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Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients
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Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 16835

Special Issue Editor

Dr. Pedro Moliner

E-Mail Website
Guest Editor
Cardio-Oncology Unit, Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
Interests: chronic heart failure; cardio-oncology; iron deficiency; biomarkers

Special Issue Information

Dear Colleagues,

In recent years, improvements in early diagnosis and treatments have greatly improved the prognosis of cancer patients. However, cancer patients are at high risk of developing cardiovascular complications, some of which due to the cancer treatments themselves. Cardio-oncology is a novel subspecialty focused on the diagnosis and treatment of cardiovascular disease in cancer patients, paying special attention to the cardiotoxicity of antitumor treatments.

This Special Issue aims to overview the current knowledge, latest evidence, and unresolved issues in the field of cardio-oncology. More specifically, the topics of interest include:

  • Role of biomarkers and cardiac imaging in early diagnosis of cardiotoxicity
  • Heart failure and cancer
  • Fluoropyrimidine-associated cardiotoxicity, i.e., 5-fluorourcil, capictabine
  • Cardiovascular complications of Bruton tyrosine kinase inhibitors such as ibrutinib
  • Cardiovascular complications of immune checkpoint inhibitors
  • Specific cardio-oncology conditions: carcinoid valve disease, AL amyloidosis, etc.

Dr. Pedro Moliner
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Cardio-oncology
  • cardiotoxicity
  • cancer
  • heart failure
  • ischemic heart disease
  • valvular heart disease
  • arrhythmia
  • cardiac imaging

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Published Papers (6 papers)

