Cancer therapy-induced cardiomyopathy

Modern advances in cancer treatment have resulted in a steady improvement in life expectancy in cancer patients. However, cardiovascular toxicity is one of the most devastating complications threatening to offset the substantive reductions in cancer-related morbidity and mortality that has been achieved with novel chemotherapeutic agents. Cardiologists and oncologists must collaborate closely to provide effective cancer therapy to kill cancer cells while minimizing toxicity to the cardiovascular system. Structural, functional, or biochemical indicators of cardiac injury are emerging as potential markers for early detection of cardiotoxicity. Imaging modalities such as tissue Doppler imaging, strain imaging, and cardiac magnetic resonance imaging have shown promise in earlier detection of cardiotoxicity. Biomarkers such as troponin I may also play an adjunctive role in earlier recognition of cardiotoxicity and identifying high-risk patients. There have been significant advances in the understanding of the mechanisms of cancer therapy-induced cardiotoxicity. These new pathways have been instrumental in the testing of preventive therapies. Several agents have been investigated in their ability to protect normal cardiac tissue during cancer therapy. These include dexrazoxane, angiotensin-converting enzyme inhibitors, and beta-blockers. However, further studies are warranted to clarify the efficacy, safety, and cancer treatment-related effects of these agents. Once clinical signs or symptoms of cardiac dysfunction develop, the patients should be promptly treated with standard heart failure therapy, and offending agents should be stopped. In some patients, cancer therapy may be resumed following the restoration of cardiac function. Close collaboration between the cardiologists and oncologists will herald in a new era where cancer patients will have a healthy heart to enjoy life after cancer therapy.