title: Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions.
abstract: Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Carine E
authors.initials: CE
authors.lastname: Hamo
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Michelle W
authors.initials: MW
authors.lastname: Bloom
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Daniela
authors.initials: D
authors.lastname: Cardinale
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Anju
authors.initials: A
authors.lastname: Nohria
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Lea
authors.initials: L
authors.lastname: Baer
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Hal
authors.initials: H
authors.lastname: Skopicki
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lenihan
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Lyon
authors.affiliation: From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.). javed.butler@stonybrookmedicine.edu.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000465:Algorithms; D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D019091:Critical Pathways; D006333:Heart Failure / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents
keywords: cardiomyopathies; cardiotoxicity; heart; heart failure; trastuzumab
references.citation: Ann Oncol. 2012 Oct;23 Suppl 7:vii155-66
references.pmid: 22997448
references.citation: J Am Heart Assoc. 2014 Apr 22;3(2):e000665
references.pmid: 24755151
references.citation: Am Heart J. 2010 Sep;160(3):487.e1-7
references.pmid: 20826257
references.citation: Cardiology. 2012;123(4):240-7
references.pmid: 23207160
references.citation: BMC Cancer. 2011 Jul 27;11:318
references.pmid: 21794114
references.citation: Curr Oncol. 2008 Jan;15(1):24-35
references.pmid: 18317582
references.citation: Circulation. 2003 Sep 2;108(9):1146-62
references.pmid: 12952829
references.citation: Toxicol Appl Pharmacol. 2004 Oct 15;200(2):159-68
references.pmid: 15476868
references.citation: Med Hypotheses. 2013 Aug;81(2):231-4
references.pmid: 23688742
references.citation: Eur Heart J Cardiovasc Imaging. 2014 Oct;15(10):1063-93
references.pmid: 25239940
references.citation: Eur Heart J. 2012 Jul;33(14):1787-847
references.pmid: 22611136
references.citation: J Am Coll Cardiol. 2011 Aug 23;58(9):988-9
references.pmid: 21851890
references.citation: Circulation. 2015 Jun 2;131(22):1981-8
references.pmid: 25948538
references.citation: J Clin Oncol. 2004 Mar 1;22(5):820-8
references.pmid: 14990637
references.citation: J Am Coll Cardiol. 2007 Oct 9;50(15):1435-41
references.pmid: 17919562
references.citation: Am J Cardiol. 2014 Jun 1;113(11):1893-8
references.pmid: 24837270
references.citation: Cell Death Dis. 2011 Aug 11;2:e190
references.pmid: 21833028
references.citation: J Appl Toxicol. 2001 Nov-Dec;21(6):469-73
references.pmid: 11746193
references.citation: Mayo Clin Proc. 2014 Sep;89(9):1287-306
references.pmid: 25192616
references.citation: J Am Soc Echocardiogr. 2013 Sep;26(9):1013-32
references.pmid: 23998694
references.citation: J Am Coll Cardiol. 2014 Jan 28;63(3):240-8
references.pmid: 24161324
references.citation: J Clin Oncol. 2009 Jan 1;27(1):127-45
references.pmid: 19018081
references.citation: J Am Coll Cardiol. 2010 Jan 19;55(3):213-20
references.pmid: 20117401
references.citation: J Thorac Cardiovasc Surg. 2011 Aug;142(2):396-403.e3
references.pmid: 21094500
references.citation: J Am Coll Cardiol. 2012 Dec 11;60(23):2384-90
references.pmid: 23141499
references.citation: Am J Hematol. 2010 Nov;85(11):894-6
references.pmid: 20872550
references.citation: Circulation. 2006 Dec 5;114(23):2474-81
references.pmid: 17101852
references.citation: Ann Oncol. 2006 Apr;17(4):614-22
references.pmid: 16423847
references.citation: J Am Coll Cardiol. 2013 Jun 11;61(23):2355-62
references.pmid: 23583763
references.citation: Int J Cardiol. 2013 Sep 1;167(5):2306-10
references.pmid: 22727976
references.citation: J Am Coll Cardiol. 2006 Dec 5;48(11):2258-62
references.pmid: 17161256
references.citation: Eur J Cancer. 2013 Sep;49(13):2900-9
references.pmid: 23706982
references.citation: Circulation. 2012 Dec 4;126(23):2749-63
references.pmid: 23212997
references.citation: Heart Fail Rev. 2015 Sep;20(5):621-31
references.pmid: 26168714
references.citation: Eur J Heart Fail. 2011 Jan;13(1):1-10
references.pmid: 21169385
references.citation: J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239
references.pmid: 23747642
references.citation: Am J Cardiol. 2010 Feb 15;105(4):522-6
references.pmid: 20152248
references.citation: Breast Cancer (Dove Med Press). 2015 Jan 16;7:21-35
references.pmid: 25653554
references.citation: Expert Rev Cardiovasc Ther. 2008 Nov;6(10):1311-7
references.pmid: 19018683
references.citation: J Clin Oncol. 2007 Sep 1;25(25):3991-4008
references.pmid: 17577017
references.citation: Res Commun Chem Pathol Pharmacol. 1978 Sep;21(3):577-80
references.pmid: 705032
references.citation: J Heart Lung Transplant. 2012 Aug;31(8):805-10
references.pmid: 22551930
references.citation: Cancer. 2005 Dec 1;104(11):2492-8
references.pmid: 16247790
references.citation: J Am Coll Cardiol. 2009 Apr 14;53(15):e1-e90
references.pmid: 19358937
references.citation: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003917
references.pmid: 18425895
references.citation: Cancer Res. 2007 Sep 15;67(18):8839-46
references.pmid: 17875725
references.citation: Ecancermedicalscience. 2014 May 29;8:433
references.pmid: 24932213
references.citation: Cardiol J. 2014;21(5):509-15
references.pmid: 24142687
references.citation: N Engl J Med. 2000 Apr 13;342(15):1077-84
references.pmid: 10760308
references.citation: Eur J Heart Fail. 2015 Jan;17(1):81-9
references.pmid: 25410653
references.citation: Circ Heart Fail. 2013 May;6(3):420-6
references.pmid: 23425978