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López-Fernández T, Marco I, Aznar MC, Barac A, Bergler-Klein J, Meattini I, Scott JM, Cardinale D, Dent S. Breast cancer and cardiovascular health. Eur Heart J 2024; 45:4366-4382. [PMID: 39320463 DOI: 10.1093/eurheartj/ehae637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024] Open
Abstract
Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
- Cardiology Department, Quironsalud University Hospital, C. Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Irene Marco
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ana Barac
- Inova ScharHeart and Vascular, Inova Schar Cancer Institute, Fall Church, VA, USA
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences 'M. Serio', Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Susan Dent
- Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, NY, USA
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Moldovan B, Adam II, Pisică RM, Untaru V, Stoica D, Șpac A, Modrigan I, Ursu M, Jupoiu L, Frâncu A, Pescaru F, Hubeishie A, Zolog A, Vecerzan L. Takotsubo Cardiomyopathy After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for a Recurrent Colon Cancer: A Life-Threatening Complication. Diagnostics (Basel) 2024; 14:2402. [PMID: 39518369 PMCID: PMC11545001 DOI: 10.3390/diagnostics14212402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 10/25/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024] Open
Abstract
(1) Background: Takotsubo cardiomyopathy, or stress cardiomyopathy, is an acute heart failure condition with transient left ventricular (LV) motion abnormalities but no significant coronary artery obstruction. It mimics acute coronary syndrome (ACS), with symptoms like chest pain, dyspnea, and ECG changes. (2) Case Report: We present the case of a 44-year-old female with relapsed colon cancer and peritoneal carcinomatosis. After undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), she experienced cardiac arrest from ventricular fibrillation 18 h postoperatively. Echocardiography revealed a reduced LV ejection fraction (20%) and apical akinesia, suggesting a Takotsubo Cardiomyopathy. Intensive resuscitation and inotropic support led to gradual recovery. Coronary angiography confirmed no coronary artery obstruction. (3) Discussion: This case highlights TTS as a rare but severe complication following major oncological surgeries, possibly triggered by both physical and emotional stressors. TTS should be considered in the differential diagnosis of perioperative cardiac events in cancer patients. (4) Conclusions: Prompt recognition and management of TTS in the perioperative period are crucial to improving outcomes, especially in high-risk oncological patients undergoing extensive surgeries.
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Affiliation(s)
- Bogdan Moldovan
- General Surgery Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (I.-I.A.); (R.-M.P.)
| | - Iris-Iuliana Adam
- General Surgery Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (I.-I.A.); (R.-M.P.)
- Faculty of Medicine, “Lucian Blaga” University, 550169 Sibiu, Romania;
| | - Radu-Mihai Pisică
- General Surgery Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (I.-I.A.); (R.-M.P.)
| | - Vlad Untaru
- Anesthesia and Intensive Care Unit, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (V.U.); (D.S.); (A.Ș.)
| | - Doly Stoica
- Anesthesia and Intensive Care Unit, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (V.U.); (D.S.); (A.Ș.)
| | - Alexandra Șpac
- Anesthesia and Intensive Care Unit, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (V.U.); (D.S.); (A.Ș.)
| | - Irina Modrigan
- Anesthesia and Intensive Care Unit, Sanador Hospital, 011031 Bucharest, Romania;
| | - Mihai Ursu
- Cardiology Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (M.U.); (L.J.); (A.F.)
| | - Liliana Jupoiu
- Cardiology Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (M.U.); (L.J.); (A.F.)
| | - Adina Frâncu
- Cardiology Department, ‘St. Constantin’ Hospital, 500299 Brasov, Romania; (M.U.); (L.J.); (A.F.)
