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COVID-19 has not only affected the respiratory but the cardiovascular system. Taiwan has encountered a less severe COVID-19 pandemic. We reported the current situation in Taiwan. In this study, we retrospectively analyzed the data from our cardio-oncology program since October of 2019 to April of 2020 (the initial months of COVID-19 pandemic). In our cardio-oncology program, newly diagnosed breast cancer patients preparing for epirubicin therapy were included. Echocardiography, 6-min walking distance and major adverse cardiovascular events (MACEs) were recorded. To evaluate whether the social atmosphere affects cardio-oncology care, we analyzed the objective (physical) and subjective (emotional) parameters before and after January 21, 2020, when the first case of COVID-19 was confirmed in Taiwan. There was no significant decrease in patients’ return ratio and LVEFs. However, there was a trend of subjective shortness of breath reported by the patients but no decline in 6 MWT. Notably, none of the enrolled patients reported MACEs during the COVID pandemic. We observed an impact of anxiety on patients receiving epirubicin but it did not influence their return ratio.

Summary Cardio-oncology is an emerging field, that transformed the medical management of patients with cancer. It encompasses the prevention and treatment of cardiovascular toxicities related to cancer treatments, aiming to reduce cardiac adverse events among cancer survivors. Cardiovascular toxicities related to cancer treatments are described through data collected during phase I to phase III therapeutic trials, and post-marketing surveillance (phase IV). Pharmacovigilance analyses, based on datamining from these extensive databases, allowed to understanding and identifying new adverse drug reactions, some recently made available, such as immunotherapy or inhibitor of Bruton tyrosine kinase (IBTK).

The field of cardio-oncology has emerged in response to the increased risk of cardiovascular disease (CVD) in patients with cancer. However, recent studies suggest a more complicated CVD-cancer relationship, wherein development of CVD, either prior to or following a cancer diagnosis, can also lead to increased risk of cancer and worse outcomes for patients. In this review, we describe the current evidence base, across epidemiological as well as preclinical studies, which supports the emerging concept of ‘reverse-cardio oncology’, or CVD-induced acceleration of cancer pathogenesis.

The aim of this article is to represent the characterization of the clinical case of chemotherapy-related atrial fibrillation (AF) development in the young woman, elaborated as a result of multiple neoadjuvant and adjuvant modes of the intake of chemotherapy (both anthracycline based and non-anthracycline ones). In this case, the noted disturbances of heart rhythm should be recognized as a manifestation of cardiotoxicity. The latter implies the degree of detrimental effect of chemotherapeutical medication on the morphophynctional parameters of the cardiovascular system. Anthracycline drugs, being highly effective chemotherapytical agents, provide well-known toxic effects on the heart and vessels. Anthracycline mediated cardiotoxicity is a well- known veracity that dates back to the 60s of the last century, but up to now this medication sustains irreplaceable components of big volume of chemotherapy modes. Moreover, it should be noted that relatively newer drugs also posses certain cardiotoxicogenic potential.

International audience; Cardiotoxicity is a common side effect induced by cancer therapies, which increases the risk of long-term morbidity and mortality in cancer survivors. To date, the mechanism leading to this toxicity is still unclear, thus complicating cardiac safety assessment and predictive factor identification. The advances in technology, particularly regarding radiation therapy and constant development of novel antineoplastic agents, require urgent development of efficient preclinical models to detect drug cardiotoxicity. A myriad of empirical preclinical models have been used to investigate cardiotoxicity, though with limited success. Recently, multicellular spheroid models have gained attention by mimicking the in vivo microenvironment. The aim of this review is to focus on the most relevant preclinical models used to assess antineoplastic drug- and radiotherapy-related cardiotoxicities, with an overview on their current use. It also aims to discuss the possible directions of translational research in the cardio-oncology field.

Introduction Thanks to the emergence of new therapeutics, prognosis and outcome of breast cancer patients (any subtype) have improved significantly. This raises the issue of the interactions and side effects related to the use of multiple drugs. Thus, to decide on a treatment the optimal benefit risk-ratio should be carefully watched as toxicities such as cardiac ones effect on long-term survival. Indeed, nowadays in France, cardiovascular diseases rank first as causes of death in women. Areas covered This non-exhaustive review aims to report the currently available data about cardiac side effects caused by the use of emerging drugs in breast cancer, in localized or metastatic disease alike. We will focus on HER2-inhibitors, cyclin-dependant-kinase 4/6 and PARP inhibitors, chemotherapy and immunotherapy, before discussing the means of prevention. Expert opinion Although this issue has largely been studied, the recent emergence of new drugs emphasizes the necessity for oncologists to adapt their practice to a multidisciplinary model that includes cardio-oncology.

