The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

Foulkes, S.; Claessen, Guido; Howden, Erin J.; Daly, Robin M.; Gerche, André La

doi:10.3389/fcvm.2020.00032

Cited by 15 publications

(11 citation statements)

References 160 publications

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“…These studies indicate that patients with myocardial injury due to underlying cardiovascular diseases are more likely at risk to develop severe complications as a result of SARS-CoV-2 infection (67,69,71). Further to this, anti-cancer drugs can trigger lateterm cardiovascular adverse effects, such as hypertension, cardiac dysfunction, thromboembolic events, and ischemia heart disease, and these cardiovascular complications are considered high risk factors of developing severe complications during COVID-19 infection in cancer survivors (90).…”

Section: Anti-cancer Drug-induced Cardiovascular Injury Might Increase Covid-19 Complication Risksmentioning

confidence: 97%

“…The cardiac reserve can be defined as "the increase in cardiac function from rest to peak exercise." In cancer survivors, anthracycline treatment reduces the cardiac reserve, and this parameter can be used as a marker of subclinical cardiac myocardial injury (90). Several reports have concluded that the risk of developing cardiac dysfunction increases over the years after completion of anthracycline cancer treatment, and in the most severe adverse effect cases, heart failure is observed (100)(101)(102)(103).…”

Section: Comorbidity Could Follow a "Two-hit" Modelmentioning

confidence: 99%

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Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Lozahic

Maddock

Sandhu

2021

Front. Cardiovasc. Med.

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Anti-cancer treatment regimens can lead to both acute- and long-term myocardial injury due to off-target effects. Besides, cancer patients and survivors are severely immunocompromised due to the harsh effect of anti-cancer therapy targeting the bone marrow cells. Cancer patients and survivors can therefore be potentially extremely clinically vulnerable and at risk from infectious diseases. The recent global outbreak of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its infection called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide health emergency, and on March 11, 2020, COVID-19 was declared a global pandemic by the World Health Organization (WHO). A high fatality rate has been reported in COVID-19 patients suffering from underlying cardiovascular diseases. This highlights the critical and crucial aspect of monitoring cancer patients and survivors for potential cardiovascular complications during this unprecedented health crisis involving the progressive worldwide spread of COVID-19. COVID-19 is primarily a respiratory disease; however, COVID-19 has shown cardiac injury symptoms similar to the cardiotoxicity associated with anti-cancer therapy, including arrhythmia, myocardial injury and infarction, and heart failure. Due to the significant prevalence of micro- and macro-emboli and damaged vessels, clinicians worldwide have begun to consider whether COVID-19 may in fact be as much a vascular disease as a respiratory disease. However, the underlying mechanisms and pathways facilitating the COVID-19-induced cardiac injury in cancer and non-cancer patients remain unclear. Investigations into whether COVID-19 cardiac injury and anti-cancer drug-induced cardiac injury in cancer patients and survivors might synergistically increase the cardiovascular complications and comorbidity risk through a “two-hit” model are needed. Identification of cardiac injury mechanisms and pathways associated with COVID-19 development overlapping with anti-cancer therapy could help clinicians to allow a more optimized prognosis and treatment of cancer survivors suffering from COVID-19. The following review will focus on summarizing the harmful cardiovascular risk of COVID-19 in cancer patients and survivors treated with an anti-cancer drug. This review will improve the knowledge of COVID-19 impact in the field of cardio-oncology and potentially improve the outcome of patients.

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Section: Anti-cancer Drug-induced Cardiovascular Injury Might Increase Covid-19 Complication Risksmentioning

confidence: 97%

Section: Comorbidity Could Follow a "Two-hit" Modelmentioning

confidence: 99%

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Lozahic

Maddock

Sandhu

2021

Front. Cardiovasc. Med.

