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Monday, October 03, 2016

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity



open access:
2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines | European Heart Journal

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1. Introduction
Advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects.1,2 Cardiovascular diseases (CVDs) are one of the most frequent of these side effects, and there is a growing concern that they may lead to premature morbidity and death among cancer survivors.3 This may be the result of cardiotoxicity, which involves direct effects of the cancer treatment on heart function and structure, or may be due to accelerated development of CVD, especially in the presence of traditional cardiovascular risk factors.4
Although the field of cardio-oncology has received increasing attention in recent years, many aspects of both radiation-induced and cancer drug–induced CVD are still to be fully elucidated. Furthermore, the inability to predict the long-term consequences of cancer treatment–associated cardiovascular side effects leads to under- or overdiagnosis of CVD, sometimes resulting in the failure to prevent adverse events and sometimes to inappropriate interruption of a potentially lifesaving cancer treatment.
The complex issue of CVD as a consequence of previous cancer treatment requires the creation of multidisciplinary teams involving specialists in cardiology, oncology and other related fields.....

Abbreviations and acronyms

2-D
two-dimensional
3-D
three-dimensional
5-FU
5-fluorouracil
ACE
angiotensin-converting enzyme
ARB
angiotensin II receptor blocker
ASE
American Society of Echocardiography
BNP
B-type natriuretic peptide
CABG
coronary artery bypass graft
CAD
coronary artery disease
CHA2DS2-VASc
Congestive heart failure or left ventricular dysfunction, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female)
CMR
cardiac magnetic resonance
COT
registry Cardiac Oncology Toxicity registry
CT
computed tomography
CTRCD
Cancer Therapeutics–Related Cardiac Dysfunction
CVD
cardiovascular disease
EACVI
European Association of Cardiovascular Imaging
ECG
electrocardiogram / electrocardiographic
ESC
European Society of Cardiology
GLS
global longitudinal strain
GY
gray
HAS-BLED
Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly (1 point each)
HDAC
histone deacetylase
HER2
human epidermal growth factor receptor 2
HF
heart failure
LMWH
low molecular weight heparin
LV
left ventricle / left ventricular
LVEF
left ventricular ejection fraction
NA
not available
NOAC
non-vitamin K antagonist oral anticoagulant
NT-proBNP
N-terminal pro-B-type natriuretic peptide
NYHA
New York Heart Association
PAD
peripheral artery disease
PAH
pulmonary arterial hypertension
PCI
percutaneous coronary intervention
RCT
randomized controlled trial
T-DM1
trastuzumab-emtansine
TKI
tyrosine kinase inhibitor
VEGF
vascular endothelial growth factor
VHD
valvular heart disease
VKA
vitamin K antagonist
VTE
venous thromboembolism
WHO
World Health Organization

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