| | | | - Amir Hubeishie
- Oncology Department, Timiş County Emergency Clinical Hospital, 300723 Timișoara, Romania;
- Oncology Department, Oncohelp Medical Center, 300425 Timișoara, Romania
| | - Adriana Zolog
- Pathology Department, Regina Maria Hospital, 400500 Cluj-Napoca, Romania;
| | - Liliana Vecerzan
- Faculty of Medicine, “Lucian Blaga” University, 550169 Sibiu, Romania;
- Oncology Department, ‘Dr. Alexandru Augustin’ Military Hospital, 550024 Sibiu, Romania
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Chen O, Mojahedi A. Investigating the effect of cancer medication in the development of Takotsubo cardiomyopathy. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:196-207. [PMID: 39309116 PMCID: PMC11410786 DOI: 10.62347/stfl9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/10/2024] [Indexed: 09/25/2024]
Abstract
Takotsubo cardiomyopathy (TCM) is a cardiac condition that is usually characterized by sudden heart failure (HF) or chest pain that resembles acute coronary syndrome (ACS). It is identified by severe systolic dysfunction of the left ventricle (LV) and can be caused by physical, medical, or emotional stress. The pathophysiological mechanisms leading to TCM have not yet been clearly determined. TCM is a complex condition to diagnose and may go undetected during cancer treatment due to the wide variety of cardiotoxic effects associated with antineoplastic therapies. Consequently, timely identification and effective treatment are critical to enhancing the prognosis. Nevertheless, TCM is a more prevalent condition in oncology than was previously believed; therefore, clinicians who treat cancer patients should consider it in their differential diagnosis. The purpose of this manuscript is to provide physicians with a summary of the available evidence regarding the ramifications of the association between TCM and cancer to aid in improving patient management.
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Affiliation(s)
- On Chen
- Divison of Cardiology, Stony Brook University HospitalStony Brook, New York, The United States
| | - Azad Mojahedi
- Department of Internal Medicine, Stony Brook University HospitalStony Brook, New York, The United States
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Jabbour JP, Arcari L, Cacciotti L, Magrì D, Recchioni T, Valeri L, Maggio E, Vizza CD, Badagliacca R, Papa S. Long-Term Functional Limitations on Cardiopulmonary Exercise Testing in Emotion-Triggered Takotsubo Syndrome. J Clin Med 2024; 13:1163. [PMID: 38398482 PMCID: PMC10889098 DOI: 10.3390/jcm13041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: In patients with prior Takotsubo syndrome (TTS), long-lasting functional cardiac limitations were described as compared with normal subjects. Emotion-triggered Takotsubo syndrome (E-TTS) has more favorable outcomes than TTS preceded by a physical trigger or by no identifiable factors. The aim of the present study was to assess long-term cardiac functional limitations in a cohort of asymptomatic E-TTS patients. Methods: We enrolled n = 40 asymptomatic patients with a diagnosis of E-TTS. Cardiopulmonary exercise tests (CPET) were performed at 30 (12-40) months median follow-up from the acute event. A cohort of n = 40 individuals matched for age, sex, body mass index and comorbidities served as control. Results: Despite recovery of left ventricular ejection fraction, patients with prior E-TTS had lower peak VO2 and percentage of predicted peak VO2 (17.8 ± 3.6 vs. 22.1 ± 6.5; p < 0.001 and 75.2 ± 14.1% vs. 100.6 ± 17.1%, p < 0.001), VO2 at anaerobic threshold (AT) (11.5 [10.1-12.9] vs. 14.4 [12.5-18.7]; p < 0.001), peak O2 pulse (9.8 ± 2.5 vs. 12.9 ± 3.5; p < 0.001) and higher VE/VCO2 slope (30.5 ± 3.7 vs. 27.3 ± 3.5; p < 0.001) compared with matched controls. We found no statistically significant differences in heart rate reserve (HRR), respiratory equivalent ratio (RER), mean blood pressure and peak PetCO2 between patients and controls. Conclusions: Despite its favorable outcome, patients with E-TTS in our population were found to have subclinical long-term functional cardiac limitations as compared with a control cohort.
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Affiliation(s)
- Jean Pierre Jabbour
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Luca Arcari
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Tommaso Recchioni
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Livia Valeri
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Carmine Dario Vizza
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Roberto Badagliacca
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Silvia Papa
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
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