In guidelines of the European Society of Cardiology (ESC) for the diagnosis and treatment of chronic and acute heart failure 2021 authors have written necessity of regular checkup of all patients with chronic heart failure (CHF) to identify anemia or iron deficiency. The prevalence of anemia in patients with CHF varies significantly depending on the clinical characteristics of the studied population and the criteria for the diagnosis of anemia from 4 to 75%. Frequency of iron deficiency without anemia, according to various studies, achieve 55% of cases. In the literature, data are increasingly appearing that even mild anemia and iron deficiency are associated with worsening symptoms, decreased exercise tolerance. They can provoke increasing of numbers of hospitalizations of patients with CHF, and decreasing of their quality of life and increasing rate of mortality. In this paper a number of factors determining iron deficiency in patients with CHF are analyzed. The article also assesses the current state of the problem of the dependence of the presence of anemic syndrome and the gender-age characteristics of patients with CHF, observed in a number of studies, which remains quite contradictory to date. The results of the study of the mechanisms of development of secondary erythrocytosis and the course of CHF against the background of anemic syndrome, iron deficiency conditions, relative erythrocytosis are presented, promising directions of drug correction are reflected. Data from randomized controlled trials (RCTs) on the possibility of using iron supplementation as part of the management of patients with CHF and iron deficiency status are presented. It was noted that using of an injectable form of iron carboxymaltosate in patients with CHF and low EF improves the functional class of CHF according to NYHA, quality of life, tolerance to physical activity, as well as contributes to an increase in the left ventricular ejection fraction and its final systolic volume.
The development of targeted drugs and immune checkpoint inhibitors (ICIs), as well as their implementation into clinical practice has allowed increasing the overall and event-free survival of oncohematological patients. Currently, assessment of the efficacy of a therapeutic strategy in each specific case includes the evaluation of an acceptable tolerability profile. The subject of discussion includes cardiovascular complications induced by target drugs and ICIs. The review mainly presents the issues of cardiovascular toxicity (CVT) in certain groups of oncohematological patients (with chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma). The spectrum of cardiovascular adverse effects associated with targeted and ICI therapy in oncohematological practice is quite wide — coronary artery disease, peripheral arterial disease, myocarditis, heart failure, arrhythmias, hypertension. The high importance of the problem of using targeted and immunosuppressive therapy dictates the need to predict adverse effects. The diagnosis of heart failure (one of CVT manifestations) is based on determining the decreased left ventricular ejection fraction during echocardiography, less often — during cardiac magnetic resonance imaging; global longitudinal myocardial strain is a significant parameter of preclinical heart failure, which is determined using the speckle tracking technique. To determine vascular toxicity, a special attention is paid to the vascular wall structure and microcirculation parameters — capillary density at rest, percentage of capillary recovery and perfused capillaries, stiffness index for large blood vessels, reflection index for small arteries, laboratory markers of inflammation and endothelial dysfunction (C-reactive protein, fibrinogen, homocysteine, endothelin 1, vascular endothelial growth factor). CVT prevention presumes the determination of the risk group, correction of risk factors, and administration of protective therapy to very high and high-risk patients. One of the promising directions for preventing vascular toxicity is the use of sodium-glucose linked transporter-2 inhibitors.
The article aims at presenting the review of literature data concerning mechanisms, diagnostic methods, and preventive approaches for cardiovascular toxicity induced by chemotherapy and target drugs. The review is devoted to the currently important issue of cardiotoxicity with antineoplastic therapy. Modern cytostatic agents cause clinically significant myocardial damage, which definitely impair the quality of life and decrease the life expec-tancy in oncological patients. Compared to traditional chemotherapy, target cancer therapy is a new strategy which inhibits key molecules of signal pathways participating in carcinogenesis and tumor spread. Target cancer therapy is characterized by lesser unfavorable effects on normal cells and considered the future of chemotherapy. However, cardiovascular toxicity induced by target cancer therapy sometimes becomes a critical issue in patients administered novel antineoplastic agents. Cardiac oncology is a new sphere of medicine which comes under scrutiny of experts despite the fact that many mechanisms of cardiovascular complications for the antineoplastic therapy have not been thoroughly studied. The current review presents the state-of-the-art information concerning mechanisms, diagnostic and monitoring problems for cardiovascular safety, a contemporary view of preventing cardiotoxicity induced by chemotherapy and target drugs.
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