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Vol. 75. Issue 8.
Pages 695-696 (August 2022)
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Vol. 75. Issue 8.
Pages 695-696 (August 2022)
Letter to the Editor
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Cardio-oncology at present: a pending challenge
Cardio-oncología en la actualidad: un reto pendiente
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Víctor Juárez Olmosa,
Corresponding author
victormjo92@gmail.com

Corresponding author:.
, Andrea Severo Sáncheza, Pilar Zamora Auñónb, Teresa López-Fernándeza
a Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, España
b Servicio de Oncología, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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María de Regla Caballero Valderrama, María Luisa Peña Peña, Silvia Navarro Herrero, María Pilar Serrano Gotarredona, José Eduardo López Haldón
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To the Editor,

We have read with considerable interest the scientific letter by Caballero Valderrama et al.1 regarding anthracycline-related onset of ventricular dysfunction associated with familial dilated cardiomyopathy. The early diagnosis and management of the cardiovascular toxicity associated with anticancer drugs is an ever-growing challenge, from both clinical and research perspectives. Undoubtedly, the risk of cardiovascular toxicity is the result of a complex interaction among the characteristics of both the patient (eg, age, genetics, and cardiovascular risk) and the tumor itself, as well as the type and length of the proposed treatment.2

Current cardio-oncology strategies recommend individualized assessment of the cardiovascular toxicity risk in all patients who may be receiving potentially cardiotoxic anticancer therapies.3 Based on this risk, prevention and monitoring protocols have been established for during and after the cancer treatment, as well as recommendations for optimizing the management of related cardiovascular events.4,5

We consider highly pertinent the publication of this late example of cardiovascular disease related to anthracyclines and radiotherapy1,2 because it reminds clinicians that they should consider cancer treatment to be a cardiovascular risk factor3 and because it exemplifies the need for multidisciplinary teams coordinating among the different levels of care.

We agree with the authors that the performance of a genetic study in patients with a family history compatible with heart disease could improve the prevention of cardiotoxicity risk. However, in terms of genetics and personalized medicine in cardio-oncology, there is still a long way to go.3,6 Until then, cardiovascular risk should be stratified before, during, and after cancer treatment to optimize the control of cardiovascular risk factors and detect subclinical phases of myocardial damage. In line with the current consensus, the reported patient had an intermediate risk of anthracycline-related toxicity, and the combination of anthracycline with radiotherapy would increase this risk in the mid-to-long–term.4,5 In this regard, monitoring of biomarkers,7 electrocardiography, and imaging techniques8 before, during, and 12 months after treatment completion could have detected subclinical changes in cardiac function requiring a more detailed long-term follow-up.5,6 Based on the authors’ report, the electrocardiographic changes could have predicted the cardiac damage.1 The cardiovascular monitoring of cardiotoxic treatments4 is a class I recommendation with level of evidence B in the 2021 European guidelines on cardiovascular disease prevention3 and most of the tests mentioned are easily accessed.

Ultimately, all of this underlines the importance of the creation of multidisciplinary programs and pragmatic intervention protocols permitting the optimal screening and follow-up of cardiovascular disease in cancer patients to improve their outcomes and facilitate their treatment.

FUNDING

The authors state that they have not received external funding for the current work.

AUTHORS’ CONTRIBUTIONS

All of the authors contributed equally to the conception, editing, and critical revision of the article.

CONFLICTS OF INTEREST

The authors declare the absence of conflicts of interest related to the current article.

References
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M.R. Caballero Valderrama, M.L. Peña Peña, S. Navarro Herrero, M.P. Serrano Gotarredona, J.E. López Haldón.
Dilated cardiomyopathy due to filamin C mutation: anthracycline treatment as a trigger.
Rev Esp Cardiol., 75 (2022), pp. 264-266
[2]
J. Herrmann, D. Lenihan, S. Armenian, et al.
Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement.
Eur Heart J., 43 (2022), pp. 280-299
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F.L.J. Visseren, F. Mach, Y.M. Smulders, et al.
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.
Eur Heart J., 42 (2021), pp. 3227-3337
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A.R. Lyon, S. Dent, S. Stanway, Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society, et al.
Eur J Heart Fail., 22 (2020), pp. 1945-1960
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A. Martín García, C. Mitroi, P. Mazón Ramos, et al.
Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC.
Rev Esp Cardiol., 74 (2021), pp. 438-448
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T. López-Fernández, A. Martín García, A. Santaballa Beltrán, et al.
Cardio-Onco-Hematology in Clinical Practice.
Position Paper and Recommendations. Rev Esp Cardiol., 70 (2017), pp. 474-486
[7]
R. Pudil, C. Mueller, J. Čelutkienė, Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology, et al.
Eur J Heart Fail., 22 (2020), pp. 1966-1983
[8]
J. Čelutkienė, R. Pudil, T. López-Fernández, Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC), et al.
Eur J Heart Fail., 22 (2020), pp. 1504-1524
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