Concepts in cardiac oncology.
Concepts in cardiac oncology.
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DOI：
10.1093/eurheartj/suaa127
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Petrolati S
中科院分区：
文献类型：
--
作者：
Bisceglia I;Cartoni D;Petrolati S
心脏肿瘤学是心脏病学的一个分支，从事心脏病学家和肿瘤学家一样，为了提供最好的可能的肿瘤治疗的患者在高心血管风险或发展心脏毒性在他们的治疗过程中，从而避免中断它，并旨在提高生存和生活质量。早期诊断和较新的癌症治疗方法的有效性使越来越多的长期幸存者（目前全世界近3 000万人）面临患心血管疾病的高风险。这种倾向不仅与肿瘤治疗的毒副作用相关，而且与该患者人群中对风险因素的真实的脆弱性相关。几十年来，心脏肿瘤学中心脏毒性的概念一直局限于心室功能障碍，但在过去的几年中，美国食品和药物管理局批准了数百种新分子，心脏肿瘤学的复杂性不断升级。新的靶向治疗、蛋白酶体抑制剂、免疫调节剂和免疫检查点抑制剂的引入，将心脏毒性的概念扩大到“心血管毒性”的更广泛定义，包括动脉高血压、缺血、心肌病、心肌炎、心血管并发症、QT间期延长以及动脉和静脉血栓形成。我们仍然缺乏关于新的和各种形式的毒性的指导方针，以及短期和长期后续行动的监测战略。
Cardiac oncology is a subspecialty of cardiology engaging cardiologists and oncologists alike, in order to provide the best possible oncologic treatment for patients at high cardiovascular risk or developing cardio-toxicity during the course of their treatment, thus avoiding discontinuing it, and aiming at improving survival and quality of life. Early diagnosis and the effectiveness of the newer cancer treatments delivered an increasing number of long-term survivors (presently almost 30 million worldwide), at high risk of developing cardiovascular diseases. This predisposition has been correlated not only to the toxic side effects of the oncologic treatment but also to a real vulnerability to the risk factors in this patients population. For decades, the concept of cardio-toxicity in cardiac oncology has been restricted to ventricular dysfunction, but during the last few years the Food and Drug Administration has approved hundreds of new molecules and cardiac oncology has escalated its complexity. The introduction of new target therapy, proteasome inhibitors, immuno-modulators, and inhibitors of the immunitary checkpoint, magnified the concept of cardio-toxicity to a wider definition of ‘cardiovascular toxicity’ incorporating arterial hypertension, ischaemia, cardiomyopathy, myocarditis, arrhythmic complications, long QT, and arterial and venous thrombosis. We are still lacking guidelines on the new and varied forms of toxicity, as well as monitoring strategies in the short- and long-term follow-up.
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