Cardiol Clin
· 2025 Feb · PMID 39551565
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Full text
Diagnosis and treatment of cardiac amyloidosis have rapidly evolved over the past decade by harnessing mechanisms of disease pathogenesis. Cardiac amyloidosis is caused by myocardial deposition of fibrils formed by misfo...Diagnosis and treatment of cardiac amyloidosis have rapidly evolved over the past decade by harnessing mechanisms of disease pathogenesis. Cardiac amyloidosis is caused by myocardial deposition of fibrils formed by misfolded proteins, namely transthyretin (ATTR) and immunoglobulin light chains (AL). Advances in noninvasive imaging have revolutionized diagnosis of ATTR cardiomyopathy (CM). Novel treatments for ATTR-CM utilize a range of therapeutic techniques, including protein stabilizers, interfering RNA, gene editing, and monoclonal antibodies. AL-CM, primarily driven by plasma cell dyscrasias, requires treatment with chemotherapy and consideration for autologous stem cell transplant. These incredible advances aim to improve patient outcomes in cardiac amyloidosis.
Cardiovascular disease is common in patients with prostate cancer and is an important cause of death. Cardiovascular risk factors are frequent in this population and are often not addressed to thresholds recommended by c...Cardiovascular disease is common in patients with prostate cancer and is an important cause of death. Cardiovascular risk factors are frequent in this population and are often not addressed to thresholds recommended by cardiovascular practice guidelines. Androgen deprivation therapy (ADT) reduces muscle strength and increases adiposity, thereby increasing the risk of diabetes and hypertension, although its relationship with adverse cardiovascular events requires confirmation. Androgen receptor signaling inhibitors and CYP17A1 inhibitors may confer incremental risks of hypertension and cardiovascular events to ADT. Lower cardiovascular risk with gonadotropin-releasing hormone antagonists as compared with agonists requires prespecified randomized clinical trial confirmation.
Improved screening and treatment have increased breast cancer survival rates, with over 7.8 million women surviving 5 years post-diagnosis globally. However, survivors face heightened cardiovascular morbidity and mortali...Improved screening and treatment have increased breast cancer survival rates, with over 7.8 million women surviving 5 years post-diagnosis globally. However, survivors face heightened cardiovascular morbidity and mortality due to cancer treatment and patient related risk factors. Cardio-oncology has emerged as a discipline to manage cardiovascular health in patients throughout and following cancer treatment. This review focuses on strategies to optimize cardiovascular health in breast cancer survivors, aligning with ASCO's survivorship principles. Key strategies include risk stratification, primary prevention, lifestyle interventions, pharmacologic management, appropriate cardiovascular monitoring, and tailored exercise programs. Effective cardio-oncology care hinges on collaboration between specialists and patients, underscoring the significance of shared-care models and telemedicine options in survivorship management.
Patients with cancer are at increased risk of ischemic heart disease (IHD). The increased risk of IHD in these patients is due to the interaction of shared risk factors, cancer type and stage, and immuno/chemotherapy and...Patients with cancer are at increased risk of ischemic heart disease (IHD). The increased risk of IHD in these patients is due to the interaction of shared risk factors, cancer type and stage, and immuno/chemotherapy and radiotherapy regimens. Management of IHD in cancer patients is challenging, due to atypical presentation, increased thrombotic and bleeding risk, and worse outcomes compared to patients without cancer. In this review, we will discuss the trends, outcomes, epidemiology and challenges in the diagnosis and treatment of IHD among cancer patients.
Cardiovascular disease and cancer are the leading cause of mortality in the United States. In 2021, there were 695,547 and 605,213 deaths due to heart disease and cancer, respectively. With novel oncologic and cardiac th...Cardiovascular disease and cancer are the leading cause of mortality in the United States. In 2021, there were 695,547 and 605,213 deaths due to heart disease and cancer, respectively. With novel oncologic and cardiac therapies, survival has improved leading to increased life-expectancy albeit with chronic illness burden. Arrhythmia management in patients with cancer, whether active or in remission, can be quite challenging. In this review, we will discuss high-risk oncological therapies, prevention, and management of Atrial fibrillation, Ventricular Arrhythmias, and Bradyarrhythmias.
Hypertension (HTN) has been found to be the most common comorbidity in patients with cancer. In addition to increased prevalence of baseline HTN, patients with cancer may be at increased risk of HTN as a short-term or lo...Hypertension (HTN) has been found to be the most common comorbidity in patients with cancer. In addition to increased prevalence of baseline HTN, patients with cancer may be at increased risk of HTN as a short-term or long-term adverse event from cancer therapy. Different classes of cancer therapies have been implicated in the development of HTN, including inhibitors of vascular endothelial growth factor (VEGF), Bruton tyrosine kinase inhibitors, proteasome inhibitors, androgen deprivation therapy, and others. While some of these drugs may lead to increases in blood pressure through on-target effects (eg, with VEGF inhibition), others may be associated with HTN from off-target mechanisms that are not always well understood.
