Cardio-oncology最新文献

Background: Chronic ischemic heart disease (IHD) is a leading cause of cardiovascular-related mortality worldwide, with a growing burden among cancer patients due to shared risk factors and treatment-related Cardiotoxicity. However, nationwide trends and disparities in IHD-related mortality among cancer patients remain unexplored.

Methodology: This study utilized CDC WONDER mortality data from 1999 to 2020, identifying U.S. adults (≥ 25 years) with cancer (ICD-10: C00-D48) who died from chronic IHD (ICD-10: I25) as the underlying cause. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated and stratified by gender, age, race, geographic region, and urbanization level.

Results: Between 1999 and 2020, there were 246,664 Chronic IHD-related deaths among adult cancer patients. The AAMR declined significantly from 8.44 per 100,000 in 1999 to 3.71 in 2020. A steady decline occurred from 1999 to 2018 (APC: -3.85%; 95% CI: -4.01 to -3.72), followed by a slight increase from 2018 to 2020 (APC: 2.92%; 95% CI: 0.33 to 4.70). Men had higher AAMRs than women (8.16 vs. 3.25). The highest CMR were observed in older adults (24.19), with significantly lower rates in middle-aged (1.26) and young adults (0.04). Racial disparities revealed the highest AAMRs in non-Hispanic Black individuals (5.64), followed by non-Hispanic Whites (5.37), NH American Indian (3.59), Hispanics (3.28), and NH Asians (2.7). Geographic trends showed that the Northeast had the highest AAMRs (6.88), while urban areas had slightly higher mortality than rural areas (5.23 vs. 5.06).

Conclusions: This nationwide analysis highlights a significant decline in chronic IHD-related mortality among cancer patients, with persistent disparities by gender, age, race, and geographic location. The recent rise in AAMRs after 2018 suggests emerging risk factors that warrant further investigation. Addressing these disparities through targeted cardiovascular risk management in cancer patients is crucial to improving long-term outcomes.

Background: Racial disparities in all-cause mortality after breast cancer (BC) have been documented. While elevated risk of BC mortality experienced by Black women is clear, it is unclear the relative contribution of cardiovascular disease (CVD) mortality to the survival disparity in Black women.

Methods: This analysis from the Women's Health Initiative (WHI) included 8,410 women diagnosed with invasive BC during follow-up. Cardiovascular (CV) events were defined as adjudicated myocardial infarction, heart failure, or stroke. Cause of death was determined through adjudication by medical chart review, ICD codes, death certificate, and/or autopsy report. 10-year cumulative incidence rates were calculated for CV events, CVD mortality, and BC mortality, stratified by race. Sub-distribution hazards ratios (sHR) were calculated using Fine and Gray models to account for competing risks.

Results: In BC survivors (mean age = 70.9 years, median follow-up = 15.1 years), 8.5% self-reported as Black. Compared to White women, Black women had higher 10-year cumulative incidence of non-fatal CV events (10.9% vs. 8.2%, P = 0.001) and BC mortality (15.3% vs. 11.5%, P = 0.039). In contrast, White women had higher 10-year incidence of CVD mortality (7.2% vs. 10.1%, P = 0.001). BC mortality in Black women represented a higher proportion of death (35% vs. 20%), which was not true for White women.

Conclusion: Our study reinforces prior findings that racial disparities are experienced by Black women with BC. This may be in large part driven by BC mortality. However, if improvements in BC mortality are made to reduce this gap, disparities in CVD mortality may become more prominent due to racial disparities in CV events.

Introduction: This study aimed to evaluate the efficacy of the mean heart dose (MHD) as a predictor of radiation exposure to cardiac substructures and its association with markers of subclinical cardiotoxicity in breast cancer (BC) patients undergoing radiotherapy (RT). Although MHD provides an overall estimate of cardiac exposure, it does not capture the heterogeneous dose distribution across critical cardiac substructures.

Materials and methods: In an ambispective study design, dosimetric parameters, including MHD and dose-volume metrics for the left anterior descending artery (LAD), left circumflex artery (LCx), and left main coronary artery (LMCA), were analyzed in a cohort of BC patients receiving adjuvant RT. Early cardiotoxicity markers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction (EF), and the Tei index, were evaluated. The relationship between MHD and radiation doses to specific cardiac substructures, as well as their association with cardiac biomarker levels, was assessed.

