ESC Congress 2016 - 8

FEATuREd ARTIclE have led to increasing numbers of cancer survivors. Treatment-related illness has become more common than mortality from cancer recurrence in these survivors. Many cancer therapies are cardiotoxic, and CVD is one of the most frequent side effects [Tukenova M et al. J Clin Oncol. 2010]. The field of cardio-oncology is focused on preventing, identifying, and treating CV complications of cancer therapy. Cardiac complications should be detected with ECG, echocardiography, nuclear cardiac imaging, cardiac magnetic resonance, and cardiac biomarkers. The types of complications and associated therapies are listed in Table 7. Cardiotoxicity in cancer patients is managed according to the type of complication, the causative agent, competing risks of cardiac- and cancer-related life expectancy, quality of life, and complication risks. If feasible, consideration should be given to discontinuing cancer therapy, reducing the dose, or using alternative therapy. Management of arrhythmias includes AADs and device therapy. Hypertension is managed according to standard guidelines. Treatments for thromboembolic disease include low-molecular-weight heparin and vitamin K agonists. Severe symptomatic valvular disease is treated with valve replacement. Significant vascular stenosis may require stenting or surgery. Discontinuation of associated cancer therapy may be considered in patients with cardiac dysfunction or HF. Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and ß-blockers are used for cardiac dysfunction. Standard HF therapies are recommended for patients with HF. CAD and ACS are treated according to the manifestation. Vasodilators may be used for patients with CAD or ACS caused by fluoropyrimidines. The ESC position paper recommends long-term surveillance programs for cancer survivors. Patients should be educated about their increased risk of CVD and preventive measures, and instructed to promptly report early signs and symptoms of CVD. GUIDELInES FOR THE MAnAGEMEnT OF HF The 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic HF [Ponikowski P et al. Eur Heart J. 2016; Eur J Heart Fail. 2016] were discussed by Adriaan Voors, MD, University Medical Center Groningen, Groningen, The Netherlands, and Piotr Ponikowski, MD, Wroclaw Medical University, Wroclaw, Poland. Among the updates in the 2016 guidelines are a new HF classification, diagnostic and therapeutic algorithms for acute and chronic HF, additional information on comorbidities and multidisciplinary care, and updated recommendations based on new evidence. Table 7. Types of Cardiovascular Complications and Causes in Treated Cancer Patients CV Complication Frequency and Causes Arrhythmia Present in 16%-36% of patients treated for cancer Associated with many cancer therapies, including anthracyclines, alkylating agents, immune therapies, small-molecule agents, topoisomerase II inhibitors, and others May cause severe symptoms or become life threatening Arterial hypertension Frequent comorbidity in cancer patients Incidence depends on patient age, medical history, type of cancer, drug type and dose, and associated cancer therapies Associated with alkylating agents, VEGF inhibitors, and steroids Thromboembolic disease VTE may affect up to 20% of hospitalized patients The combination of chemotherapy and VEGF inhibitors increases VTE risk 6-fold and recurrent VTE 2-fold Valvular disease Caused by mediastinal RT (up to 10% 10-20 years post treatment) May be due to pre-existing valve lesions, infective endocarditis, or secondary to LV dysfunction Vasculopathy Caused by radiotherapy, occurring > 10 years post RT LV dysfunction Associated with antimicrotubule agents, and HER2, VEGF, BCR-ABL, and proteasome inhibitors Incidence depends on type of drug and dose Heart failure Associated with anthracyclines, alkylating agents, HER2 inhibitors, and VEGF inhibitors CAD and ACS Associated with fluoropyrimidines, platinum compound, VEGF inhibitors, and RT Incidence varies with type of therapy ACS, acute coronary syndrome; CAD, coronary artery disease; HER2, human epidermal growth factor receptor; LV, left ventricular; RT, radiotherapy; VEGF, vascular endothelial growth factor; VTE, venous thromboembolism. 8 October 2016 medicom-publishers.com/mcr http://www.medicom-publishers.com/mcr

Table of Contents for the Digital Edition of ESC Congress 2016