About this Research Topic
Cancer and heart disease coexist and the field of cardio-oncology/onco-cardiology is gaining every day in relevance as both fields report success in treatment in their individual arena. This new medical domain has combined the most lethal categories of patients and has exploded in interest, obligating clinicians to clarity and perspective.
There have been three generations of Cardio-Oncologists/Onco-Cardiologists. The first were mainly oncologists who recognized cardiac toxicities, decreased doses, modified schedules of administration of cardiotoxic drugs and changed drugs. Equally as important, they recognized the need for specialized cardiac treatment. This is when Cardio-Oncology developed into a fusion field and included Onco-Cardiology. As this happened almost 40 years ago, limited diagnostic tools (clinical examination, CXR, EMB) and limited treatment options (beta-blockers were prohibitive and ACE inhibitors were in their beginnings) were reflected in a rather heavier oncology perspective in the field.
The second generation were predominantly cardiologists with an interest in cancer patients. They began treating patients with ACE inhibitors/ARB’s and beta-blockers, introduced monitoring toxicity with cardiac biomarkers and recognized the role of echocardiographic studies. They created a new dimension by allowing patients under cardioprotective regimens to continue cancer treatment despite initial toxicities and “balanced the balance”, with both fields becoming more evenly represented.
The third generation slowly nudged the balance towards the cardiology side and included experts in echocardiography (echo with strain/3D echo), multimodality imaging (cardiac CT/MR), advanced heart failure, interventional cardiology and electrophysiology.
We are now preparing for a fourth generation, with skills to facilitate individualized cancer treatment and the new landscape of immunotherapies, “re-balancing the balance”.
This topic will cover the three major moments when cardiologists become involved, each one with both common and specific challenges, highlighting the unique cardiovascular issues of patients that face this double jeopardy of cancer and heart disease. In all aspects, there is a need for risk factor modification, controlling HTN, HL, lifestyle changes, and maintaining CV fitness:
1. Cardiac evaluation before cancer treatment - antiplatelet management, cardioprotection
2. During cancer treatment – cardiotoxicity, acute coronary syndrome, stress-induced cardiomyopathy, myocarditis
3. Cancer survivors – radiation-induced heart disease, vascular toxicities, heart failure
The topic will be informative, extremely clinically useful and modify the approach to the field. The goal will be to fuse the knowledge and wisdom of the previous three onco-cardiologist generations in an attempt to shape the fourth.
Specific themes for authors to address include:
•The incidence, risk factors (including emerging concepts of genetic risks), proposed pathophysiology, and current clinical guidelines for assessing cardiotoxicity from chemotherapy (anthracyclines, trastuzumab and newer HER2 antagonists, vascular endothelial growth factor (VEGF) inhibitors and proteasome inhibitors), immunotherapy or radiation.
•The advantages and disadvantages of various imaging modalities—including 2- and 3-dimensional transthoracic echocardiogram, radionuclide angiography, and cardiac magnetic resonance imaging—and explanations of the role of cardiac biomarkers for detecting cardiotoxicity.
•The unique challenges in treating this population (anemia, thrombocytopenia, and frailty), balancing timelines and risks.
•The explosion of interest and science in the field of cardio-oncology with a focus on genetic predisposition and genomic biomarkers, the role of positron emission
•Topography (including cardiac) and the use of cardiac MRI in diagnosis.
All types of manuscripts are considered, including original basic science reports, translational research, clinical studies, review articles, and methodology papers.
Keywords: Onco-Cardiology, Cardio-Oncology, vascular toxicity, cardiotoxicity, heart failure, anthracycline, tyrosine kinase inhibitors, thrombocytopenia, percutaneous coronary intervention (PCI), aortic stenosis, TAVR
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