Results: Among 104 patients, the overall MHD was 6.4 ± 5.4 Gy. Left-sided BC patients received a significantly higher MHD of 10.5 ± 4.37 Gy. The LAD mean dose was 16.12 ± 15.19 Gy for the entire cohort, increasing to 30.17 ± 5.74 Gy in left-sided cases. Patients with higher MHDs were more likely to receive elevated doses to the LMCA and LCx; however, a notable discrepancy was observed in LAD dose correlation. Regression analysis showed that MHD explained only 9.4% of the variance in LAD mean dose compared to 65% for LMCA. Receiver operating characteristic (ROC) analysis identified heart Dmax (43.12 Gy), heart V25 (13%), and LAD mean dose (28.92 Gy) as strong predictors of subclinical cardiotoxicity, whereas MHD was not.

Conclusion: Our findings confirm that MHD is an inadequate surrogate for predicting the heterogeneous dose distribution among cardiac substructures. Elevated NT-proBNP levels and reduced EF were significantly associated with higher substructure doses, highlighting the need for individualized, substructure-specific dose constraints in RT planning. These findings support the use of advanced cardiac-sparing techniques such as deep inspiration breath-hold (DIBH), intensity-modulated radiotherapy (IMRT), and proton therapy.

Background: Cancer survivors (CSs) are at increased risk of atrial fibrillation (AF), potentially due to cancer-related inflammation and treatment effects. While inflammation has been implicated in both cancer and AF, the association between C-reactive protein (CRP) and AF risk in CSs remains unclear.

Methods: We analyzed data from 19,677 UK Biobank participants (mean age 60; 34.2% male) with a prior cancer diagnosis. Incident AF was evaluated using competing-risk Cox proportional hazards models, adjusting for sociodemographic, lifestyle, and clinical factors.

Results: Over a median follow-up of 10.4 years, 836 CSs (4.2%) developed AF. Competing risk analysis revealed that the significant association between elevated CRP (> 2 mg/L) and AF risk in CSs, observed in models adjusted for sociodemographic and clinical factors (HR 1.21, 95% CI 1.06-1.37; P = 0.005), progressively attenuated with further adjustment for lifestyle factors (HR 1.14, 95% CI 0.99-1.31; P = 0.076). Despite losing statistical significance in the fully adjusted model, a consistent, suggestive trend was observed. This association was particularly pronounced in individuals not receiving radiotherapy.

Conclusions: Our findings suggest that systemic inflammation is associated with an increased risk of AF among CSs, particularly in individuals without a history of radiotherapy. Further studies are needed to explore underlying mechanisms and therapeutic implications.

Background: Anthracycline-induced cardiotoxicity (CTX) requires close monitoring in lymphoma patients. Increased myocardial uptake of fluorine-18-fluorodeoxyglucose (18F-FDG) via positron emission tomography combined with computed tomography (PET/CT) may reflect early metabolic alterations and serve as a potential marker for CTX.

Objectives: To evaluate changes in cardiac metabolism, myocardial strain, and troponin levels during anthracycline-based chemotherapy.

Methods: This prospective multicenter study included 55 adult lymphoma patients receiving anthracycline therapy. Echocardiography, high-sensitivity troponin, and cardiac 18F-FDG PET/CT were performed at baseline, mid-therapy, and posttreatment. CTX was defined as a ≥ 15% reduction in global longitudinal strain (GLS) from baseline.

Results: The mean age was 42 ± 16.7 years; 60% were female. Subclinical CTX occurred in 34% of patients, with a GLS decline observed after 3 months of follow-up, despite preserved left ventricular ejection fraction (LVEF). CTX was associated with older age, hypertension, diabetes, and dyslipidemia. Troponin levels were elevated in 33% but did not differ between the CTX and non-CTX groups. Myocardial 18F-FDG uptake increased in 49.1% of patients (≥ 30% standardized uptake value increase), without correlation with GLS or LVEF changes.

Conclusions: GLS can detect early myocardial changes in lymphoma patients treated with anthracyclines, whereas increased 18F-FDG uptake on PET/CT did not correlate with ventricular dysfunction. The clinical significance of myocardial metabolic upregulation requires further investigation.

Background: Cardiotoxicity remains a critical barrier to effective cancer treatment, contributing significantly to morbidity and mortality in cancer survivors. Recent advancements (2020-2025) highlight artificial intelligence (AI) as a transformative tool in cardio-oncology, enhancing cardiotoxicity detection, personalized risk assessment, and patient management. Despite rapid technological progress, significant gaps remain in AI integration across different healthcare settings globally.

