Chemotherapy-related cardiotoxicity: new diagnostic and preventive strategies.
Chemotherapy is an established approach for several malignancies, but its utility may be hampered by induced cardiac toxicity possibly leading to heart failure, with a negative impact on the patient's quality of life and ultimately survival. Prospective left ventricular systolic function monitoring has demonstrated that cardiotoxicity could be subclinically present for many months or years before its overt manifestation. Although considered irreversible, some reports suggested recovery or delayed progression of cardiac dysfunction by preventive cardioactive therapies. Thus, the identification of earlier instrumental or biochemical markers of cardiac injury able to predict heart failure remains a major task. Diastolic indexes as a primary expression of hemodynamic dysfunction after cardiac damage, analyzed by means of conventional or newer Doppler technologies (tissue Doppler, color M-mode, etc.) are discussed. Moreover, brain natriuretic peptides, troponins and endothelin-1, as possible sensitive/specific markers/predictors of subclinical cardiotoxicity are reviewed in order to update and possibly improve the strategy for the detection and clinical management of chemotherapy-related cardiotoxic effects.
Benvenuto
Giuseppe Marino
GM
Cardiology Unit, Heart Department, San Bortolo Hospital, Vicenza, Italy. benvenuto1@libero.it
Ometto
Renato
R
Fontanelli
Alessandro
A
Fortunato
Antonio
A
Ruffini
Pier Adelchi
PA
Fosser
Vinicio
V
Morandi
Paolo
P
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use / Q000633:toxicity*; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000139:chemically induced / Q000175:diagnosis; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000188:drug therapy; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D011788:Quality of Life; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014336:Troponin / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology
D015415:Biomarkers; D019332:Endothelin-1; D014336:Troponin; D020097:Natriuretic Peptide, Brain