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The Diagnosis and Management of Cardiovascular Disease in Cancer Patients
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The Diagnosis and Management of Cardiovascular Disease in Cancer Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 20036

Special Issue Editors

Dr. Hideshi Okada

E-Mail Website
Guest Editor
Department of Emergency & Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
Interests: vascular endothelial disorder; microcirculation disorder; endothelial glycocalyx; sepsis; multiple organ failure; cardiovascular disease; heart failure
Prof. Dr. Hiroyuki Tomita

E-Mail
Co-Guest Editor
Department of Tumor Pathology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
Interests: pathology; tumor microenvironment; carcinogenesis; stem cell; mouse models
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cancer therapies, such as chemotherapy, radiotherapy, and surgical procedures, are closely associated with an increased risk of cardiovascular disease (CVD) developing during the life of cancer patients. Cancer-related cardiovascular risks, in part, are considered to be present for up to 50 years after therapy. New anticancer drugs, such as immunotherapy, tyrosine kinase inhibitors, and antihormone therapies, are proven to cause endothelial dysfunction, leading to increased occurrence of CVD and related events. Furthermore, evidence that the risk factors between the occurrence of cancer and CVD overlaps are accumulating. Cardiovascular risk factors, such as unhealthy diet, tobacco smoking, obesity, diabetes mellitus, and hypertension have been reported to be related to an increased cancer risk. On the other hand, the assessment, prediction, and treatment on the risk of cardiovascular events in cancer patients receiving some cancer therapy, are improved by clinicians and researchers; however, the overall result remains insufficient. In going with times, we should continue to tackle the problems related to cardiovascular disease in cancer patients. Thus, in this Special Issue, we broadly discuss “The Diagnosis and Management of Cardiovascular Disease in Cancer Patients”.

Dr. Hideshi Okada
Dr. Hiroyuki Tomita
Guest Editors

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Keywords

  • cardiovascular disease (CVD)
  • cancer
  • risk factor

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Published Papers (5 papers)

