Cardiac Complications

Abstract

Overview Patients with malignant diseases often have coexisting cardiovascular disorders or may face serious cardiovascular complications in the course of their disease. The disorders may result from underlying conditions such as atherosclerosis, hypertension, or valvular abnormalities, or they may result directly from cancer or its treatment (Table 1). In addition, cardiovascular disorders that are unusual in patients not afflicted with cancer may be more common in the cancer patient and sometimes are unsuspected. Furthermore, cardiovascular diseases common in the general population must not be overlooked in patients with cancer; the presentation of such entities may be unusual, and the diagnosis often is more complex. Increased clinical scrutiny is therefore necessary in this vulnerable population. Multiple clinical problems may also coexist and defy a simple illumination because of the complex interactions between the malignancy, its treatment, and the cardiovascular system; what affects one often alters the presentation and course of the others. This chapter will look at some of the more common cardiovascular complications of cancer and its treatment, and will also address some of the dilemmas encountered in cancer patients with concomitant cardiac conditions.

Quantification of Extracellular Volume in CT in Neoadjuvant Chemotherapy in Breast Cancer: New Frontiers in Assessing the Cardiotoxicity of Anthracyclines and Trastuzumab

“…Our observation is confirmed by other authors who failed to find a statistically significant difference in ECV values from baseline in women treated with schemes with only epirubicin as the cardiac toxicant at the same doses [ 7 ]. To our knowledge, we are the first to describe this phenomenon at 5 years [ 39 , 41 , 42 ], confirming a possible recovery from EPI–TRAS subclinical damage.…”

“…This trend in the general asymptomatic population exposed to EPI–TRAS suggests a recover from an early damage in agreement with the type II damage. This effect is largely attributable to trastuzumab-related cardiac effect [ 39 , 41 ], whereas epirubicin is known to have fewer cardiotoxic effects than DOX. Indeed, at the cumulative dose of 900 mg/m 2 , epirubicin is responsible for an incidence peak of only 3.3% and the risk of HF become consistent only when exceeding this threshold [ 37 , 38 , 41 ].…”

“…This effect is largely attributable to trastuzumab-related cardiac effect [ 39 , 41 ], whereas epirubicin is known to have fewer cardiotoxic effects than DOX. Indeed, at the cumulative dose of 900 mg/m 2 , epirubicin is responsible for an incidence peak of only 3.3% and the risk of HF become consistent only when exceeding this threshold [ 37 , 38 , 41 ]. Of note in our study, epirubicin was delivered at 300 mg/mq, far lower than the threshold previously described, thus confirming trastuzumab as the relevant cardiac toxicant.…”