Methods: This narrative review systematically synthesizes literature published between 2020 and 2025, evaluating key applications of AI in cardio-oncology, including imaging modalities, predictive modeling, wearable technology, and clinical decision-support systems. Comparative analyses between high-income countries (HICs) and low-to-middle-income countries (LMICs), with an emphasis on the Middle East, were performed to illustrate global disparities and unique regional challenges.

Results: AI-enabled imaging technologies, particularly echocardiography and cardiac MRI, significantly improved the early detection and management of cardiotoxicity. Predictive algorithms integrating multimodal data demonstrated superior risk stratification accuracy over traditional methods. Wearable technologies combined with AI enabled real-time cardiac monitoring, demonstrating feasibility in diverse resource settings. Nonetheless, adoption barriers such as dataset biases, inadequate regulatory frameworks, prohibitive costs, ethical dilemmas, and limited digital infrastructure persist, disproportionately affecting LMICs.

Conclusion: To harness the full potential of AI in cardio-oncology, strategic investments in collaborative international research, standardized regulatory frameworks, educational initiatives, and infrastructural support are urgently needed. Future research should prioritize equitable, inclusive AI solutions, validated through prospective trials and adapted specifically to underserved populations.

Objectives: Primary cardiac sarcomas (PCSs) are uncommon malignant tumors with a poor prognosis. This study aims to present the clinical characteristics and treatment outcomes for PCS observed in our centers.

Method: We retrospectively gathered records of patients diagnosed with PCS at Peking University Cancer Hospital and Zhejiang Cancer Hospital between 2016 and 2023. Clinicopathological data, treatments, and outcomes were included in the analysis.

Result: Between January 2016 and October 2023, a total of 26 patients with primary cardiac sarcoma were included in this study, with a majority being female (57.7%). The median age of the patients was 38.5 years, ranging from 15 to 82 years. The median overall survival (OS) for all patients was 18.7 months (95% CI: 16.2-25.4). Patients with normal baseline LDH levels had a significantly longer median OS of 25.4 months compared to 12.9 months for those with elevated LDH levels (p < 0.01). The median OS for patients who underwent R0 resection was 23.7 months, while it was 16.9 months for those who underwent R1/R2 resection, and 11.6 months for those who did not undergo surgery. Patients who received anthracycline-based chemotherapy seem to have better survival outcomes compared to those who received paclitaxel-based chemotherapy (mOS for chemotherapy 11.3 vs. 8.97 months, p = 0.25), but there was no statistical difference. First-line treatment with antiangiogenic agents or immunotherapy may enhance survival, with statistical significance observed.

Conclusion: PCS presents a complex management challenge. Complete surgical resection remains the primary treatment option when feasible. Systemic treatment options, including chemotherapy, targeted therapy, and immunotherapy, may also improve survival outcomes.

Background: CPX-351, a dual-drug liposomal encapsulation of daunorubicin and cytarabine in a synergistic 1:5 molar ratio, has demonstrated significantly improved overall survival in acute myeloid leukemia (AML) compared with 7 + 3, but its impact on cardiac function remains unclear. In a post hoc analysis of the pivotal clinical trial, we sought to determine the relative cardiotoxicity of CPX-351 vs. 7 + 3 in high-risk AML.

Methods: We evaluated cardiotoxicity in 102 patients with AML (CPX-351, n = 57; 7 + 3, n = 45) who had normal baseline left ventricular ejection fraction (LVEF) ≥ 53% and at least one post-baseline echocardiographic assessment. Cardiotoxicity was assessed through reported cardiac adverse events (AEs) and core lab assessment of echocardiograph changes in LVEF and/or left ventricular global longitudinal strain (GLS).

Results: A clinically significant change in LVEF (absolute change from baseline > 10% and LVEF <53%) and GLS (relative change from baseline > 12% and GLS < 18%) was less common with CPX-351 vs. 7 + 3 at follow-up 1 and/or 2 (8.8% vs. 20.0% and 21.1% vs. 44.4%, respectively). No CPX‑351-treated patients evaluated at final follow-up (follow-up 2) had decreased LVEF < 53% at follow-up 2, compared to 17.8% of 7 + 3-treated patients. The frequency of reported cardiac AEs was similar with CPX-351 (40.4%) and 7 + 3 (42.2%); most frequent were tachycardia in CPX-351-treated patients (CPX-351, 21.1%; 7 + 3, 8.9%) and atrial fibrillation/flutter in 7 + 3-treated patients (CPX-351, 7.0%; 7 + 3, 11.1%).  CONCLUSION: In addition to improving overall survival as demonstrated in the pivotal trial, CPX-351 may also be associated with less cardiotoxicity than 7 + 3 in high-risk AML patients.