Gemtuzumab ozogamicin (GO) is an anti-CD33 antibody-tumor antibiotic conjugate with proven efficacy in pediatric and adult patients with CD33+ acute myeloid leukemia. Adverse effects commonly associated with GO include hyperbilirubinemia, elevated transaminases, and sinusoidal obstruction syndrome. Cardiotoxicity has not been a commonly described adverse event. We describe two pediatric patients with relapsed/refractory acute myeloid leukemia who received fractionated GO monotherapy and subsequently developed severe acute left ventricular dysfunction. Both patients achieved remission, recovered cardiac function with medical therapy, and tolerated subsequent stem cell transplantation.

Author(s): Jackson, Samuel B; Tanoue, Michael; Shahandeh, Negeen; Lopez-Mattei, Juan; Brown, Sherry-Ann; Han, Janet K; Yang, Eric H

Author(s): Brown, Sherry-Ann; Yang, Eric H; Reza, Nosheen; Guha, Avirup; Ismail-Khan, Roohi; Pemmaraju, Naveen; Fradley, Michael G; Lopez-Mattei, Juan

The anthracyclines, represented by Doxorubicin, Epirubicin or Idarubicin, are paramount in Oncology due to their antitumoral efficacy in a multitude of solid cancers, making them essential in breast cancer treatment. The biggest disadvantage of anthracyclines, cardiotoxicity, happens as a direct effect of the oncologic treatment on the anatomy and the physiology of the heart and acts also as an element which advances pre-existent cardiovascular disease(2). We are presenting the case of a 51-year-old lady, clinically, with imagistic and biopsy diagnosis of breast cancer cT3N3M0, negative HR, HER 2neu-3+, that was treated with neoadjuvant chemotherapy consisting of anthracyclines and biological therapy with Herceptin (Trastuzumab – monoclonal humanized IgG1 antibodies, administered in HER2 + breast cancer). By cumulating the current clinical data with the therapeutic challenges of the anthracyclines (antitumoral effect vs cardiotoxicity), we are trying to encourage the multidisciplinary approach (oncology and cardiology), in order to reach the best therapeutic decision for each patient.

Physicians have a duty to present diagnostic and therapeutic choices with rational guidance that respects patient values and realizes patient goals. In cardio-oncology, we commonly encounter patients who understandably feel overwhelmed or feel that they have no favorable options, particularly in the context of advanced malignancy. Accordingly, a longitudinal multidisciplinary commitment to shared decision making (SDM) ensures that physicians and patients actively participate in this process to promote the best possible outcomes from the patient perspective. We propose a practical framework for approaching these difficult decisions in cardio-oncology drawing upon our experience in clinical practice.

Highlights • Cancer cells can promote metabolic remodeling in the heart. • Metabolic changes provide opportunities for novel treatment strategies to prevent heart failure and monitor disease progression through new imaging techniques. • Translational biomarker and imaging studies are needed to further understand the impact of cancer cell biology on the heart., Central Illustration, Summary An important priority in the cardiovascular care of oncology patients is to reduce morbidity and mortality, and improve the quality of life in cancer survivors through cross-disciplinary efforts. The rate of survival in cancer patients has improved dramatically over the past decades. Nonetheless, survivors may be more likely to die from cardiovascular disease in the long term, secondary, not only to the potential toxicity of cancer therapeutics, but also to the biology of cancer. In this context, efforts from basic and translational studies are crucial to understanding the molecular mechanisms causal to cardiovascular disease in cancer patients and survivors, and identifying new therapeutic targets that may prevent and treat both diseases. This review aims to highlight our current understanding of the metabolic interaction between cancer and the heart, including potential therapeutic targets. An overview of imaging techniques that can support both research studies and clinical management is also provided. Finally, this review highlights opportunities and challenges that are necessary to advance our understanding of metabolism in the context of cardio-oncology.

Diagnosis of acute and late cardiotoxicity from cancer therapeutics has become increasingly important as the scope of cardio-oncology increases exponentially, both in terms of the number o...

