Cardio-oncology: protecting the heart from curative breast cancer treatment

Gland Surgery
Jenica N Upshaw

Abstract

Patients with breast cancer have higher rates of cardiovascular disease than age-matched controls. Anthracyclines and trastuzumab increase the risk of heart failure (HF) and radiation increases the risk of ischemic heart disease, valvular disease and HF. Older age, low normal ejection fraction, history of coronary artery disease (CAD), cardiac risk factors, higher cumulative anthracycline exposure, combination anthracycline and trastuzumab and/or radiation all increase the risk of cardiac events post treatment. Clinical prediction models (CPMs) and/or genetic testing may be useful in guiding treatment decisions but further external validation is necessary. Screening for asymptomatic cardiotoxicity using echocardiography after completion of therapy is reasonable in patients receiving anthracyclines and/or radiation, especially in those with traditional cardiac risk factors such as hypertension, diabetes, hyperlipidemia, and obesity or with low normal baseline left ventricular ejection fraction (LVEF). Elevated cardiac troponins during anthracycline therapy and early reductions in myocardial deformation may predict subsequent reductions in LVEF but further research is needed to demonstrate clinical benefit to routine screening an...Continue Reading

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