Background: Cardiac involvement in diffuse large B-cell lymphoma (DLBCL) is rare but often complicated by life-threatening arrhythmias, conduction disturbances, and heart failure. Electrocardiography (ECG) is essential for early recognition and guiding intervention.

Objectives: To characterize ECG manifestations of cardiac-involved DLBCL and evaluate strategies for managing associated cardiac complications.

Methods: This study is a retrospective institutional case series conducted at MacKay Memorial Hospital from 2010 to 2025. We reviewed five patients with histologically confirmed primary or secondary cardiac DLBCL. Data on tumor location, ECG and echocardiographic findings, cardioprotective and anti-arrhythmic therapy, chemotherapy regimens, and outcomes were analyzed to correlate electrical abnormalities with anatomical involvement and therapeutic response.

Results: ECG patterns varied according to tumor distribution. Right atrial involvement was often associated with atrial tachycardia or atrial fibrillation. Pericardial infiltration produced low-voltage QRS complexes and electrical alternans in cases of massive effusion, whereas minimal effusion preserved normal sinus rhythm. Myocardial infiltration appeared to increase the risk of ventricular tachycardia and high-grade atrioventricular block, which is supported by the previous research about the reentry circuits at tumor-myocardium interfaces. Chemotherapy remains the principal therapeutic approach for cardiac DLBCL; however, our limited observations suggest that integrating anti-arrhythmic and cardioprotective therapy may improve chemotherapy tolerance. Successful arrhythmia control frequently correlated with improved clinical outcomes. However, the optimal use of anthracycline-based regimens in cardiac DLBCL remains uncertain and warrants further investigation.

Conclusions: Our findings highlight the importance of early recognition and multidisciplinary management for cardiac complications in the patients with cardiac-involved DLBCL. Cardioprotective strategies, anti-arrhythmic management, and careful chemotherapy selection are crucial to balance oncologic efficacy with cardiovascular safety.

Immune checkpoint inhibitors (ICIs) have significantly advanced cancer therapy. However, these therapies can disrupt immune self-tolerance, leading to immune-related adverse events, among which immune checkpoint inhibitor-related myocarditis (ICIrM) is associated with the highest mortality rates. Clinical presentation of ICIrM varies widely, ranging from asymptomatic cardiac biomarker elevation to fulminant heart failure. As such, uniform treatment guidelines may not be appropriate, and a personalized approach is essential. There is no universal consensus on routine screening; however, baseline ECG and echocardiography are recommended by most cardio-oncology guidelines. Serial cardiac biomarker monitoring may aid in early detection and intervention. Both cardiac troponin T and cardiac troponin I are sensitive for the diagnosis of ICIrM and prognosis of increased risk of major adverse cardiovascular events. Two diagnostic frameworks for ICIrM help clinicians in establishing diagnosis. Echocardiographic global longitudinal strain measurement provides a more sensitive risk assessment than traditional measures like ejection fraction. Cardiac MRI plays a critical role, offering high diagnostic accuracy. Endomyocardial biopsy confirms ICIrM and provides both diagnostic and prognostic information based on the presence or absence of myocyte necrosis. For confirmed ICIrM, corticosteroids remain the cornerstone of therapy, with high-dose regimens shown to reduce major adverse cardiovascular events. In steroid-refractory or severe cases, adjunctive immunomodulators such as mycophenolate mofetil, janus kinase inhibitors, and notably abatacept are utilized, although evidence is largely case-based. Abatacept, a CTLA-4 fusion protein, is the only drug under investigation in a randomized trial as a targeted therapy for ICIrM. In conclusion, ICIrM represents a diagnostic and therapeutic challenge due to its rarity, heterogeneous presentation, and the limitations of current tools. By describing the management of three illustrative real-life cases, this article aims to provide a framework for individualized management of ICIrM in adults, integrating current guidelines, literature, and clinical experience. Continued research and prospective trials are critical to refine diagnostic algorithms and improve patient outcomes.