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Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology.
- Source :
-
Wiener klinische Wochenschrift [Wien Klin Wochenschr] 2022 Sep; Vol. 134 (17-18), pp. 654-674. Date of Electronic Publication: 2022 May 04. - Publication Year :
- 2022
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Abstract
- Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients.<br /> (© 2022. The Author(s).)
- Subjects :
- Angiotensin-Converting Enzyme Inhibitors therapeutic use
Angiotensins pharmacology
Angiotensins therapeutic use
Austria
Biomarkers
Cardiotoxicity diagnosis
Cardiotoxicity drug therapy
Cardiotoxicity etiology
Female
Humans
Immune Checkpoint Inhibitors
Natriuretic Peptides pharmacology
Natriuretic Peptides therapeutic use
Stroke Volume
Troponin
Ventricular Function, Left
Antineoplastic Agents adverse effects
Breast Neoplasms
Cardiology
Heart Failure chemically induced
Heart Failure diagnosis
Heart Failure therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1613-7671
- Volume :
- 134
- Issue :
- 17-18
- Database :
- MEDLINE
- Journal :
- Wiener klinische Wochenschrift
- Publication Type :
- Academic Journal
- Accession number :
- 35507087
- Full Text :
- https://doi.org/10.1007/s00508-022-02031-0