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Canadian Journal of Cardiology

Prevention, Detection, and Management of Chemotherapy-Related Cardiac Dysfunction

  • Husam Abdel-Qadir
    Affiliations
    Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada
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  • Eitan Amir
    Affiliations
    Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Paaladinesh Thavendiranathan
    Correspondence
    Corresponding author: Dr Paaladinesh Thavendiranathan, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. Tel.: +1-416-340-5326; fax: +1-416-340-3640.
    Affiliations
    Division of Cardiology, Peter Munk Cardiac Centre and the Joint Division of Medical Imaging, Ted Rogers Program in Cardiotoxicity Prevention, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Published:January 30, 2016DOI:https://doi.org/10.1016/j.cjca.2016.01.028

      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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