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Research

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13 pages, 1823 KiB  
Article
Myocardial 18F-FDG Uptake Pattern for Cardiovascular Risk Stratification in Patients Undergoing Oncologic PET/CT
by Ahmed Haider, Susan Bengs, Katharina Schade, Winandus J. Wijnen, Angela Portmann, Dominik Etter, Sandro Fröhlich, Geoffrey I. Warnock, Valerie Treyer, Irene A. Burger, Michael Fiechter, Ken Kudura, Tobias A. Fuchs, Aju P. Pazhenkottil, Ronny R. Buechel, Philipp A. Kaufmann, Alexander Meisel, Paul Stolzmann and Catherine Gebhard
J. Clin. Med. 2020, 9(7), 2279; https://doi.org/10.3390/jcm9072279 - 17 Jul 2020
Cited by 20 | Viewed by 6001
Abstract
Objective: Positron emission tomography/computed tomography with 18F-fluorodeoxy-glucose (18F-FDG-PET/CT) has become the standard staging modality in various tumor entities. Cancer patients frequently receive cardio-toxic therapies. However, routine cardiovascular assessment in oncologic patients is not performed in current clinical practice. Accordingly, this [...] Read more.
Objective: Positron emission tomography/computed tomography with 18F-fluorodeoxy-glucose (18F-FDG-PET/CT) has become the standard staging modality in various tumor entities. Cancer patients frequently receive cardio-toxic therapies. However, routine cardiovascular assessment in oncologic patients is not performed in current clinical practice. Accordingly, this study sought to assess whether myocardial 18F-FDG uptake patterns of patients undergoing oncologic PET/CT can be used for cardiovascular risk stratification. Methods: Myocardial 18F-FDG uptake pattern was assessed in 302 patients undergoing both oncologic whole-body 18F-FDG-PET/CT and myocardial perfusion imaging by single-photon emission computed tomography (SPECT-MPI) within a six-month period. Primary outcomes were myocardial 18F-FDG uptake pattern, impaired myocardial perfusion, ongoing ischemia, myocardial scar, and left ventricular ejection fraction. Results: Among all patients, 109 (36.1%) displayed no myocardial 18F-FDG uptake, 77 (25.5%) showed diffuse myocardial 18F-FDG uptake, 24 (7.9%) showed focal 18F-FDG uptake, and 92 (30.5%) had a focal on diffuse myocardial 18F-FDG uptake pattern. In contrast to the other uptake patterns, focal myocardial 18F-FDG uptake was predominantly observed in patients with myocardial abnormalities (i.e., abnormal perfusion, impaired LVEF, myocardial ischemia, or scar). Accordingly, a multivariate logistic regression identified focal myocardial 18F-FDG uptake as a strong predictor of abnormal myocardial function/perfusion (odds ratio (OR) 5.32, 95% confidence interval (CI) 1.73–16.34, p = 0.003). Similarly, focal myocardial 18F-FDG uptake was an independent predictor of ongoing ischemia and myocardial scar (OR 4.17, 95% CI 1.53–11.4, p = 0.005 and OR 3.78, 95% CI 1.47–9.69, p = 0.006, respectively). Conclusions: Focal myocardial 18F-FDG uptake seen on oncologic PET/CT indicates a significantly increased risk for multiple myocardial abnormalities. Obtaining and taking this information into account will help to stratify patients according to risk and will reduce unnecessary cardiovascular complications in cancer patients. Full article
(This article belongs to the Special Issue The Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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13 pages, 1548 KiB  
Article
Early Arterial Intimal Thickening and Plaque Is Related with Treatment Regime and Cardiovascular Disease Risk Factors in Young Adults Following Childhood Hematopoietic Stem Cell Transplantation
by Johnny K. M. Sundholm, Anu Suominen, Taisto Sarkola and Kirsi Jahnukainen
J. Clin. Med. 2020, 9(7), 2208; https://doi.org/10.3390/jcm9072208 - 13 Jul 2020
Cited by 5 | Viewed by 3528
Abstract
The long-term vascular effects following childhood hematopoietic stem cell transplantation (HSCT) are not well characterized. We compared arterial wall morphology and function using very-high resolution ultrasound (25–55 MHz) in 62 patients following autologous (n = 19) or allogenic (n = 43) [...] Read more.
The long-term vascular effects following childhood hematopoietic stem cell transplantation (HSCT) are not well characterized. We compared arterial wall morphology and function using very-high resolution ultrasound (25–55 MHz) in 62 patients following autologous (n = 19) or allogenic (n = 43) HSCT for childhood malignancies and hematological disease (median age 25.9 years, IQR 21.1–30.1; median follow-up time 17.5 years IQR 14.1–23.0) with an age matched healthy control group (n = 44). Intima-media thickness of carotid (CIMT 0.49 ± 0.11 vs. 0.42 ± 0.06 mm, p < 0.001), brachial, femoral, radial arteries, and local carotid stiffness, but not adventitial thickness, were increased (p < 0.001). Diffuse intimal thickening (>0.06 mm) of femoral or radial arteries (n = 17) and subclinical carotid or femoral plaques (n = 18) were more common (p < 0.001). Radiation predicted plaques (p < 0.001) and local carotid stiffness (p < 0.001), but not intimal thickening. CIMT was predicted by age, BMI >30 kg/m2, hsCRP >2.5 mg/L, hypertension, HbA1c > 42 mmol/L, and cumulative anthracycline >150 mg/m2. Cumulative metabolic syndrome criteria and cardiovascular disease (CVD) risk factors were more common among HSCT and related with CIMT (p < 0.001), but CIMT was similar among controls and HSCT without CVD risk factors. Long-term childhood HSCT survivors show early arterial aging related with radiation, metabolic, and CVD risk factors. Prevention of risk factors could potentially decelerate early arterial wall thickening. Full article
(This article belongs to the Special Issue The Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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15 pages, 511 KiB  
Article
The Preventive Role of Regular Physical Training in Ventricular Remodeling, Serum Cardiac Markers, and Exercise Performance Changes in Breast Cancer in Women Undergoing Trastuzumab Therapy—An REH-HER Study
by Katarzyna Hojan, Danuta Procyk, Dorota Horyńska-Kęstowicz, Ewa Leporowska and Maria Litwiniuk
J. Clin. Med. 2020, 9(5), 1379; https://doi.org/10.3390/jcm9051379 - 7 May 2020
Cited by 27 | Viewed by 3384
Abstract
Cardiotoxicity is known as a severe clinical problem in oncological practice that reduces the options for cancer therapy. Physical exercise is recognized as a well-established protective measure for many heart and cancer diseases. In our study, we hypothesized that supervised and moderate-intensity exercise [...] Read more.
Cardiotoxicity is known as a severe clinical problem in oncological practice that reduces the options for cancer therapy. Physical exercise is recognized as a well-established protective measure for many heart and cancer diseases. In our study, we hypothesized that supervised and moderate-intensity exercise training would prevent heart failure and its consequences induced by trastuzumab therapy. The aim of this study was to examine the effect of physical training on ventricular remodeling, serum cardiac markers, and exercise performance in women with human epidermal growth receptor 2 (HER2+) breast cancer (BC) undergoing trastuzumab therapy. This was a prospective, randomized, clinical controlled trial. Forty-six BC women were randomized into either an intervention group (IG) or a control group (CG). An exercise program (IG) was performed after 3–6 months of trastuzumab therapy at 5 d/week (to 80% maximum heart rate (HRmax)) for 9 weeks. We then evaluated their cardiac function using echocardiography, a 6-Minute Walk Test (6MWT), and plasma parameters (C-reactive protein (CRP), myoglobin (MYO), interleukin-6 (IL-6), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK)). After the physical training program, we did not observe any significant changes in the left ventricular (LV) ejection fraction (LVEF) and 6MWT (p > 0.05) in the IG compared to the CG (decrease p < 0.05). The differences in the blood parameters were not significant (p < 0.05). To conclude, moderate-intensity exercise training prevented a decrease in the LVEF and physical capacity during trastuzumab therapy in HER2+ BC. Further research is needed to validate our results. Full article
(This article belongs to the Special Issue The Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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Review