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Research

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9 pages, 501 KiB  
Article
Incremental Value of Myocardial Work over Global Longitudinal Strain in the Surveillance for Cancer-Treatment-Related Cardiac Dysfunction: A Case–Control Study
by Wojciech Kosmala, Tomoko Negishi, Paaladinesh Thavendiranathan, Martin Penicka, Jonathan De Blois, Klaus Murbræch, Sakiko Miyazaki, Mitra Shirazi, Ciro Santoro, Dragos Vinereanu, Goo-Yeong Cho, Krassimira Hristova, Bogdan A. Popescu, Koji Kurosawa, Masaki Izumo, Kazuaki Negishi, Monika Przewlocka-Kosmala and Thomas H. Marwick
J. Clin. Med. 2022, 11(4), 912; https://doi.org/10.3390/jcm11040912 - 9 Feb 2022
Cited by 12 | Viewed by 2155
Abstract
The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, could overcome this [...] Read more.
The load dependence of global longitudinal strain (GLS) means that changes in systolic blood pressure (BP) between visits may confound the diagnosis of cancer-treatment-related cardiac dysfunction (CTRCD). We sought to determine whether the estimation of myocardial work, which incorporates SBP, could overcome this limitation. In this case–control study, 44 asymptomatic patients at risk of CTRCD underwent echocardiography at baseline and after oncologic treatment. CTRCD was defined on the basis of the change in the ejection fraction. Those with CTRCD were divided into subsets with and without a follow-up SBP increment >20 mmHg (CTRCD+BP+ and CTRCD+BP−), and matched with patients without CTRCD (CTRCD−BP+ and CTRCD−BP−). The work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were assessed in addition to the GLS. The largest increases in the GWI and GCW at follow-up were found in CTRCD−BP+ patients. The CTRCD+BP− patients demonstrated significantly larger decreases in GWI and GCW than their CTRCD+BP+ and CTRCD−BP− peers. ROC analysis for the discrimination of LV functional changes in response to increased afterload in the absence of cardiotoxicity revealed higher AUCs for GCW (AUC = 0.97) and GWI (AUC = 0.93) than GLS (AUC = 0.73), GWW (AUC = 0.51), or GWE (AUC = 0.63, all p-values < 0.001). GCW (OR: 1.021; 95% CI: 1.001–1.042; p < 0.04) was the only feature independently associated with CTRCD−BP+. Myocardial work is superior to GLS in the serial assessments in patients receiving cardiotoxic chemotherapy. The impairment of GLS in the presence of an increase in GWI and GCW indicates the impact of elevated afterload on LV performance in the absence of actual myocardial impairment. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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14 pages, 2923 KiB  
Article
Evaluation of Risk Prediction Models to Identify Cancer Therapeutics Related Cardiac Dysfunction in Women with HER2+ Breast Cancer
by Sivisan Suntheralingam, Chun-Po Steve Fan, Oscar Calvillo-Argüelles, Husam Abdel-Qadir, Eitan Amir and Paaladinesh Thavendiranathan
J. Clin. Med. 2022, 11(3), 847; https://doi.org/10.3390/jcm11030847 - 5 Feb 2022
Cited by 9 | Viewed by 2975
Abstract
Cancer-therapeutics-related cardiac dysfunction (CTRCD) is an important concern in women receiving trastuzumab therapy for HER2+ breast cancer. However, the ability to assess CTRCD risk remains limited. In this retrospective cohort study, we apply three published risk prediction models (Ezaz et al., NSABP-31 cardiac [...] Read more.
Cancer-therapeutics-related cardiac dysfunction (CTRCD) is an important concern in women receiving trastuzumab therapy for HER2+ breast cancer. However, the ability to assess CTRCD risk remains limited. In this retrospective cohort study, we apply three published risk prediction models (Ezaz et al., NSABP-31 cardiac risk scores (CRS), and HFA-ICOS trastuzumab proforma) to 629 women (mean age 52.4 ± 10.9 years) with Stage I-III HER2+ breast cancer treated with trastuzumab ± anthracyclines to assess their performance to identify CTRCD during or immediately post treatment. Using these models, patients were classified into CTRCD risk categories according to the pre-treatment characteristics. With NSABP-31 CRS and HFA-ICOS proformas, patients in the highest risk category had a 1.7-to-2.4-fold higher relative risk of CTRCD than the low-risk category (p = 0.010 and 0.005, respectively). However, with all three risk models, those in the low-risk category had a high absolute risk of CTRCD (15.5–25.5%). The discrimination of the models for CTRCD (AUC 0.51–0.60) and their calibration was limited. NSAP-31 CRS and HFA-ICOS proformas can identify relative differences in CTRCD risk between patients, but when considering absolute risk, they are only able to identify the highest risk patients. There remains an ongoing need for accurate CTRCD risk prediction models in women with HER2+ breast cancer. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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13 pages, 1403 KiB  
Article
Thirty-Day Readmission Rates after Takotsubo Syndrome with or without Malignancy: A Nationwide Readmissions Database Analysis
by Sun-Joo Jang, Ilhwan Yeo, Chanel Jonas, Parag Goyal, Jim W. Cheung, Dmitriy N. Feldman, S. Andrew McCullough, Udhay Krishnan, David L. Narotsky, Harsimran S. Singh, Robert M. Minutello, Geoffrey Bergman, S. Chiu Wong and Luke K. Kim
J. Clin. Med. 2021, 10(16), 3701; https://doi.org/10.3390/jcm10163701 - 20 Aug 2021
Cited by 3 | Viewed by 1886
Abstract
The association between malignancy and readmission after Takotsubo syndrome (TTS) hospitalization has not been fully described. We sought to examine the rates, cause, and cost of 30-day readmissions of TTS, with or without malignancy, by utilizing Nationwide Readmissions Databases from 2010 to 2014. [...] Read more.
The association between malignancy and readmission after Takotsubo syndrome (TTS) hospitalization has not been fully described. We sought to examine the rates, cause, and cost of 30-day readmissions of TTS, with or without malignancy, by utilizing Nationwide Readmissions Databases from 2010 to 2014. We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy tended to be older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio (OR), 1.35; 95% confidence interval (CI), 1.18–1.56). Non-cardiac causes were the most common causes of readmission for TTS patients with malignancy versus without malignancy (75.5% vs. 68.1%, p < 0.001). The 30-day readmission rate due to recurrent TTS was very low in both groups (0.4% and 0.5%; p = 0.47). The total costs were higher by 25% (p < 0.001) in TTS patients with vs. without malignancy. In summary, among patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission and increased costs. These findings highlight the importance of optimized management for TTS patients with malignancy. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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Review

