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Cardio-Oncology: An Emerging Paradigm in Modern Medicine

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 13750

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Special Issue Editor

Dr. Rohit Moudgil

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Section of Clinical Cardiology Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Interests: cardio-oncology
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Special Issue Information

Tremendous strides have been made in improving oncological outcomes with innovation and dedicated research. However, the success has been marred by an increase in cardiovascular events in cancer patients. This is also overshadowed by the fact that cardiovascular disease (CVD) remains the number one cause of morbidity and mortality. While disease processes (cancer and heart disease) are independent causes of increased mortality, recent evidence suggests that they are intertwined. Therefore, the mitigation of risk factors from one (such as CVD) can protect patients from the other (such as cancer). In this Special Issue, our aim is to highlight the significant points of intersection between CVD and cancer. This will be achieved by discussing the major clinical implications regarding the prevention, diagnosis, management, and treatment of cardio-oncological diseases/syndromes. A salient aspect of the Issue will be the current state of the field and what the future holds for cardio-oncological patients.

Dear Colleagues,

Cancer and cardiovascular disease are the two most common causes of death worldwide. As the fields of cardiovascular medicine and oncology continue to expand, the area of overlap is becoming more prominent, demanding dedicated attention and individualized patient care. We have come to realize that both fields are inextricably intertwined in several aspects, so much so that the mere presence of one, with its resultant downstream implications, has an impact on the other. Nonetheless, cardiovascular disease and cancer are generally approached independently. The focus that is granted to the predominant pathological entity (either cardiovascular disease or cancer) does not allow for optimal medical care for the other. As a result, ample opportunities for improvement in overall health care are being overlooked. Herein, we hope to shed light on the interconnected relationship between cardiovascular disease and cancer, and to uncover some of the unintentionally neglected intricacies of common cardiovascular therapeutics from an oncologic standpoint.

We are pleased to invite you:

To contribute to this one-of-a-kind Special Issue dedicated to discussing the past, present and, most importantly, future of this field. We would like to establish the current state of this field so that as we move forward we have a clear picture of past research, a considerable understanding of today’s ongoing work, and a forecast of potential knowledge gaps and areas of interest to accelerate the advancement in cardio-oncology.

This Special Issue aims to:

Highlight the basic science of cardiotoxicity to cancer-related therapies.
Highlight clinical research and studies that have shed light on the importance of and advancements in cardio-oncology.
Highlight social determinants, inequalities, and racial/ethnic disparities that still hinder in the deployment of equitable care.
Enable future directions with the development of global registries and the deployment of artificial intelligence.

We look forward to receiving your contributions.

Dr. Rohit Moudgil
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cardio-oncology
CTRCD
arrhythmias
anthracyclines
anti-her2 therapies
immune checkpoint inhibitors
artificial intelligence
guidelines
emerging research

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Published Papers (6 papers)

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Research

18 pages, 4022 KiB

Open AccessArticle

The sGCa Vericiguat Exhibit Cardioprotective and Anti-Sarcopenic Effects through NLRP-3 Pathways: Potential Benefits for Anthracycline-Treated Cancer Patients

by Vincenzo Quagliariello, Massimiliano Berretta, Irma Bisceglia, Ilaria Giacobbe, Martina Iovine, Vienna Giordano, Raffaele Arianna, Matteo Barbato, Francesca Izzo, Carlo Maurea, Maria Laura Canale, Andrea Paccone, Alessandro Inno, Marino Scherillo, Domenico Gabrielli and Nicola Maurea

Cancers 2024, 16(8), 1487; https://doi.org/10.3390/cancers16081487 - 12 Apr 2024

Viewed by 1915

Abstract

Anthracycline-induced cardiomyopathies and sarcopenia are frequently seen in cancer patients, affecting their overall survival and quality of life; therefore, new cardioprotective and anti-sarcopenic strategies are needed. Vericiguat is a new oral guanylate cyclase activator that reduces heart failure hospitalizations or cardiovascular death. This study highlighted the potential cardioprotective and anti-sarcopenic properties of vericiguat during anthracycline therapy. Human cardiomyocytes and primary skeletal muscle cells were exposed to doxorubicin (DOXO) with or without a pre-treatment with vericiguat. Mitochondrial cell viability, LDH, and Cytochrome C release were performed to study cytoprotective properties. Intracellular Ca⁺⁺ content, TUNEL assay, cGMP, NLRP-3, Myd-88, and cytokine intracellular levels were quantified through colorimetric and selective ELISA methods. Vericiguat exerts significant cytoprotective and anti-apoptotic effects during exposure to doxorubicin. A drastic increase in cGMP expression and reduction in NLRP-3, MyD-88 levels were also seen in Vericiguat-DOXO groups vs. DOXO groups (p < 0.001) in both cardiomyocytes and human muscle cells. GCa vericiguat reduces cytokines and chemokines involved in heart failure and sarcopenia. The findings that emerged from this study could provide the rationale for further preclinical and clinical investigations aimed at reducing anthracycline cardiotoxicity and sarcopenia in cancer patients. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

