Cardiogenic shock in cancer

Keramida, Kalliopi; Parissis, John; Chioncel, Ovidiu; Farmakis, Dimitrios

doi:10.1007/s10741-019-09819-9

Cited by 15 publications

(10 citation statements)

References 83 publications

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“…Although data regarding the incidence of CS in patients with a malignancy are scarce, history of cancer is an independent risk factor of mortality in CS 226 . CS can develop due to cancer itself, the co‐existing cardiovascular disease, thromboembolic events, or the type of treatment (surgery, chemotherapy, immune checkpoint inhibitors and radiotherapy) 227 …”

Section: Cardiogenic Shock In Various Clinical Settingsmentioning

confidence: 99%

Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Chioncel

Parissis

Mebazaa

et al. 2020

European J of Heart Fail

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307

348

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O. Chioncel et al. Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patient's underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management.

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Section: Cardiogenic Shock In Various Clinical Settingsmentioning

confidence: 99%

Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Chioncel

Parissis

Mebazaa

et al. 2020

European J of Heart Fail

Self Cite

307

348

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“…CV toxicity associated with ICI (e.g. ipilimumab, nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab), including myocarditis sometimes causing cardiogenic shock 69 and/or malignant ventricular tachyarrhythmias, pericarditis (including effusion and tamponade), arrhythmias, and non‐inflammatory LV systolic dysfunction, was initially considered rare (<1%) but with expanding use its incidence is increasing 70,71 . ICI‐mediated fulminant myocarditis is relatively rare but has been associated with a high mortality rate (25–50%) 24 .…”

Section: Echocardiography During Immune Checkpoint Inhibitor Treatmentmentioning

confidence: 99%

Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the European Society of Cardiology (ESC)

Čelutkienė

Pudil

López‐Fernández

et al. 2020

European J of Heart Fail

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265

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Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed.

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“…[14] A meta-analysis on patients with TTS and cancer showed a 3.33-fold incidence of adverse events occurring in hospital (including life-threatening arrhythmias, cardiogenic shock, thromboembolism, and requirement for respiratory support) and a 2.08-fold incidence at follow-up (including allcause mortality and re-hospitalization for cardiovascular disease). [8,15] Previous studies have reported that the diagnosis of cancer may decrease the psychic threshold for stress stimuli, [4] and nearly 50% of patients with cancer suffer from significant emotional disorders and physical stressors, which might increases the effect of further external stressors. [8,16] Patients with cancer and mental disorders have longer hospitalizations and a worse prognosis than those without mental disorders, but often remain unnoticed during somatic treatment settings.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic shock caused by Takotsubo syndrome complicated with severe anxiety

Fang

Wang

et al. 2021

Medicine

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Rationale:Takotsubo syndrome (TTS) is characterized by transient and reversible left ventricular systolic dysfunction, which are often associated with acute physical or emotional stressors. Cancer is one of the comorbidities in TTS, and TTS is even considered as a paraneoplastic syndrome, but its mechanism remains unclear. We report a patient in whom cancer and untreated mental disorders triggered TTS.Patient concerns:A 59-year-old man was transferred to the Department of Cardiology because of acute onset of severe chest pain and dyspnea before cystoscopy. He presented with hematuria, had been diagnosed with a high-grade urothelial bladder cancer, and underwent transurethral resection of bladder tumors 4 months previously. He had severe anxiety regarding recurrence and death from cancer, especially after the hematuria recurred.Diagnosis:TTS and severe anxiety.Interventions:The results of coronary angiography, a left ventriculogram, echocardiography, and the clinical outcome led to the diagnosis of TTS. The patient was treated with extracorporeal membrane oxygenation support, mechanical ventilation, and drugs for heart failure and anxiety.Outcomes:Echocardiography showed normal wall motion on day 6 of symptom onset. Six months after symptom onset, the anxiety score was reduced from 12 to 11, and the patient had no episodes of any discomfort, and no evidence of cancer recurrence was observed.Lessons:Patients with cancer and TTS have a higher level of stress, and physicians need to pay more attention to early screening and early treatment of mental disorders in these patients. Prompt and effective multidisciplinary treatment, including psychological counseling and antianxiety drugs, can improve the prognosis in such cases.

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Cardiogenic shock in cancer

Cited by 15 publications

References 83 publications

Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the European Society of Cardiology (ESC)

Cardiogenic shock caused by Takotsubo syndrome complicated with severe anxiety

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