Anthracyclines, Diastolic Dysfunction and the road to Heart Failure in Cancer survivors: An untold story

IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Progress in cardiovascular diseases Pub Date : 2024-09-01 DOI:10.1016/j.pcad.2024.07.002
Massimiliano Camilli , Péter Ferdinandy , Emanuela Salvatorelli , Pierantonio Menna , Giorgio Minotti
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Abstract

Many cardiovascular diseases are characterized by diastolic dysfunction, which associates with worse clinical outcomes like overall mortality and hospitalization for heart failure (HF). Diastolic dysfunction has also been suspected to represent an early manifestation of cardiotoxicity induced by cancer drugs, with most of the information deriving from patients treated with anthracyclines; however, the prognostic implications of diastolic dysfunction in the anthracycline-treated patient have remained poorly explored or neglected. Here the molecular, pathophysiologic and diagnostic aspects of anthracycline-related diastolic dysfunction are reviewed in the light of HF incidence and phenotype in cancer survivors. We describe that the trajectories of diastolic dysfunction toward HF are influenced by a constellation of patient- or treatment- related factors, such as comorbidities and exposure to other cardiotoxic drugs or treatments, but also by prospective novel opportunities to treat diastolic dysfunction. The importance of a research-oriented multidimensional approach to patient surveillance or treatment is discussed within the framework of what appears to be a distinct pathophysiologic entity that develops early during anthracycline treatment and gradually worsens over the years.

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蒽环类药物、舒张功能障碍和癌症幸存者的心力衰竭之路:一个不为人知的故事。
许多心血管疾病都以舒张功能障碍为特征,舒张功能障碍与总体死亡率和心力衰竭(HF)住院治疗等较差的临床结果有关。舒张功能障碍也被怀疑是癌症药物诱发心脏毒性的早期表现,其中大部分信息来自接受蒽环类药物治疗的患者;然而,舒张功能障碍对接受蒽环类药物治疗的患者预后的影响仍未得到充分探讨或被忽视。在此,我们根据癌症幸存者的高频发生率和表型,对蒽环类药物相关舒张功能障碍的分子、病理生理学和诊断方面进行了综述。我们描述了舒张功能障碍向心房颤动发展的轨迹受到一系列患者或治疗相关因素的影响,如合并症和接触其他心脏毒性药物或治疗,同时也受到治疗舒张功能障碍的前瞻性新机会的影响。以研究为导向的多维方法对患者进行监测或治疗的重要性将在蒽环类药物治疗期间早期出现并在数年后逐渐恶化的独特病理生理实体的框架内进行讨论。
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来源期刊
Progress in cardiovascular diseases
Progress in cardiovascular diseases 医学-心血管系统
CiteScore
10.90
自引率
6.60%
发文量
98
审稿时长
7 days
期刊介绍: Progress in Cardiovascular Diseases provides comprehensive coverage of a single topic related to heart and circulatory disorders in each issue. Some issues include special articles, definitive reviews that capture the state of the art in the management of particular clinical problems in cardiology.
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