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Left Ventricular Dysfunction and Chemotherapeutic Agents

  • Heart Failure (H Eisen, Section Editor)
  • Published:
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Abstract

Purpose of Review

We aim to summarize the effect of cancer therapy-related cardiotoxicity on the development of left ventricular (LV) dysfunction.

Recent Findings

We discuss commonly used cancer therapeutics that have the potential for both acute and delayed cardiotoxicity. LV dysfunction from cancer therapies may be found by routine cardiac imaging prior to clinical manifestations of heart failure (HF) and we discuss the current multi-modality approaches for early detection of toxicity with the use of advanced echocardiographic parameters including strain techniques. Further, we discuss the role of biomarkers for detection of LV dysfunction from cancer therapies. Current approaches monitoring and treating LV dysfunction related to cancer therapy-related cardiotoxicity include addressing modifiable cardiovascular risk factors especially hypertension and early initiation of neurohormonal blockade (NHB) with disease-modifying beta-blockers and renin–angiotensin–aldosterone system (RAAS) inhibitors. Once LV dysfunction is identified, traditional ACC/AHA guideline-directed therapy is employed. Further, we highlight the use of advanced heart failure therapies including mechanical resynchronization devices, the use of durable ventricular assist devices, and cardiac transplantation as increasingly employed modalities for treatment of severe LV dysfunction and advanced heart failure in the cardio-oncology population.

Summary

This review seeks to highlight the importance of early detection, treatment, and prevention of LV dysfunction from cancer therapy-related cardiotoxicity.

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Abbreviations

ACC:

American College of Cardiology

ACEi:

angiotensin-converting enzyme inhibitors

AHA:

American Heart Association

ARB:

angiotensin receptor blockers

BB:

beta-blockers

cMRI:

cardiac magnetic resonance imaging

CVD:

cardiovascular disease

CVRF:

cardiovascular risk factors

GLS:

global longitudinal strain

HF:

heart failure

INTERMACS:

Interagency Registry for Mechanically Assisted Circulatory Support

LV:

left ventricle

LVEF:

left ventricular ejection fraction

NHB:

neurohormonal blockade

MUGA:

multiple-gated acquisition

RAAS:

renin–angiotensin–aldosterone system

TKI:

tyrosine kinase inhibitors

Tn:

troponin

Tn I:

troponin I

Tn T:

troponin T

UNOS:

United Network for Organ Sharing

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Funding

Suparna C. Clasen reports grants from NIH T32 funding.

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Authors and Affiliations

  1. Cardio-oncology in the Division of Cardiology, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion 11th Floor, Philadelphia, PA, 19104, USA

    Suparna C. Clasen

  2. Advanced Heart Failure in the Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Joyce W. Wald

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  1. Suparna C. Clasen
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Correspondence to Suparna C. Clasen.

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Suparna C. Clasen and Joyce W. Wald declare that they have no conflict of interest.

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This article is part of the Topical Collection on Heart Failure

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Clasen, S.C., Wald, J.W. Left Ventricular Dysfunction and Chemotherapeutic Agents. Curr Cardiol Rep 20, 20 (2018). https://doi.org/10.1007/s11886-018-0967-x

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