In the summer of 2016, Dr. Vijay Rao of Franciscan Physician Network Indiana Heart Physicians was alarmed when he realized that three patients he was treating for congestive heart failure had a his...

Cardiovascular diseases (CVDs) and cancer, which are the leading causes of mortality globally, have been viewed as two distinct diseases. However, the fact that cancer and CVDs may coincide has been noted by cardiologists when taking care of patients with CVDs caused by cancer chemotherapy; this entity is designated cardio-oncology. More recently, patients with CVDs have also been found to have increased risk of cancers, termed reverse cardio-oncology. Although reverse cardio-oncology has been highlighted as an important disease state in recent studies, how the diseased heart affects cancer and the potential mediators of the crosstalk between CVDs and cancer are largely unknown. Here, we focus on the roles of cardiac-specific microRNA-208a (miR-208a) in cardiac and cancer biology and explore its essential roles in reverse cardio-oncology. Accumulating evidence has shown that within the heart, increased miR-208a promotes myocardial injury, arrhythmia, cardiac remodeling, and dysfunction and that secreted miR-208a in the circulation may have novel roles in promoting tumor proliferation and invasion. This review, therefore, provides insights into the novel roles of miR-208a in reverse cardio-oncology and strategies to prevent secondary carcinogenesis in patients with early- or late-stage heart failure.

The impact of radiotherapy on the heart has become an area of interest in recent years. Many different cardiac dose-volume constraints have been associated with cardiac toxicity and survival; however, no consistent constraint has been found. Many patients undergoing treatment for lung cancer have risk factors for cardiovascular disease or known cardiac comorbidities; however, there is little evidence on the effects of radiotherapy on the heart in these patients. We aim to provide a summary of the existing literature on cardiac toxicity of lung cancer radiotherapy, propose strategies to avoid and manage cardiac toxicity, and suggest avenues for future research.

Cardio-oncology is a unique subspecialty within oncology nursing that focuses on the assessment, identification, and management of cardiotoxicity induced or exacerbated by cancer treatment. Nurses are pivotal to the delivery of evidence-based assessment of and care for individuals who have preexisting cardiac conditions, as well as those for whom cardiac complications are related to the known and emerging toxicities of cancer treatment.

Successful chemotherapy in the treatment of hematological diseases is determined not only by the efficacy of antitumor drugs, but by the timely correction of adverse events, among which especially important are cardiac complications associated with both already existing cardiovascular diseases and cardiotoxicity of cytostatic drugs. Of particular importance is also a frequent lack of systemic cardiological examination of oncohematological patients. The urgency of this issue was the reason for creating cardio-oncological clinics focused on the closest co-operation of cardiologists with drug chemotherapy experts. Hematological patients are a particular group among chemotherapy recipients. Potential curability of an oncohematological disease and achieving durable MRD-negative remission raise the importance of irreversible or long-term cardiac complications directly affecting the quality of life and life expectancy. Besides, in some cases long-term or life-long administration of certain cardiotoxic antitumor drugs requires a particular cardiological follow-up. A broad variety of cardiotoxic effects of antitumor drugs and peculiarities of their clinical manifestations call for the exact algorithms of cardiological examination to be observed for the timely detection and treatment of cardiovascular complications. The now available st udies and interdisciplinary work of cardiologists and oncologists (oncohematologists) can yield such algorithms for examination and the approaches to prophylactic and treatment of cardiotoxicity as well as to rehabilitation of patients.

"Cardiac imaging is an essential tool in the field of cardio-oncology. Cardiovascular magnetic resonance (CMR) stands out for its accuracy, reproducibility, and ability to provide tissue characterization. These attributes are particularly helpful in screening and diagnosing cardiotoxicity, infiltrative disease, and inflammatory cardiac disease. The ability of CMR to detect subtle changes in cardiac function and tissue composition has made it a useful tool for understanding the pathophysiology of cardiotoxicity. Because of these unique features, CMR is gaining prominence in both the clinical and research aspects of cardio-oncology."

