Advanced cancer is also a heart failure syndrome: a hypothesis.
Advanced cancer is also a heart failure syndrome: a hypothesis.
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晚期癌症也是一种心力衰竭综合征：一种假设。
DOI：
10.1002/jcsm.12694
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Anker SD
中科院分区：
文献类型：
--
作者：
Anker MS;Sanz AP;Zamorano JL;Mehra MR;Butler J;Riess H;Coats AJS;Anker SD
我们提出的假设是，晚期癌症也是一种心力衰竭综合征。它可以独立于抗癌治疗的心脏毒性作用发展，也可以在抗癌治疗的心脏毒性作用之外发展。这包括增加室性心律失常的风险。我们认为，这些进展的病理生理学联系包括由于组织内稳态改变导致的全身性肌肉萎缩(即肌质疏松症)，从而导致心脏损耗相关的心肌病。心脏萎缩与室壁变薄会增加室壁应力，即使在没有扩大的情况下也是如此。此外，影响电细胞和传导通路的结构和功能的细胞损耗过程也可能导致心律失常。我们提出，在一些晚期癌症(但不是晚期癌症)患者中，心力衰竭治疗或除颤器可能是相关的治疗选择。选择患者接受此类治疗的关键点可能是预期寿命、干预时的生活质量、症状负担以及进一步抗癌治疗的后果。晚期癌症的死亡原因很难确定，关于癌症事件定义的共识尚未建立。需要对此进行临床研究。当以癌症患者的心血管问题为目标时，必须考虑更广泛的伦理考虑。我们认为，专注于评估癌症中的心脏损耗和心律失常将预示着心脏肿瘤学领域的进一步发展。
We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti‐cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways. We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti‐cancer therapies. The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients. We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio‐oncology.
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影响因子：
10.8
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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晚期癌症也是一种心力衰竭综合征：一种假设。
DOI：
10.1002/jcsm.12694
发表时间：
2021-06
期刊：
Journal of cachexia, sarcopenia and muscle
影响因子：
--
作者：
Anker MS;Sanz AP;Zamorano JL;Mehra MR;Butler J;Riess H;Coats AJS;Anker SD
通讯作者：
Anker SD