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19 pages, 10122 KiB  
Review
Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It
by Fabiana Lucà, Iris Parrini, Maurizio Giuseppe Abrignani, Carmelo Massimiliano Rao, Laura Piccioni, Stefania Angela Di Fusco, Roberto Ceravolo, Irma Bisceglia, Carmine Riccio, Sandro Gelsomino, Furio Colivicchi and Michele Massimo Gulizia
J. Clin. Med. 2022, 11(7), 1792; https://doi.org/10.3390/jcm11071792 - 24 Mar 2022
Cited by 13 | Viewed by 3218
Abstract
Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing [...] Read more.
Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. Nonetheless, cancer patients have generally not been evaluated in ACS trials, so that the treatment in these cases is still not fully known. We reviewed the current literature and discussed the best management for these very high-risk patients. The treatment strategy must be tailored based on the cancer type and stage, balancing thrombotic and bleeding risks. When the prognosis is longer than six months, especially if a clinical instability coexists, patients with ACS and cancer should be referred for percutaneous coronary intervention (PCI) as soon as possible. Moreover, an invasive strategy should be preferred in STEMI patients as well as in NSTEMI patients who are considered as high risk. On the contrary, in clinically stable NSTEMI patients, a conservative non-invasive strategy could be adopted, especially in cases of a poor life expectancy and/or of high risk of bleeding. Drug-Eluting-Stents (DES) should be the first choice if an invasive strategy is adopted. Conservative therapy could instead be considered in cancer patients with more stable CAD at an increased risk of major bleeding complications. However, the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended, but it should be as short as possible, whereas triple antithrombotic therapy is non-advised because it significantly increases the risk of bleeding. ACS management among cancer patients should be based on an accurate evaluation of the risk of thrombosis and bleeding. Future studies focused on choosing optimal strategies in tumor patients with ACS should be performed to treat this subset of patients better. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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16 pages, 296 KiB  
Review
The Role of Vasospasm and Microcirculatory Dysfunction in Fluoropyrimidine-Induced Ischemic Heart Disease
by Natalia Fabin, Maria Bergami, Edina Cenko, Raffaele Bugiardini and Olivia Manfrini
J. Clin. Med. 2022, 11(5), 1244; https://doi.org/10.3390/jcm11051244 - 25 Feb 2022
Cited by 7 | Viewed by 2765
Abstract
Cardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, [...] Read more.
Cardiovascular diseases and cancer are the leading cause of morbidity and mortality globally. Cardiotoxicity from chemotherapeutic agents results in substantial morbidity and mortality in cancer survivors and patients with active cancer. Cardiotoxicity induced by 5-fluorouracil (5-FU) has been well established, yet its incidence, mechanisms, and manifestation remain poorly defined. Ischemia secondary to coronary artery vasospasm is thought to be the most frequent cardiotoxic effect of 5-FU. The available evidence of 5-FU-induced epicardial coronary artery spasm and coronary microvascular dysfunction suggests that endothelial dysfunction or primary vascular smooth muscle dysfunction (an endothelial-independent mechanism) are the possible contributing factors to this form of cardiotoxicity. In patients with 5-FU-related coronary artery vasospasm, termination of chemotherapy and administration of nitrates or calcium channel blockers may improve ischemic symptoms. However, there are variable results after administration of nitrates or calcium channel blockers in patients treated with 5-FU presumed to have myocardial ischemia, suggesting mechanisms other than impaired vasodilatory response. Clinicians should investigate whether chest pain and ECG changes can reasonably be attributed to 5-FU-induced cardiotoxicity. More prospective data and clinical randomized trials are required to understand and mitigate potentially adverse outcomes from 5-FU-induced cardiotoxicity. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
8 pages, 584 KiB  
Review
The Potential Cardiotoxicity of Immune Checkpoint Inhibitors
by Inbar Nardi Agmon, Osnat Itzhaki Ben Zadok and Ran Kornowski
J. Clin. Med. 2022, 11(3), 865; https://doi.org/10.3390/jcm11030865 - 7 Feb 2022
Cited by 9 | Viewed by 2076
Abstract
The use of immune checkpoint inhibitors (ICIs) as a mono- or adjuvant oncologic treatment is rapidly expanding to most fields of cancer. Alongside their efficacy, ICIs carry the risk of immune-related adverse events (irAEs) arising from misguided immune-mediated response to normal tissues. In [...] Read more.
The use of immune checkpoint inhibitors (ICIs) as a mono- or adjuvant oncologic treatment is rapidly expanding to most fields of cancer. Alongside their efficacy, ICIs carry the risk of immune-related adverse events (irAEs) arising from misguided immune-mediated response to normal tissues. In the cardiovascular system, the cardiac toxicity of ICIs has been primarily related to the development of an acute, immune-mediated myocarditis; beyond this potentially fatal complication, evidence of an increased risk of cardiovascular events and accelerated atherosclerosis is emerging, as well as reports of other cardiovascular adverse events such as arrythmias, Takotsubo-like syndrome and vascular events. The absence of identified risk factors for cardiotoxic complications, specific monitoring strategies or diagnostic tests, pose challenges to the timely recognition and optimal management of such events. The rising numbers of patients being treated with ICIs make this potential cardiotoxic effect one of paramount importance for further investigation and understanding. This review will discuss the most recent data on different cardiotoxic effects of ICIs treatment. Full article
(This article belongs to the Special Issue Cardio-Oncology: Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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