Treating asymptomatic chemotherapy-induced cardiac dysfunction a chance that cardiologists and oncologists should not miss.

摘要

We have read the work by Yoon et al. (1) with great interest. The authors point out that many cancer survivors showing cardiac dysfunction after oncologic therapy do not receive treatment consistent with heart failure guidelines, particularly if they are in the asymptomatic phase of this form of cardiomyopathy. Moreover, they state that it is not clear whether treatment of asymptomatic cardiac dysfunction in cancer patients decreases the risk of developing symptomatic heart failure and adverse cardiac events and that no prospective studies have ever evaluated this topic. However, some stronger and more recent evidence than that reported by the authors-like the work by Haq et al. (2), dating back to 1985, in which patients were treated with only digoxin and diuretics-have been provided with regard to treatment of chemotherapy-induced left ventricular dysfunction with modern heart failure therapy. A few years ago, Tallaj et al. (3) reported that the cardiac prognosis of chemotherapy-induced cardiomyopathy can be positively affected when patients are treated. with angiotensin-converting enzyme inhibitors and that the addition of a beta-blocker might further improve the clinical outcome and reverse left ventricular dysfunction. Moreover, in a recently published prospective study, considering a population of 201 patients with anthracycline-induced cardiomyopathy, we demonstrated that an early treatment including angiotensin-converting enzyme inhibitor and beta-blocker, started within 6 months from the end of chemotherapy, allows for a complete recovery of left ventricular ejection fraction and positively impacts cardiac outcome (4). Notably, the clinical benefit was more evident in asymptomatic patients; indeed, most patients showing a complete recovery from cardiac dysfunction were either asymptomatic or had a low New York Heart Association functional class at the time heart failure therapy was initiated. This suggests that early detection of asymptomatic left ventri...