with some echocardiographic changes: a decrease in EF of at least 5 percentage points (OR = 5.78), an increase in LV GLS of 3 percentage points (OR = 3.81), an increase in E/E′ ratio of at least 3.25 (OR = 3.39), as well as a decrease in RV free wall GLS of at least 4 percentage points (OR = 4.9) and an increase in FAC of at least 4.1 percentage points (OR = 4.9). Cancer therapeutics-related cardiac dysfunction was diagnosed in accordance with the definition of the International Cardio-Oncology Society and was found more frequently in patients with radiologically confirmed lung cancer disease progression (p = 0.003). In further prospective studies, the hypothesis about the possible coexistence of the cardiotoxic effect of cancer therapy and cardiac dysfunction related to the progression of inoperable lung cancer should be clarified.

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Lung cancer is associated with an increased risk of venous thromboembolism, including pulmonary embolism. In some situations, clinical deterioration in patients with lung cancer accompanied by elevated pressure in the right ventricle, usually measured by commonly used echocardiography, may support the diagnosis of pulmonary embolism. However, there are many other causes of increased pressure in the right ventricle in such patients, for example: progression of cancer, pre-existing lung diseases, surgical resection of pulmonary tissue, pnemotoxicity of radiotherapy or concomitant diseases of the left heart. The article presents 2 clinical cases of patients with lung cancer, in which elevated pressure in the right ventricle was resulted from other causes and accompanied the progression of cancer, despite the clinical picture suggesting a pulmonary embolism. Increased pressure in the right ventricle and usually associated pulmonary hypertension, significantly worsen already poor prognosis of patients with lung cancer. The differential diagnosis should, therefore, take into account the whole clinical picture, excluding venous thromboembolism as an important cause of pulmonary hypertension, but also take into account other potential factors to be able to make the right diagnosis and implement optimal treatment as early as possible.

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