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“…Anthracycline-induced subclinical cardiac dysfunction still affects up to 65% of DOX-treated pediatric cancer patients [15,41]. It has been suggested that anthracycline-treated childhood cancer survivors have lower cardiac reserve as compared to control subjects [24]. The subclinical cardiotoxicity and reduced cardiac reserve predispose anthracycline-treated survivors to other cardiovascular risk factors later in life in a "two-hit" manner [81].…”

Section: -Reduced Cardiac Reservementioning

confidence: 99%

“…Cancer-related survival has significantly increased in the last two decades thanks to advanced diagnosis and treatment, leading to more than 15.5 million cancer survivors in the United States [15][16][17][18]. Unfortunately, cancer survivors suffer from multitude of adverse health conditions [19][20][21], with a considerably increased risk for premature cardiovascular diseases [22][23][24]. For instance, childhood cancer survivors have an estimated 15 times higher risk of heart failure than their siblings who did not have cancer [25].…”

mentioning

confidence: 99%

Cardiovascular Vulnerability to COVID-19 in Cancer Survivors

Zordoky¹

2020

Preprint

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Coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2). Although primarily a respiratory disease, cardiovascular complications of COVID-19 have been increasingly recognized. In addition, higher fatality has been reported in COVID-19 patients with underlying cardiovascular diseases. Cancer survivors have a considerably increased risk for premature cardiovascular diseases, mainly due to cardiotoxic cancer treatments. Therefore, it is foreseeable that cancer survivors will be more vulnerable to cardiovascular complications caused by COVID-19. In this review, three scenarios for increased cardiovascular complications of COVID-19 in cancer patients are proposed. In the first scenario, cardiotoxic cancer treatment and COVID-19 synergize to exacerbate direct myocardial damage. In the second scenario, cardiotoxic cancer treatment leads to a reduced cardiac reserve in cancer survivors, making them more vulnerable to COVID-19 in a “two-hit” model. The third scenario suggests that several shared risk factors may aggravate cardiovascular complications caused by both cancer treatment and COVID-19. Taken together, cancer survivors may be more vulnerable to cardiovascular complications when challenged by the COVID-19, and special cardiovascular care should be given to these patients.

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“…Echocardiography or radionuclide angiography are typically used to measure LVEF changes in order to diagnose CTRCD. However, the variability of echocardiography measurements, the high false negative rate of radionuclide angiography and the radiation involved in measurements cannot be ignored ( 7 ). Ejection fraction-preserved HF is very prevalent in cases of HF.…”

Section: Introductionmentioning

confidence: 99%

Advances in Biomarkers for Detecting Early Cancer Treatment-Related Cardiac Dysfunction

Xiao

Wang

et al. 2021

Front. Cardiovasc. Med.

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With the gradual prolongation of the overall survival of cancer patients, the cardiovascular toxicity associated with oncology drug therapy and radiotherapy has attracted increasing attention. At present, the main methods to identify early cancer treatment-related cardiac dysfunction (CTRCD) include imaging examination and blood biomarkers. In this review, we will summarize the research progress of subclinical CTRCD-related blood biomarkers in detail. At present, common tumor therapies that cause CTRCD include: (1) Chemotherapy—The CTRCD induced by chemotherapy drugs represented by anthracycline showed a dose-dependent characteristic and most of the myocardial damage is irreversible. (2) Targeted therapy—Cardiovascular injury caused by molecular-targeted therapy drugs such as trastuzumab can be partially or completely alleviated via timely intervention. (3) Immunotherapy—Patients developed severe left ventricular dysfunction who received immune checkpoint inhibitors have been reported. (4) Radiotherapy—CTRCD induced by radiotherapy has been shown to be significantly associated with cardiac radiation dose and radiation volume. Numerous reports have shown that elevated troponin and B-type natriuretic peptide after cancer treatment are significantly associated with heart failure and asymptomatic left ventricular dysfunction. In recent years, a few emerging subclinical CTRCD potential biomarkers have attracted attention. C-reactive protein and ST2 have been shown to be associated with CTRCD after chemotherapy and radiation. Galectin-3, myeloperoxidas, placental growth factor, growth differentiation factor 15 and microRNAs have potential value in predicting CTRCD. In this review, we will summarize CTRCD caused by various tumor therapies from the perspective of cardio-oncology, and focus on the latest research progress of subclinical CTRCD biomarkers.

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The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

Cited by 15 publications

References 160 publications

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Cardiovascular Vulnerability to COVID-19 in Cancer Survivors

Advances in Biomarkers for Detecting Early Cancer Treatment-Related Cardiac Dysfunction

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