Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission

Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission

A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxic...

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Published in:Frontiers in cardiovascular medicine Vol. 8; p. 713694
Main Authors: Montisci, Andrea, Palmieri, Vittorio, Liu, Jennifer E, Vietri, Maria T, Cirri, Silvia, Donatelli, Francesco, Napoli, Claudio
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 03-09-2021
Subjects:
anthracycline
cancer
Cardiovascular Medicine
chemotherapy
heart failure
heart transplant
mechanical circulatory support
heart failure
chemotherapy toxicity
anthracycline
mechanical circulatory support
heart transplant
cancer
chemotherapy
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Abstract A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented.
AbstractList A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented.
Author Montisci, Andrea
Palmieri, Vittorio
Napoli, Claudio
Cirri, Silvia
Donatelli, Francesco
Vietri, Maria T
Liu, Jennifer E
AuthorAffiliation 1 Division of Cardiothoracic Intensive Care, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili , Brescia , Italy
5 Department of Anesthesia and Intensive Care, Istituto Clinico Sant'Ambrogio , Milan , Italy
8 Istituto di Ricovero e Cura a Carattere Scientifico - Synlab Diagnostica Nucleare (IRCCS SDN) , Naples , Italy
6 Department of Cardiac Surgery, University of Milan , Milan , Italy
4 Department of Precision Medicine, University of Campania “Luigi Vanvitelli” , Naples , Italy
2 Department of Cardiac Surgery and Transplantation, Ospedali dei Colli Monaldi-Cotugno-CTO , Naples , Italy
3 Department of Medicine/Cardiology Service, Memorial Sloan Kettering Cancer Center , New York, NY , United States
7 Clinical Department of Internal Medicine and Specialistics, University Department of Advanced Clinical and Surgical Sciences, University of Campania “Luigi Vanvitelli” , Naples , Italy
AuthorAffiliation_xml – name: 2 Department of Cardiac Surgery and Transplantation, Ospedali dei Colli Monaldi-Cotugno-CTO , Naples , Italy
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– name: 1 Division of Cardiothoracic Intensive Care, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili , Brescia , Italy
– name: 3 Department of Medicine/Cardiology Service, Memorial Sloan Kettering Cancer Center , New York, NY , United States
– name: 6 Department of Cardiac Surgery, University of Milan , Milan , Italy
– name: 4 Department of Precision Medicine, University of Campania “Luigi Vanvitelli” , Naples , Italy
– name: 7 Clinical Department of Internal Medicine and Specialistics, University Department of Advanced Clinical and Surgical Sciences, University of Campania “Luigi Vanvitelli” , Naples , Italy
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  surname: Napoli
  fullname: Napoli, Claudio
  organization: Istituto di Ricovero e Cura a Carattere Scientifico - Synlab Diagnostica Nucleare (IRCCS SDN), Naples, Italy
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ContentType Journal Article
Copyright Copyright © 2021 Montisci, Palmieri, Liu, Vietri, Cirri, Donatelli and Napoli.
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Keywords heart failure
chemotherapy toxicity
anthracycline
mechanical circulatory support
heart transplant
cancer
chemotherapy
Language English
License Copyright © 2021 Montisci, Palmieri, Liu, Vietri, Cirri, Donatelli and Napoli.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Reviewed by: Martin Štěrba, Charles University, Czechia; Edoardo Bertero, University Hospital Würzburg, Germany
These authors have contributed equally to this work
Edited by: Alessandra Ghigo, University of Turin, Italy
This article was submitted to Cardio-Oncology, a section of the journal Frontiers in Cardiovascular Medicine
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Snippet A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated...
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SubjectTerms anthracycline
cancer
Cardiovascular Medicine
chemotherapy
heart failure
heart transplant
mechanical circulatory support
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Title Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission
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