Cardiotoxicity of Cancer Treatments: Focus on Anthracycline Cardiomyopathy

Significant progress has been made in developing new treatments and refining the use of preexisting ones against cancer. Their successful use and the longer survival of cancer patients have been associated with reports of new cardiotoxicities and the better characterization of the previously known cardiac complications. Immunotherapies with monoclonal antibodies against specific cancer-promoting genes, chimeric antigen receptor T cells, and immune checkpoint inhibitors have been developed to fight cancer cells, but they can also show off-target effects on the heart. Some of these cardiotoxicities are thought to be due to nonspecific immune activation and inflammatory damage. Unlike immunotherapy-associated cardiotoxicities which are relatively new entities, there is extensive literature on anthracycline-induced cardiomyopathy. Here, we provide a brief overview of the cardiotoxicities of immunotherapies for the purpose of distinguishing them from anthracycline cardiomyopathy. This is especially relevant as the expansion of oncological treatments presents greater diagnostic challenges in determining the cause of cardiac dysfunction in cancer survivors with a history of multiple cancer treatments including anthracyclines and immunotherapies administered concurrently or serially over time. We then provide a focused review of the mechanisms proposed to underlie the development of anthracycline cardiomyopathy based on experimental data mostly in mouse models. Insights into its pathogenesis may stimulate the development of new strategies to identify patients who are susceptible to anthracycline cardiomyopathy while permitting low cardiac risk patients to receive optimal treatment for their cancer.

Perioperative Myocardial Damage and Heart Failure in Noncardiac Surgery. Part 2. Reduction of the Risk of Perioperative Cardiac Complications by Pharmacological Measures and Optimization of Anesthetic and Critical Care Support (Review)

The second part of the overview presents and analyzes the current data on the methods of adjuvant pharmacological cardioprotection and possibilities of optimizing the anesthetic support and perioperative monitoring in high cardiac risk patients. Amendments made in international guidelines for the last 2–3 years on the basis of conclusive studies and meta-analyses have been examined. Cardioprotection mechanisms and information about its implementation in real clinical practice have been analysed. It has been shown that by no means all drugs under discussion can be widely used for prophytlactic purposes. Contemporary evidencebased recommendations concerning the optimization of anesthetic support and perioperative monitoring are given. A conclusion has been made that practical implementation of a comprehensive strategy aimed at reduction of the risk of cardiac complications might ensure decrease of both the incidence of severe cardiac complications and mortality due to them.

Perioperative Myocardial Damage and Heart Failure in Noncardiac Surgery. Part 1. Etiopathogenesis and Prognosis of Perioperative Cardiac Complications (Review)

The purpose of this paper is to provide scientific and practical information on assessment of the risk of myocardical damage development after noncardiac operations (NOMD): ischemia or myocardial infarction (MI), and/or heart failure (HF) and their prevention in adult patients. This overview of literature consists of two parts. The first part analyzes epidemiology, etiopathogeneis, and POCC risk prediction methods; the second part describes the possibilities of adjuvant pharmacological cardioprotection and approaches to optimizing anesthesiological support of operative interventions in high cardiac risk patients.The problem of perioperative cardiac complications in noncardiac surgey is one of relevant complex issues of contemporary medicine. In line with contemporary views, NOMD is now regarded as a separate variant of a pathological process in the heart muscle. According to extensive studies, about 40% of mortality of adult patients during non-cardial operative inverventions are caused by various NOMD and/or HF. The problem under discussion is particularly relevant when medical assistance is rendered to elderly patients.