Heart Failure Reviews

, Volume 24, Issue 6, pp 977–987 | Cite as

Cardio-oncology, the myth of Sisyphus, and cardiovascular disease in breast cancer survivors

  • Sophie I. MavrogeniEmail author
  • Elisa Sfendouraki
  • George Markousis-Mavrogenis
  • Angelos Rigopoulos
  • Michel Noutsias
  • Genovefa Kolovou
  • Constantina Angeli
  • Dimitrios Tousoulis


The number of breast cancer (BC) survivors has been increasing lately, due to the improvement in early detection strategies and oncological treatments. However, BC survivors are 3 times as likely to develop heart failure (HF) within 5 years of cancer diagnosis, and 7/100 of them will develop HF in a median follow-up of 8.5 years. Furthermore, HF in BC survivors has a worse prognosis compared to other causes of HF. Anthracyclines and trastuzumab have been proven to improve survival. However, they are also considered as the main causative factors of HF in BC survivors. Old patients, those with a pre-existing cardiovascular (CV) risk factors/disease, prior exposure to chemotherapy and radiotherapy are at increased risk. Serial evaluation of troponins and cardiac imaging parameters using echocardiography and cardiovascular magnetic resonance can significantly contribute to the early diagnosis of cardiac involvement before overt HF will develop. Assessment and immediate treatment of traditional CV risk factors is the first step for cardiotoxicity prevention. In BC survivors with known heart disease, the clinical stabilization is strongly recommended for cardiotoxicity prevention. Finally, in high-risk CV patients, primary prevention including cardioprotectants and/or CV drugs should be applied. According to recent studies, the early start of ACE inhibitors and β-blockers and the modification of anti-cancer treatment can prevent the decline in left ventricular ejection fraction. However, further multicenter studies are needed to establish both prevention and treatment protocols to successfully overcome HF development in BC survivors.


Anti-cancer treatment Cardiotoxicity Heart failure β-Blockers ACE inhibitors 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sophie I. Mavrogeni
    • 1
    Email author
  • Elisa Sfendouraki
    • 2
  • George Markousis-Mavrogenis
    • 1
  • Angelos Rigopoulos
    • 3
  • Michel Noutsias
    • 3
  • Genovefa Kolovou
    • 1
  • Constantina Angeli
    • 2
  • Dimitrios Tousoulis
    • 2
  1. 1.Onassis Cardiac Surgery Center and KapodistrianUniversity of AthensAthensGreece
  2. 2.First Cardiology Department, Hippokration HospitalUniversity of AthensAthensGreece
  3. 3.Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital HalleMartin-Luther-University Halle-WittenbergHalle (Saale)Germany

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