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13 pages, 2305 KiB

Open AccessArticle

Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study

by Gloria Heredia, Rafael Gonzalez-Manzanares, Soledad Ojeda, Jose R. Molina, Consuelo Fernandez-Aviles, Francisco Hidalgo, Jose Lopez-Aguilera, Manuel Crespin, Dolores Mesa, Manuel Anguita, Juan C. Castillo and Manuel Pan

Cancers 2023, 15(21), 5158; https://doi.org/10.3390/cancers15215158 - 26 Oct 2023

Cited by 2 | Viewed by 1203

Abstract

There are limited data regarding right ventricle (RV) impairment in long-term survivors of childhood acute lymphoblastic leukemia (CLS). The aim of this study was to assess RV function in these patients using echocardiographic conventional measurements and automated RV strain. Echocardiographic recordings of 90 CLS and 58 healthy siblings from the CTOXALL cohort were analyzed. For group comparisons, inverse probability weighting was used to reduce confounding. The CLS group (24.6 ± 9.7 years, 37.8% women) underwent an echocardiographic evaluation 18 (11–26) years after the diagnosis. RV systolic dysfunction was found in 16.7% of CLS individuals using RV free-wall strain (RVFWS) compared to 2.2 to 4.4% with conventional measurements. RV systolic function measurements were lower in the CLS than in the control group: TAPSE (23.3 ± 4.0 vs. 25.2 ± 3.4, p = 0.004) and RVFWS (24.9 ± 4.6 vs. 26.8 ± 4.7, p = 0.032). Modifiable cardiovascular risk factors such as obesity (p = 0.022) and smoking (p = 0.028) were independently associated with reduced RVFWS. In conclusion, RV systolic function impairment was frequent in long-term survivors of childhood leukemia, underscoring the importance of RV assessment, including RVFWS, in the cardiac surveillance of these patients. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

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12 pages, 278 KiB

Open AccessArticle

Cardiologist-Performed Baseline Evaluation with an Assessment of Coronary Status for Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: Impact on Newly Diagnosed Coronary Artery Disease

by Maximilien Rogé, Valentine Guimas, Emmanuel Rio, Loïg Vaugier, Tanguy Perennec, Joachim Alexandre, Stéphane Supiot and Elvire Martin Mervoyer

Cancers 2023, 15(16), 4157; https://doi.org/10.3390/cancers15164157 - 17 Aug 2023

Cited by 1 | Viewed by 1281

Abstract

Background: Given the potential cardiovascular risks of androgen deprivation therapy (ADT), it is essential to identify patients who may be at an increased risk for coronary artery disease (CAD). Despite the recent ESC recommendations, there is no consensus on when to refer a patient to a cardiologist for further evaluation. Objective: To report on new diagnoses of CAD in patients with prostate cancer (PCa) requiring ADT who underwent a systematic cardio-onco evaluation with an assessment of their coronary status. Design, Setting, and Participants: This is a retrospective, monocentric study that included patients with PCa who had completed a cardio-onco evaluation with an assessment of their coronary status in the cardio-oncology department at the Western Cancer Institute, Nantes, between January 2019 and August 2022. Intervention: The baseline cardio-onco evaluation included a physical exam, transthoracic echography, and electrocardiogram, followed with a systematic evaluation of their coronary status. Outcome Measurements and Statistical Analysis: The primary objective was to determine the incidence of newly diagnosed CAD. The secondary objective was to evaluate the number of changes in cardiovascular treatment. Results and Limitations: Among the 34 patients who underwent cardio-onco evaluation, 7 (20.6%) were diagnosed with CAD, with a median time to diagnosis of 5 months. Most patients were asymptomatic, with one who experienced a myocardial infarction. Of the 27 patients without CAD, 44.4% underwent a therapeutic intervention by the cardiologist, with no cardiac deaths during follow-up. Overall, 55.9% of patients had a therapeutic intervention after the cardio-onco evaluation. Conclusions: The high incidence of newly diagnosed CAD in asymptomatic patients supports the need for screening for CAD in this population. Further research is needed to determine whether routine screening for CAD in patients receiving ADT would result in significant clinical benefits. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

14 pages, 2469 KiB

Open AccessArticle

Beta Blockers with Statins May Decrease All-Cause Mortality in Patients with Cardiovascular Diseases and Locally Advanced Unresectable Non-Small-Cell Lung Cancer after Chemoradiotherapy

by Magdalena Zaborowska-Szmit, Sebastian Szmit, Marta Olszyna-Serementa, Paweł Badurak, Katarzyna Zajda, Anna Janowicz-Żebrowska, Aleksandra Piórek, Magdalena Knetki-Wróblewska, Piotr Jaśkiewicz, Adam Płużański, Maciej Krzakowski and Dariusz M. Kowalski