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10 pages, 366 KiB  
Review
Arrhythmic Sudden Cardiac Death and the Role of Implantable Cardioverter-Defibrillator in Patients with Cardiac Amyloidosis—A Narrative Literature Review
by Aleksandra Liżewska-Springer, Grzegorz Sławiński and Ewa Lewicka
J. Clin. Med. 2021, 10(9), 1858; https://doi.org/10.3390/jcm10091858 - 25 Apr 2021
Cited by 8 | Viewed by 2603
Abstract
Cardiac amyloidosis (CA) is considered to be associated with an increased risk of sudden cardiac death (SCD) due to ventricular tachyarrhythmias and electromechanical dissociation. However, current arrhythmic risk stratification and the role of an implantable cardioverter-defibrillator (ICD) for primary prevention of SCD remains [...] Read more.
Cardiac amyloidosis (CA) is considered to be associated with an increased risk of sudden cardiac death (SCD) due to ventricular tachyarrhythmias and electromechanical dissociation. However, current arrhythmic risk stratification and the role of an implantable cardioverter-defibrillator (ICD) for primary prevention of SCD remains unclear. This article provides a narrative review of the literature on electrophysiological abnormalities in the context of ventricular arrhythmias in patients with CA and the role of ICD in terms of survival benefit in this group of patients. Full article
(This article belongs to the Special Issue The Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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18 pages, 743 KiB  
Review
Cancer Therapy-Related Cardiovascular Complications in Clinical Practice: Current Perspectives
by Michał Bohdan, Anna Kowalczys, Agnieszka Mickiewicz, Marcin Gruchała and Ewa Lewicka
J. Clin. Med. 2021, 10(8), 1647; https://doi.org/10.3390/jcm10081647 - 13 Apr 2021
Cited by 13 | Viewed by 3838
Abstract
Cardiovascular (CV) diseases and cancer are the leading causes of death in Europe and the United States. Both diseases have extensive overlap and share common risk factors, symptoms, and outcomes. As the number of patients with both cancer and CV diseases continues to [...] Read more.
Cardiovascular (CV) diseases and cancer are the leading causes of death in Europe and the United States. Both diseases have extensive overlap and share common risk factors, symptoms, and outcomes. As the number of patients with both cancer and CV diseases continues to rise, the field of cardio-oncology is gaining increased attention. A frequent problem during anti-cancer treatment is cardiotoxicity caused by the side-effects of chemo-, immuno-, targeted, and radiation therapies. This problem may manifest as acute coronary syndrome, myocarditis, arrhythmias, or heart failure. Modern cardio-oncology spans many different research areas. While some researchers focus on treating patients that have already developed cardiotoxicity, others aim to identify new methods for preventing cardiotoxicity before, during, and after anti-cancer therapy. Both groups share the common understanding that regular monitoring of cancer patients is the basis for optimal medical treatment. Optimal treatment can only be achieved through close cooperation between cardiologists and oncologists. This review summarizes the current views on cardio-oncology and discusses the cardiotoxicities associated with commonly used chemotherapeutics. Full article
(This article belongs to the Special Issue The Diagnosis and Management of Cardiovascular Disease in Cancer Patients)
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