Advanced cancer is also a heart failure syndrome : a hypothesis
© the Author(s) 2020. This article has been co-published with permission in European Journal of Heart Failure (published by John Wiley & Sons Ltd on behalf of European Society of Cardiology) and Journal of Cachexia, Sarcopenia and Muscle (published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
European journal of heart failure - 23(2021), 1 vom: 01. Jan., Seite 140-144 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Anker, Markus S [VerfasserIn] |
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| Links: |
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| Themen: |
Arrhythmia |
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| Anmerkungen: |
Date Completed 05.07.2021 Date Revised 05.07.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.2071 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318140241 |
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| 520 | |a © the Author(s) 2020. This article has been co-published with permission in European Journal of Heart Failure (published by John Wiley & Sons Ltd on behalf of European Society of Cardiology) and Journal of Cachexia, Sarcopenia and Muscle (published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders). | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Arrhythmia | |
| 650 | 4 | |a Cancer | |
| 650 | 4 | |a Cardiac wasting associated cardiomyopathy | |
| 650 | 4 | |a Heart failure | |
| 700 | 1 | |a Sanz, Ana Pardo |e verfasserin |4 aut | |
| 700 | 1 | |a Zamorano, José L |e verfasserin |4 aut | |
| 700 | 1 | |a Mehra, Mandeep R |e verfasserin |4 aut | |
| 700 | 1 | |a Butler, Javed |e verfasserin |4 aut | |
| 700 | 1 | |a Riess, Hanno |e verfasserin |4 aut | |
| 700 | 1 | |a Coats, Andrew J S |e verfasserin |4 aut | |
| 700 | 1 | |a Anker, Stefan D |e verfasserin |4 aut | |
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