Graphical abstract

While the number of cancer patients is increasing with the arrival of the super-aging society, the age-adjusted mortality rate of cancer decreases due to medical advances, and the number of cancer survivors is growing rapidly. Cardiovascular disease (CVD) is one of the most important causes of death among cancer survivors. In recent years, the number of cancer patients with CVD risk factors has increased. Also, the emergence of new drugs has led to the emergence of a new condition called cancer treatment-related cardiovascular disease (CTRCD). Cardio-oncology (onco-cardiology) is a new multidisciplinary field with the common goal of completing cancer treatment and improving the prognosis of cancer patients and survivors, including the prevention, diagnosis, and treatment of CTRCD. Cardio-oncology rehabilitation (CORE) is a new concept that aims to reduce the risk of CVD and improve cardiopulmonary fitness in cancer survivors by providing exercise prescriptions and cardiac rehabilitation in addition to so-called cancer rehabilitation during and after cancer treatment. This review provides an overview of the theoretical background, feasibility, challenges, and opportunities of CORE, including a series of recent white papers and scientific statements released by the American Heart Association.

Background Atrial fibrillation (AF) is a common cardiovascular complication affecting patients with cancer, but management strategies are not well established. Objectives The purpose of this retrospective cohort study was to evaluate cross-sectional patterns of anticoagulation (AC) use in patients with cancer with AF or atrial flutter (AFL) on the basis of their risk for stroke and bleeding. Methods Patients with cancer and electrocardiograms showing AF or AFL performed at Moffitt Cancer Center in either the inpatient or outpatient setting were included in this retrospective analysis. We described percentages of AC prescription by stroke and bleeding risk, as determined by individual CHA2DS2-VASc and HAS-BLED scores, respectively. Multivariable logistic regression evaluated clinical variables independently associated with anticoagulant prescription. Results The prevalence of electrocardiography-documented AF or AFL was 4.8% (n = 472). The mean CHA2DS2-VASc score was 2.8 ± 1.4. Among patients with CHA2DS2-VASc scores ≥2 and HAS-BLED scores, Central Illustration

Resume La cardio-oncologie est une specialite de la cardiologie dont le but est de prevenir, identifier et prendre en charge les complications cardio-vasculaires liees aux traitements anticancereux. Parmi ces complications, l’apparition d’une dysfonction cardiaque voire d’une insuffisance cardiaque clinique est une des plus inquietantes. Elle va ainsi impacter la qualite de vie du patient et son pronostic, ceci expliquant l’importance de la prevention et de la detection. Cette mise au point a pour but de decrire les principaux traitements anticancereux pouvant entrainer une dysfonction cardiaque et de mettre l’accent sur le role central de l’echocardiographie dans le suivi. Nous avons egalement essaye de donner au lecteur une meilleure comprehension de la conduite a tenir en cas de dysfonction cardiaque.

Onkologische Therapien zeigen am Herz-Kreislauf-System eine Reihe unerwunschter Wirkungen. Insbesondere neuere Therapien sind diesbezuglich unzureichend verstanden, und klinische Daten fehlen bei der Interpretation neuer kardialer Komplikationen. Der vorliegende Beitrag bietet einen Uberblick uber die Mechanismen kardialer Nebenwirkungen bestimmter onkologischer Therapien. Die Ubersichtsarbeit bezieht sich im Wesentlichen auf Daten praklinischer Untersuchungen. Zahlreiche toxische Nebenwirkungen wurde bereits in praklinischen Modellen vorbeschrieben. Fur bestimmte Gruppen von Medikamenten (z. B. Anthrazykline, Tyrosinkinaseinhibitoren, Immun-Checkpoint-Inhibitoren) sind die zugrunde liegenden molekularen Mechanismen aber nicht abschliesend geklart. Basierend auf den bekannten molekularen Mechanismen von Kardiotoxizitat erschliesen sich moglicherweise verbesserte klinische Entscheidungswege. Ein besseres Verstandnis ermoglicht auch neue Einblicke in die Pathophysiologie kardialer Erkrankungen. Ziel wird sein, die Ergebnisse translational zu nutzen und in geeigneten kardioonkologischen Einheiten klinisch umzusetzen.