Adults with congenital heart disease make up most patients with congenital heart disease vastly surpassing the pediatric patients largely because of significant improvements in the medical, interventional, and surgical a...Adults with congenital heart disease make up most patients with congenital heart disease vastly surpassing the pediatric patients largely because of significant improvements in the medical, interventional, and surgical approaches. An increasing body of evidence highlights the impact of noncardiac morbidity and mortality in these patients. Malignancy is a known major cause of death in adult patients with congenital heart disease. The causes are multifactorial, including genetics, radiation, delayed age-appropriate screening, anatomy variations, and thymectomy. This article provides an overview of the specific risk factors and how health care providers and patient education can mitigate some of these risk factors.
The organization of a cardio-oncology clinic and overall program is designed to provide comprehensive cardiovascular care to patients who are at risk of or have developed cardiovascular sequelae during or following cance...The organization of a cardio-oncology clinic and overall program is designed to provide comprehensive cardiovascular care to patients who are at risk of or have developed cardiovascular sequelae during or following cancer treatments. In this article, we summarize the core components of a contemporary cardio-oncology program, including its core members (cardiologists, oncologists, clinical pharmacists, advanced practice providers, nurses, and coordinators), key services (risk assessment, treatment planning, cardiac imaging, intervention, and management), and practical integration within the health care system.
Cardio-oncology is an emerging multidisciplinary field intended to mitigate and manage cardiovascular side effects and risks associated with cancer therapies. Clinician awareness of drug interaction management among canc...Cardio-oncology is an emerging multidisciplinary field intended to mitigate and manage cardiovascular side effects and risks associated with cancer therapies. Clinician awareness of drug interaction management among cancer treatments, cardiovascular medications, and supportive care agents is important for optimizing efficacy and safety. Historically, chemotherapies have been associated with pharmacodynamic interactions with few, but important, pharmacokinetic interactions. The advent of oral targeted inhibitors has introduced more complex pharmacokinetic interactions, especially via cytochrome P450 pathways. Given the accelerated development of oncology therapies, clinicians need to be familiar with reviewing multiple sources for interaction information as well as adjusting and monitoring regimens when contending with drug interaction challenges.
Immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy have revolutionized cancer treatment but can cause life-threatening cardiovascular toxicities through immune-related adverse events. Myocarditis i...Immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy have revolutionized cancer treatment but can cause life-threatening cardiovascular toxicities through immune-related adverse events. Myocarditis is the most common and potentially fatal toxicity with immune checkpoint inhibitors. T-cell therapies can potentially lead to cytokine release syndrome. Diagnosis of ICI-myocarditis requires a multimodal approach, including biomarkers, imaging, and endomyocardial biopsy, while CRS is characterized by a clinical syndrome resembling distributive shock. Management involves discontinuing the offending therapy, immunosuppression with corticosteroids for ICI-myocarditis, and interleukin-6 antagonists for CRS. Collaboration between oncologists and cardiologists is crucial for early recognition and prompt treatment.
Raddatz MA, Pershad Y, Parker AC
… +1 more, Bick AG
Cardiol Clin
· 2025 Feb · PMID 39551555
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Full text
Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related phenomenon in which somatic mutations lead to clonal expansion of hematopoietic stem cells without the development of hematologic abnormalities. A...Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related phenomenon in which somatic mutations lead to clonal expansion of hematopoietic stem cells without the development of hematologic abnormalities. A growing body of literature demonstrates an association between CHIP and cardiovascular disease. This pathophysiology demonstrates a novel connection between global inflammation and cardiovascular morbidity. While there is limited consensus addressing the cardiovascular care of these patients, risk factor optimization and disease surveillance are advisable. Investigation into possible therapies is ongoing and provides promise for the treatment of inflammation contributing to cardiovascular disease in patients with and without CHIP.
Radiation therapy is a critical component in managing many malignancies by improving local control and survival. The benefits of radiation may come at the expense of unintended radiation injury to the surrounding normal...Radiation therapy is a critical component in managing many malignancies by improving local control and survival. The benefits of radiation may come at the expense of unintended radiation injury to the surrounding normal tissues, with the heart being one of the most affected organs in thoracic radiation treatments. As cancer survivors live longer, radiation-induced cardiotoxicity (RICT) is now increasingly recognized. In this review, we highlight the spectrum and pathophysiology of RICT. We summarize contemporary recommendations for risk stratification, screening, prevention, and management of RICT. We briefly highlight novel applications for radiation to treat some cardiac conditions such as resistant arrhythmias.
