Abstract
Cancer treatment-related cardiac dysfunction (CTRCD) occurs with many agents used
in the treatment of cancer. This is most relevant in patients receiving cancer treatment
with curative intent as opposed to those treated with a palliative intent where lifespan
is more likely to be limited by the cancer diagnosis. Clinicians need to be aware
of methods to prevent, detect, and manage CTRCD. This article frames an approach to
CTCRD based on the American College of Cardiology/American Heart Association stages
of heart failure (HF). In patients who are at risk for CTRCD (stage A HF), risk reduction
methods may be warranted, including management of cardiovascular risk factors, modification
of cancer treatment, and universal preventive therapy. Once cancer therapy begins,
it is prudent to detect and promptly treat myocardial dysfunction (stage B HF). This
can be achieved by careful monitoring during therapy using echocardiography, multigated
acquisition scans, or cardiac MRI. Subclinical myocardial systolic dysfunction (ie,
without a drop in ejection fraction) can be identified using either echocardiography
measured peak systolic global longitudinal strain or cardiac troponin I. At present,
there is insufficient evidence to institute preventive interventions based on changes
in these preclinical markers. Finally, in patients with stage C/D HF, management strategies
should follow existing guidelines. Advanced treatment including cardiac transplantation
and mechanical circulatory support may be considered in appropriate circumstances.
Résumé
De nombreux agents utilisés pour traiter le cancer entraînent une dysfonction cardiaque.
Les patients recevant un traitement curatif sont plus susceptibles de subir une telle
dysfonction puisque les patients traités de manière palliative voient généralement
leur espérance de vie limitée par la maladie. Les médecins doivent être au fait des
modalités de prévention, de dépistage et de prise en charge de la dysfonction cardiaque
liée au traitement du cancer. Cet article définit l’approche fondée sur la statification
de l’insuffisance cardiaque (IC) de l’American College of Cardiology et de l’American
Heart Association. Chez les patients à risque de présenter une dysfonction cardiaque
(IC de stade A), des mesures de réduction du risque cardiaque peuvent être justifiées,
notamment la prise en charge des facteurs de risque cardiovasculaire, la modification
du traitement anticancéreux et l’application de mesures préventives générales. Une
fois le traitement anticancéreux en cours, il convient de procéder au dépistage et
au traitement précoce de toute dysfonction myocardique (IC de stade B). Un dépistage
soigneux s’effectuera à l’aide des méthodes suivantes : échocardiographie, ventriculographie
isotopique à l’équilibre (MUGA) ou imagerie par résonance magnétique (IRM) cardiaque.
La dysfonction systolique myocardique infraclinique (c.-à-d. sans diminution de la
fraction d’éjection ventriculaire) pourra être diagnostiquée soit en mesurant, par
échocardiographie, la déformation longitudinale globale au pic systolique, soit par
un dosage du taux de troponine I cardiaque. Il n’existe toutefois pas, à l’heure actuelle,
suffisamment de données probantes pour établir des mesures préventives fondées sur
les variations des marqueurs précliniques susmentionnés. En ce qui a trait aux patients
atteints d’une IC de stade C et D, il faudra miser sur une prise en charge selon les
lignes directrices en vigueur. Dans certains cas, on pourra même envisager, le cas
échéant, une transplantation cardiaque ou le recours à un dispositif d’assistance
ventriculaire.
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Article info
Publication history
Published online: January 30, 2016
Accepted:
January 24,
2016
Received:
December 7,
2015
Footnotes
See page 897 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