The Hellenic Heart Failure Association has undertaken the initiative to develop a national network of heart failure clinics (HFCs) and cardio‐oncology clinics (COCs). We conducted two questionnaire surveys among these clinics within 17 months and another during the coronavirus disease 2019 outbreak to assess adjustments of the developing network to the pandemic. Out of 68 HFCs comprising the network, 52 participated in the first survey and 55 in the second survey. The median number of patients assessed per week is 10. Changes in engaged personnel were encountered between the two surveys, along with increasing use of advanced echocardiographic techniques (23.1% in 2018 vs. 34.5% in 2020). Drawbacks were encountered, concerning magnetic resonance imaging and ergospirometry use (being available in 14.6% and 29% of HFCs, respectively), exercise rehabilitation programmes (applied only in 5.5%), and telemedicine applications (used in 16.4%). There are 13 COCs in the country with nine of them in the capital region; the median number of patients being assessed per week is 10. Platforms for virtual consultations and video calls are used in 38.5%. Coronavirus disease 2019 outbreak affected provision of HFC services dramatically as only 18.5% continued to function regularly, imposing hurdles that need to be addressed, at least temporarily, possibly by alternative methods of follow‐up such as remote consultation. The function of COCs, in contrast, seemed to be much less affected during the pandemic (77% of them continued to follow up their patients). This staged, survey‐based procedure may serve as a blueprint to help building national HFC/COC networks and provides the means to address changes during healthcare crises.

Cardiovascular diseases constitute one of the main aetiologies of mortality among patients with cancer. Population ageing and cancer survival rate improvements have resulted in the coexistence of cardiovascular diseases and malignancies in an increasing number of patients. With the diversity in treatments and the introduction of new drug lines, multiple mechanisms of cardiovascular injury have been recognized in these patients. Cardio‐oncology is an emerging entity introduced to provide a proper solution to the several challenges encountered in the management of patients with cancer and cardiac involvement. This review will assess the logical grounds for establishing a cardio‐oncology unit, describe the main objectives and the detailed responsibilities in such systems, and outline the target population. Furthermore, the importance of research and appropriate data collection will be highlighted. Lastly, the special considerations and modifications required for setting up such centres in the developing countries are discussed.

In the last decade, cardio-oncology has become a discipline on its own, with tremendous research going on to unravel the mechanisms underpinning different manifestations of cardiotoxicity caused by anticancer drugs. Although this domain is much broader than the effect of chemotherapy alone, a lot of questions about anthracycline-induced cardiotoxicity remain unknown. In this invited review, we provide insights in molecular mechanisms behind anthracycline-induced cardiotoxicity and put it in a clinical framework emphasizing the need for patients to understand, detect, and treat this detrimental condition. ispartof: Curr Heart Fail Rep vol:17 issue:6 pages:357-364 ispartof: location:United States status: published

Objective To summarize the proposed mechanisms behind hypertension and QT interval prolongation associated with use of targeted systemic cancer therapies and provide recommendations for monitoring or managing these toxicities. Summary The cardiotoxic effects of targeted systemic cancer therapies represents a new paradigm of cancer treatment associated cardiovascular adverse events. National guidelines regarding optimal monitoring and management strategies for hypertension and QT interval prolongation associated with use of these therapies are lacking. While the pathophysiological drivers of hypertension due to targeted systemic cancer therapies differ by class of targeted therapy, general management strategies do not. Routine blood pressure monitoring throughout the duration of therapy is recommended for all agents. Patients who experience hypertension often can be treated with the addition or modification of antihypertensive therapies. Uncontrolled hypertension despite optimal medical management may require dose modifications or discontinuation of the targeted systemic cancer therapy. Electrocardiogram monitoring is recommended for patients who receive targeted therapies that may prolong the QT interval. Minimizing or managing drug interactions with other QT prolonging medications is recommended in addition to ensuring adequate electrolyte supplementation. Dose modifications or discontinuation of the targeted systemic therapy may be necessary for patients who experience QT interval prolongation. Conclusions Appropriate cardiovascular monitoring and timely management of treatment-emergent toxicities can optimize therapy for patients receiving targeted systemic cancer therapies associated with a risk of drug-induced hypertension or QT interval prolongation.

The cardiovascular (CV) toxicity profiles of traditional cancer therapies such as anthracyclines and radiation therapy are familiar to many cardiologists. With the development and widespread use of additional cancer therapeutics, CV toxicities related to these agents are becoming more common. Cardiovascular specialists are often integrated into the care team for individuals with cancer and knowledge of the CV toxicities of cancer therapeutics has become essential. In this review, we provide a clinically focused summary of the current data regarding CV toxicities of common cancer therapies and identify potential management strategies for the CV specialist.

Remarkable progress in cancer treatments has resulted in improved long-term survival. However, cardiovascular complications related to these therapies may result in treatment interruptions and worse oncologic and cardiovascular outcomes. Early diagnosis and management of cancer therapy