Cancers 2023, 15(4), 1277; https://doi.org/10.3390/cancers15041277 - 17 Feb 2023

Cited by 4 | Viewed by 2249

Abstract

The study was conducted in the era when maintenance immunotherapy with durvalumab was not available in clinical practice after chemoradiotherapy (CRT) in unresectable non-small-cell lung cancer (NSCLC). The main aim of the study was to check whether the presence of cardiovascular diseases (CVD) and their pharmacotherapy affects the overall survival (OS) in such NSCLC patients undergoing sequential CRT. The group of 196 patients were analyzed: 101 patients with CVD (51.53%) and 95 patients with other reasons of qualification for sequential CRT (decreased performance status, older age, and other non-cardiovascular co-morbidities). Although patients with CVD were more often in older age, and they more often experienced cardiac and nephrological complications (p < 0.05 for all), there was a statistically nonsignificant trend for lower all-cause mortality in patients with CVD. The lowest all-cause mortality was observed in patients treated with beta-blockers and statins after two (HR = 0.31; 95%CI: 0.1–0.98; p = 0.047), three (HR = 0.33; 95%CI: 0.13–0.81; p = 0.015) and even four (HR = 0.45; 95%CI: 0.22–0.97; p = 0.027) years of follow-up. The benefit in OS remained significant in 101 patients with CVD treated with beta-blockers (HR = 0.65; 95%CI: 0.43–0.99; p = 0.045), and eventually statin, throughout the whole follow-up (log-rank p < 0.05). Further prospective studies are necessary to confirm the role of beta-blockers and statins in reduction of mortality in NSCLC patients undergoing radical CRT. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

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15 pages, 5261 KiB

Open AccessArticle

Evaluating Cardiotoxicity in Breast Cancer Patients Treated with HER2 Inhibitors: Could a Combination of Radionuclide Ventriculography and Cardiac Biomarkers Predict the Cardiac Impact?

by Mirela Gherghe, Alexandra Maria Lazar, Mario-Demian Mutuleanu, Cristian Ioan Bordea, Sinziana Ionescu, Raluca Ioana Mihaila, Cristina Petroiu and Adina Elena Stanciu

Cancers 2023, 15(1), 207; https://doi.org/10.3390/cancers15010207 - 29 Dec 2022

Cited by 8 | Viewed by 3234

Abstract

(1) Background: The aim of our study was to determine whether monitoring cardiac function through RNV and cardiac biomarkers could predict the cardiac impact of combined therapy with trastuzumab, pertuzumab and docetaxel, which are regularly used nowadays to treat HER2-positive breast cancer. (2) Methods: This prospective monocentric study included 22 patients, diagnosed with HER2-positive breast cancer, who had their LVEFs and cardiac biomarkers evaluated both at the beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were collected to assess circulating cardiac biomarkers. RNV was performed in each patient after “in vivo” radiolabeling of the erythrocytes. The obtained results were then statistically correlated. (3) Results: The average LVEF decrease between the two time points was approximately 4%. Of the five biomarkers we considered in this paper, only NT-proBNP correlated with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = −0.615 for T0 and r = −0.751 for T1, respectively). ST2/IL-33R proved statistically significant at the T1 time point (r = −0.547). (4) Conclusions: A combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab and docetaxel. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

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14 pages, 2109 KiB

Open AccessArticle

Long-Term Cardiovascular Mortality among 80,042 Older Patients with Bladder Cancer

by Tianwang Guan, Miao Su, Zehao Luo, Weien Peng, Ruoyun Zhou, Zhenxing Lu, Manting Feng, Weirun Li, Yintong Teng, Yanting Jiang, Caiwen Ou and Minsheng Chen

Cancers 2022, 14(19), 4572; https://doi.org/10.3390/cancers14194572 - 21 Sep 2022

Cited by 8 | Viewed by 2294

Abstract

Background: To identify the risk of death from cardiovascular disease (CVD) in older patients with bladder cancer (BC). Methods: This population-based study included 80,042 older BC patients (≥65 years) diagnosed between 1975 and 2018, with a mean follow-up of 17.2 years. The proportion of deaths, competing risk models, standardized mortality ratio (SMR), and absolute excess risk (AER) per 10,000 person-years were applied to identify the risk of CVD-related deaths among older BC patients. Results: For older patients with BC, CVD-related death was the chief cause of death, and cumulative CVD-related mortality also exceeded primary BC as the leading cause of death mostly 5–10 years after BC diagnosis, especially in localized-stage and low-grade subgroups. The risk of short- and long-term CVD-related death in older BC patients was higher than in the general older adult population (SMR = 1.30, 95% CI 1.28–1.32; AER = 105.68). The risk of sex-specific CVD-related deaths also increased compared to the general population of older adults, including heart disease, cerebrovascular diseases, hypertension without heart disease, atherosclerosis, aortic aneurysm and dissection, and other diseases of the arteries, arterioles, and capillaries. Conclusions: CVD-related death is an important competing risk among older BC patients and has surpassed primary BC as the chief cause of death, mainly 5–10 years after BC diagnosis. The risk of CVD-related death in older patients with BC was greater than in the general population. The management of older patients with BC should focus not only on the primary cancer but also on CVD-related death. Full article

(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine)

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