Anthracycline chemotherapy is associated with cardiotoxicity, predominantly manifesting as left ventricular systolic dysfunction within the first year of treatment. Early detection is possible through biomarkers and card...Anthracycline chemotherapy is associated with cardiotoxicity, predominantly manifesting as left ventricular systolic dysfunction within the first year of treatment. Early detection is possible through biomarkers and cardiovascular imaging before clinical symptoms develop. Comprehensive cardiovascular risk assessment is essential for all patients prior to anthracycline therapy to stratify their risk of cardiotoxicity. Preventive measures, including cardiovascular risk optimization, as well as anthracycline dose adjustments, the use of liposomal anthracyclines, and dexrazoxane in high-risk patients, are crucial to mitigate the risk of cardiotoxicity. Long-term follow-up and cardiovascular risk optimization are critical for cancer survivors to optimize cardiovascular outcomes.
This review goes beyond traditional approaches in cardio-oncology, highlighting often-neglected factors impacting patient care. Social determinants, environment, health care access, and gut microbiome significantly influ...This review goes beyond traditional approaches in cardio-oncology, highlighting often-neglected factors impacting patient care. Social determinants, environment, health care access, and gut microbiome significantly influence patient outcomes. Powerful tools like multi-omics and wearable technologies offer deeper insights into real-world experiences. The future lies in integrating these advancements with established practices to achieve precision cardio-oncology care. By crafting tailored therapies and continuously updating comprehensive management plans based on real-time data, we can unlock the full potential of personalized care for all patients.
Patent foramen ovale (PFO) may be an underlying factor in the pathogenesis of migraine, vasospastic angina, and Takotsubo cardiomyopathy. This article reviews the role that PFO may play in each of these clinical entities...Patent foramen ovale (PFO) may be an underlying factor in the pathogenesis of migraine, vasospastic angina, and Takotsubo cardiomyopathy. This article reviews the role that PFO may play in each of these clinical entities and discusses potential interventions. It also proposes a novel clinical syndrome wherein PFO may be the unifying link among migraine, coronary vasospasm, and Takotsubo cardiomyopathy in predisposed individuals.
The patent foramen ovale (PFO) jeopardizes health and its problems may be major. A nineteenth century case report was the first description of a PFO as cause of death. To the present day, the PFO does not get the deserve...The patent foramen ovale (PFO) jeopardizes health and its problems may be major. A nineteenth century case report was the first description of a PFO as cause of death. To the present day, the PFO does not get the deserved attention. A PFO is found in roughly 25% of people, its particularly dangerous forms in about 5%. Those have a high enough risk for harm by the PFO to justify screening for it for closure, even as primary prevention. After all, closing a PFO is as simple as fixing a tooth and can be considered a mechanical vaccination.
Percutaneous PFO closure is a well-established medical procedure to mitigate paradoxic embolism and the future risk of stroke in a well-selected patient clientele. When it comes to procedural guidance during PFO closure,...Percutaneous PFO closure is a well-established medical procedure to mitigate paradoxic embolism and the future risk of stroke in a well-selected patient clientele. When it comes to procedural guidance during PFO closure, various modalities exist, each with its own advantages and disadvantages. Guidance by transesophageal echocardiography (in combination with fluoroscopy) offers high-resolution 2D/3D imaging, however, it requires the presence of a peri-interventional imager and conscious sedation (or endotracheal intubation). Intracardiac echocardiography and fluoroscopy guidance can be performed by a single operator and omits the need for conscious sedation (or endotracheal intubation).
Presence of patent foramen ovale (PFO), particularly if high-grade, increases the risk of decompression illness (DCI) and its severe forms. In unprovoked or recurrent DCI, neurologic, cutaneous, or cardiopulmonary DCI, t...Presence of patent foramen ovale (PFO), particularly if high-grade, increases the risk of decompression illness (DCI) and its severe forms. In unprovoked or recurrent DCI, neurologic, cutaneous, or cardiopulmonary DCI, testing for PFO is indicated with bubble contrast echocardiography or transcranial Doppler using provocative maneuvers. In patients with PFO and history of DCI, evaluation by a cardiologist with expertise in diving medicine is recommended. Consideration should be given to PFO closure if cessation of diving or conservative diving cannot be achieved. Prospective studies evaluating long-term outcomes in patients who continue to dive after PFO closure are required.