[Anthracycline-induced cardiomyopathy].
Anthracycline-based antineoplastic therapy is the standard of care for various cancers today and represents a breakthrough in this area. The cardiac toxicity of anthracyclines is well established. The acute form is often reversible and has no predictive value for the future. This early form does not prevent continuation of chemotherapy. Late cardiac toxicity due to anthracycline is the leading limiting factor in its use. In adults, this resembles dilated cardiomyopathy, while in children it may be expressed as restrictive cardiomyopathy. The discovery of modifiable risk factors has made it possible to identify patients at high risk of developing late cardiac toxicity and heart failure. Because left ventricular dysfunction and heart failure may develop long after anthracycline treatment ends, prolonged close follow-up is mandatory in asymptomatic subjects. Follow-up of asymptomatic patients requires serial echocardiography (M-mode, 2D echo, Doppler, tissue Doppler, speckle tracking, etc.). Anthracycline-induced cardiomyopathy must be treated according to the standard guidelines for chronic heart failure with left ventricular dysfunction, by angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. Lifestyle changes may reduce the long-term risk. Close collaboration between cardiologists and oncologists is highly desirable for optimizing management of these patients.
Service de cardiologie, Hôpitaux universitaires de Strasbourg, Nouvel hôpital Civil, F-67000 Strasbourg, France. geraldroul@aol.com
Gerald
G
Roul
Cyril
C
Cohen
Ari
A
Lieber
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000359:Aftercare; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001706:Biopsy; D002309:Cardiology; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D002908:Chronic Disease; D016903:Drug Monitoring; D004452:Echocardiography; D004562:Electrocardiography; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D008019:Life Style; D008495:Medical Oncology; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic