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Pubblicazioni recenti - cardio-oncology
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Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement.
Curr Cardiol Rep2022 Jun;():. doi: 10.1007/s11886-022-01732-2.
Ahmad Javaria, Muthyala Anjani, Kumar Ashish, Dani Sourbha S, Ganatra Sarju,
Abstract
PURPOSE OF REVIEW:
The purpose of this article is to provide a comprehensive review of available data on health disparities and the interconnected social determinants of health (SDOH) in cardio-oncology. We identify the gaps in the literature and suggest areas for future research. In addition, we propose strategies to address these disparities at various levels.
RECENT FINDINGS:
There has been increasing recognition of health disparities and the role of SODH on an individual's access to health care, quality of care, and outcomes of the illness. There is growing evidence of sex and race-based differences in cancer therapy-related cardiotoxicity. Recent studies have shown how access and quality of health care are affected by financial stability and rurality. Our recent study utilizing the social vulnerability index (SVI) and county-level patient data found graded increase in county-level cardio-oncology mortality with greater social vulnerability. The incremental impact of social vulnerability was higher for cardio-oncology mortality than for mortality related to either cancer or CVD alone. The mortality rates in these patients were higher in rural areas compared to urban areas regardless of social vulnerability. Additionally, for those within the counties within highest social vulnerability, Black individuals had significantly higher cardio-oncology mortality compared with White individuals. Disparities in the cardio-oncology population are deep-rooted and widespread, leading to poor quality of life and increased mortality. It is crucial to integrate SDOH, not only in clinical care delivery but also in future research, and registry data to improve our understanding and the outcomes in our unique subset of cardio-oncology patients.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Commentary on "Risk of venous thromboembolism after COVID-19 vaccination".
J Thromb Haemost -
Cardiovascular Morbidity and Mortality in Men - Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone.
J Sex Med2022 Jun;():. doi: S1743-6095(22)01462-X.
Fallara Giuseppe, Pozzi Edoardo, Belladelli Federico, Corsini Christian, Boeri Luca, Capogrosso Paolo, Montorsi Francesco, Salonia Andrea,
Abstract
BACKGROUND:
In the context of established male hypogonadism, testosterone therapy (TTh) has been employed to regain physiologic levels of circulating testosterone and improve sexual function and overall quality of life.
AIM:
To assess the risk of cardiovascular disease and mortality as time-dependent outcomes in treated vs TTh untreated hypogonadal men.
METHODS:
A meta-analysis using weighted time-related measure of risk (hazard ratios (HRs)) for each of the outcome for all included studies was performed. Studies investigating male adults (?18 years old) diagnosed with hypogonadism and divided into 2 arms (a treatment arm [any TTh] and a control arm [observation or placebo]) and assessing the risk of death and/or cardiovascular events were included. Single arm, non-comparative studies were excluded as well as studies that did not report the HRs for the chosen outcomes. This systemic review was registered on PROSPERO (CRD42022301592) and performed according to MOOSE and PRISMA guidelines.
OUTCOMES:
Overall mortality and cardiovascular events of any type.
RESULTS:
Overall, 10 studies were included in the meta-analysis, involving 179,631 hypogonadal men. Hypogonadal men treated with TTh were found to be at lower mortality risk from all causes relative to the control (observation or palcebo) arm (HR: 0.70; 95% Confidence Interval [CI]: 0.54-0.90; P
CLINICAL IMPLICATIONS:
TTh in hypogonadal men might play a role in reducing the overall risk of death without increasing cardiovascular events risk.
STRENGTHS & LIMITATION:
Main limitations are represented by the high heterogeneity among the studies in terms of included population, definition for hypogonadism, type of TTh, definition of cardio-vascular event used, and the length of follow-up.
CONCLUSION:
According to time-related measures of risk only, an increased risk of long-term morbidity and early mortality for untreated hypogonadal men was depicted, further outlining the clinical importance and safety of TTh in true hypogonadal men, with the urgent need of collecting long-term follow-up data. Fallara G, Pozzi E, Belladelli F, et al. Cardiovascular Morbidity and Mortality in Men - Findings From a Meta-analysis on the Time-related Measure of Risk of Exogenous Testosterone. J Sex Med 2022;XX:XXX-XXX.
Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
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Emergency department cardiovascular disease encounters and associated mortality in patients with cancer: A study of 20.6 million records from the USA.
Int J Cardiol2022 Jun;():. doi: S0167-5273(22)01005-1.
Kobo Ofer, Moledina Saadiq M, Raisi-Estabragh Zahra, Shanmuganathan Jan Walter Dhillon, Chieffo Alaide, Al Ayoubi Fakhr, Alraies M Chadi, Biondi-Zoccai Giuseppe, Elgendy Islam Y, Mohamed Mohamed O, Roguin Ariel, Freeman Phillip, Mamas Mamas A,
Abstract
BACKGROUND:
there is limited data on Emergency department (ED) cardiovascular disease (CVD) presentations and outcomes amongst cancer patients.
OBJECTIVES:
The present study aimed to describe the clinical characteristics, prevalence, and clinical outcomes of the most common cardiovascular ED admissions in patients with cancer.
METHODS:
All ED encounters with a primary CVD diagnosis from the US Nationwide Emergency Department Sample between January 2016 to December 2018 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios of in-hospital mortality in different groups.
RESULTS:
From a total of 20,737,247 ED encounters with a primary CVD diagnosis, cancer was present in 3.4%. In patients with cancer the most common CVDs were DVT/PE (20%), hypertensive heart or kidney disease (14.7%), and AF/flutter (11.2%). The distribution of CVDs varied by cancer type, with AF/flutter most common in patients with lung cancer, AMI most common in patients with prostate cancer, heart failure most common in those with haematological malignancies, and patients with colorectal cancer having the greatest frequency of DVT/PE. Cancer status was independently associated with significantly higher risk of mortality in almost all CVD categories, consistent across all the cancer types, amongst which lung cancer patients had the highest risk of mortality across all CVD categories, except intracranial haemorrhage and hypertensive crisis.
CONCLUSIONS:
Cardiovascular presentations to the ED varied by cancer subtype. Across all cancer subtypes, patients presenting with cardiovascular presentations carried a significantly increased risk of mortality compared to patients with no cancer.
Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.
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Cardiovascular Toxicities with Chimeric Antigen Receptor T-cell Therapy.
Curr Cardiol Rev2022 Jun;():. doi: 10.2174/1573403X18666220623152350.
Gill Jashan,
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has shown remarkable efficacy in treating highly refractory and relapsing hematological malignancies in pediatric and adult patients. However, this promising therapy is limited by severe and potentially life-threatening toxicities. Cytokine release syndrome (CRS) is the most commonly observed of these toxicities. The cardiovascular manifestations of CRS include tachycardia, hypotension, left ventricular dysfunction, arrhythmias, troponin elevation, cardiogenic shock, and pulmonary edema. Recent data suggest that cardiotoxicities may be transient and reversible in younger patients with few cardiac comorbidities; however, cardiotoxicities may be fatal in older patients with significant cardiac risk factors. The literature remains sparse regarding long-term cardiotoxicities associated with CAR-T cell therapy. Furthermore, consensus guidelines for monitoring and prevention of cardiotoxicities remain ill-defined. Therefore, this review will detail the cardiovascular toxicities of CAR T-cell therapy seen in clinical trials and observational studies, summarize treatment approaches for CRS, outline the currently adopted surveillance protocols for CAR T-cell associated cardiotoxicity, and explore the future directions of research in this rapidly emerging field.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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New Insights on the Toxicity on Heart and Vessels of Breast Cancer Therapies.
Med Sci (Basel)2022 May;10(2):. doi: 27.
Lanza Oreste, Ferrera Armando, Reale Simone, Solfanelli Giorgio, Petrungaro Mattia, Tini Melato Giacomo, Volpe Massimo, Battistoni Allegra,
Abstract
Cardiovascular diseases are largely represented in patients with cancer and appear to be important side effects of cancer treatments, heavily affecting quality of life and leading to premature morbidity and death among cancer survivors. In particular, treatments for breast cancer have been shown to potentially play serious detrimental effects on cardiovascular health. This review aims to explore the available literature on breast cancer therapy-induced side effects on heart and vessels, illustrating the molecular mechanisms of cardiotoxicity known so far. Moreover, principles of cardiovascular risk assessment and management of cardiotoxicity in clinical practice will also be elucidated. Chemotherapy (anthracycline, taxanes, cyclophosphamide and 5-fluorouracil), hormonal therapy (estrogen receptor modulator and gonadotropin or luteinizing releasing hormone agonists) and targeted therapy (epidermal growth factor receptor 2 and Cyclin-dependent kinases 4 and 6 inhibitors) adverse events include arterial and pulmonary hypertension, supraventricular and ventricular arrhythmias, systolic and diastolic cardiac dysfunction and coronary artery diseases due to different and still not well-dissected molecular pathways. Therefore, cardiovascular prevention programs and treatment of cardiotoxicity appear to be crucial to improve morbidity and mortality of cancer survivors.
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Potential pathophysiologic mechanisms underlying the inherent risk of cancer in patients with atherosclerotic cardiovascular disease.
Int J Cardiol2022 Jun;():. doi: S0167-5273(22)00947-0.
Di Fusco Stefania Angela, Cianfrocca Cinzia, Bisceglia Irma, Spinelli Antonella, Alonzo Alessandro, Mocini Edoardo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Imperoli Giuseppe, Colivicchi Furio,
Abstract
Emerging evidence demonstrates an intimate interplay between cardiovascular disease and cancer pathophysiology. The aim of this review is to shed light on the common biological pathways underlying cardiovascular disease and cancer. These common pathways form the basis of "reverse cardio-oncology". We focus on the role of inflammation, stress response, cell proliferation, angiogenesis and tissue remodeling, neurohormonal system activation, and genomic instability as pathogenic pathways shared by cardiovascular disease and cancer. We also discuss shared mediators that may have a potential role as biomarkers for risk prediction in both diseases. Furthermore, we highlight current knowledge on biological pathways and mediators that are upregulated in diabetes and myocardial infarction and may be involved in tumorigenesis. On the basis of the shared pathophysiologic mechanisms, we also suggest an integrated approach to reduce the global burden of both cardiovascular disease and cancer.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Artificial intelligence opportunities in cardio-oncology: Overview with spotlight on electrocardiography.
Am Heart J Plus2022 Mar;15():. doi: 100129.
Martinez Daniel Sierra-Lara, Noseworthy Peter A, Akbilgic Oguz, Herrmann Joerg, Ruddy Kathryn J, Hamid Abdulaziz, Maddula Ragasnehith, Singh Ashima, Davis Robert, Gunturkun Fatma, Jefferies John L, Brown Sherry-Ann,
Abstract
Cardiovascular disease is a leading cause of death among cancer survivors, second only to cancer recurrence or development of new tumors. Cardio-oncology has therefore emerged as a relatively new specialty focused on prevention and management of cardiovascular consequences of cancer therapies. Yet challenges remain regarding precision and accuracy with predicting individuals at highest risk for cardiotoxicity. Barriers such as access to care also limit screening and early diagnosis to improve prognosis. Thus, developing innovative approaches for prediction and early detection of cardiovascular illness in this population is critical. In this review, we provide an overview of the present state of machine learning applications in cardio-oncology. We begin by outlining some factors that should be considered while utilizing machine learning algorithms. We then examine research in which machine learning has been applied to improve prediction of cardiac dysfunction in cancer survivors. We also highlight the use of artificial intelligence (AI) in conjunction with electrocardiogram (ECG) to predict cardiac malfunction and also atrial fibrillation (AF), and we discuss the potential role of wearables. Additionally, the article summarizes future prospects and critical takeaways for the application of machine learning in cardio-oncology. This study is the first in a series on artificial intelligence in cardio-oncology, and complements our manuscript on echocardiography and other forms of imaging relevant to cancer survivors cared for in cardiology clinical practice.
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Utility and Drawbacks of Chimeric Antigen Receptor T Cell (CAR-T) Therapy in Lung Cancer.
Front Immunol2022 ;13():903562. doi: 10.3389/fimmu.2022.903562.
Kandra Prameela, Nandigama Rajender, Eul Bastian, Huber Magdalena, Kobold Sebastian, Seeger Werner, Grimminger Friedrich, Savai Rajkumar,
Abstract
The present treatments for lung cancer include surgical resection, radiation, chemotherapy, targeted therapy, and immunotherapy. Despite advances in therapies, the prognosis of lung cancer has not been substantially improved in recent years. Chimeric antigen receptor (CAR)-T cell immunotherapy has attracted growing interest in the treatment of various malignancies. Despite CAR-T cell therapy emerging as a novel potential therapeutic option with promising results in refractory and relapsed leukemia, many challenges limit its therapeutic efficacy in solid tumors including lung cancer. In this landscape, studies have identified several obstacles to the effective use of CAR-T cell therapy including antigen heterogeneity, the immunosuppressive tumor microenvironment, and tumor penetration by CAR-T cells. Here, we review CAR-T cell design; present the results of CAR-T cell therapies in preclinical and clinical studies in lung cancer; describe existing challenges and toxicities; and discuss strategies to improve therapeutic efficacy of CAR-T cells.
Copyright © 2022 Kandra, Nandigama, Eul, Huber, Kobold, Seeger, Grimminger and Savai.
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Translational Cardio-Oncology Research to Promote Better Outcomes for One and All.
Heart Fail Clin2022 Jul;18(3):xv-xvii. doi: S1551-7136(22)00038-1.
Baliga Ragavendra R, Mensah George A, Bossone Eduardo,
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Spectrum of National Institutes of Health-Funded Research in Cardio-Oncology: A Basic, Clinical, and Observational Science Perspective.
Heart Fail Clin2022 Jul;18(3):515-528. doi: S1551-7136(22)00001-0.
Adhikari Bishow B, Shi Scarlet, Dimond Eileen P, Shelburne Nonniekaye, Desvigne-Nickens Patrice, Minasian Lori M,
Abstract
Advances in cancer treatments have led to nearly 17 million survivors in the US today. Cardiovascular complications attributed to cancer treatments are the leading cause of morbidity and mortality in cancer survivors. In response, NCI and NHLBI held 2 workshops and issued funding opportunities to strengthen research on cardiotoxicity. A representative portfolio of NIH grants categorizing basic, interventional, and observational projects is presented. Compared with anthracyclines, research on radiation therapy and newer treatments is underrepresented. Multidisciplinary collaborative research that considers the cardiotoxicity stage and optimizes the balance between cardiovascular risk and cancer-treatment benefit might support continued improvements in cancer outcomes.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Training and Career Development in Cardio-Oncology Translational and Implementation Science.
Heart Fail Clin2022 Jul;18(3):503-514. doi: S1551-7136(22)00015-0.
Brown Sherry-Ann, Yang Eric H, Branch Mary, Beavers Craig, Blaes Anne, Fradley Michael G, Cheng Richard K,
Abstract
Cardiovascular disease is a leading cause of death in cancer survivors, after recurrence of the primary tumor or occurrence of a secondary malignancy. Consequently, the interdisciplinary field of cardio-oncology has grown rapidly in recent years to address the cardiovascular care needs of this unique population through clinical care and research initiatives. Here, the authors discuss the ideal infrastructure for training and career development in cardio-oncology translational and implementation science and emphasize the importance of the multidisciplinary cardiovascular team for both research and patient care. Cardio-oncology training opportunities in general cardiology, hematology/oncology, and specialized cardio-oncology clinical and research fellowships are also considered.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Clinical Practice Guidelines in Cardio-Oncology.
Heart Fail Clin2022 Jul;18(3):489-501. doi: S1551-7136(22)00003-4.
Leong Darryl P, Lenihan Daniel J,
Abstract
Consensus statements on recommended definitions and practice in cardio-oncology have been developed. There is recognition of the potential for anthracyclines, trastuzumab, pertuzumab, immune checkpoint inhibitors, tyrosine kinase inhibitors, cyclophosphamide, and radiotherapy to cause left ventricular dysfunction and heart failure with heterogeneous natural histories. Cardiac function should be evaluated by echocardiography before the initiation of these therapies. For the prevention of cardiotoxicity, there is evidence to support the use of dexrazoxane under specific circumstances; existing research does not support the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or ?-blockers in unselected individuals but should be considered in specific instances.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Cardiovascular Imaging in Cardio-Oncology: The Role of Echocardiography and Cardiac MRI in Modern Cardio-Oncology.
Heart Fail Clin2022 Jul;18(3):455-478. doi: S1551-7136(22)00008-3.
Gambril John Alan, Chum Aaron, Goyal Akash, Ruz Patrick, Mikrut Katarzyna, Simonetti Orlando, Dholiya Hardeep, Patel Brijesh, Addison Daniel,
Abstract
Cardiovascular (CV) events are an increasingly common limitation of effective anticancer therapy. Over the last decade imaging has become essential to patients receiving contemporary cancer therapy. Herein we discuss the current state of CV imaging in cardio-oncology. We also provide a practical apparatus for the use of imaging in everyday cardiovascular care of oncology patients to improve outcomes for those at risk for cardiotoxicity, or with established cardiovascular disease. Finally, we consider future directions in the field given the wave of new anticancer therapies.
Copyright © 2022 Elsevier Inc. All rights reserved.
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T-cell Immunotherapy and Cardiovascular Disease: Chimeric Antigen Receptor T-cell and Bispecific T-cell Engager Therapies.
Heart Fail Clin2022 Jul;18(3):443-454. doi: S1551-7136(22)00009-5.
Stein-Merlob Ashley F, Ganatra Sarju, Yang Eric H,
Abstract
Chimeric antigen receptor (CAR) T-cell and bispecific T-cell engager (BiTE) therapies have revolutionized the treatment of refractory or relapsed leukemia and lymphoma. Increased use of these therapies has revealed signals of significant cardiotoxicity, including cardiomyopathy/heart failure, arrhythmia, myocardial injury, hemodynamic instability, and cardiovascular death mainly in the context of a profound inflammatory response to CAR T-cell antitumor effects known as cytokine release syndrome (CRS). Preexisting cardiovascular risk factors and disease may increase the risk of such cardiotoxicity. High index of suspicion and close monitoring is required for prompt recognition. Supportive hemodynamic care and targeted anti-IL-6 therapy, as well as possibly broader immunosuppression with corticosteroids, are the cornerstones of the management.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Intracellular Signaling Pathways Mediating Tyrosine Kinase Inhibitor Cardiotoxicity.
Heart Fail Clin2022 Jul;18(3):425-442. doi: S1551-7136(22)00004-6.
Scott Shane S, Greenlee Ashley N, Matzko Anna, Stein Matthew, Naughton Michael T, Zaramo Taborah Z, Schwendeman Ethan J, Mohammad Somayya J, Diallo Mamadou, Revan Rohith, Shimmin Gabriel, Tarun Shwetabh, Ferrall Joel, Ho Thai H, Smith Sakima A,
Abstract
Tyrosine kinase inhibitors (TKIs) are used to treat several cancers; however, a myriad of adverse cardiotoxic effects remain a primary concern. Although hypertension (HTN) is the most common adverse effect reported with TKI therapy, incidents of arrhythmias (eg, QT prolongation, atrial fibrillation) and heart failure are also prevalent. These complications warrant further research toward understanding the mechanisms of TKI-induced cardiotoxicity. Recent literature has given some insight into the intracellular signaling pathways that may mediate TKI-induced cardiac dysfunction. In this article, we discuss the cardiotoxic effects of TKIs on cardiomyocyte function, signaling, and possible treatments.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Understanding Myocardial Metabolism in the Context of Cardio-Oncology.
Heart Fail Clin2022 Jul;18(3):415-424. doi: S1551-7136(22)00005-8.
Liu Jing, Chen Zsu-Zsu, Patel Jagvi, Asnani Aarti,
Abstract
Cardiovascular events, ranging from arrhythmias to decompensated heart failure, are common during and after cancer therapy. Cardiovascular complications can be life-threatening, and from the oncologist's perspective, could limit the use of first-line cancer therapeutics. Moreover, an aging population increases the risk for comorbidities and medical complexity among patients who undergo cancer therapy. Many have established cardiovascular diagnoses or risk factors before starting these therapies. Therefore, it is essential to understand the molecular mechanisms that drive cardiovascular events in patients with cancer and to identify new therapeutic targets that may prevent and treat these 2 diseases. This review will discuss the metabolic interaction between cancer and the heart and will highlight current strategies of targeting metabolic pathways for cancer treatment. Finally, this review highlights opportunities and challenges in advancing our understanding of myocardial metabolism in the context of cancer and cancer treatment.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Radiation-Induced Cardiac Dysfunction: Optimizing Radiation Delivery and Postradiation Care.
Heart Fail Clin2022 Jul;18(3):403-413. doi: S1551-7136(22)00013-7.
Pedersen Lauren N, Khoobchandani Menka, Brenneman Randall, Mitchell Joshua D, Bergom Carmen,
Abstract
Radiation therapy (RT) is part of standard-of-care treatment of many thoracic cancers. More than 60% of patients receiving thoracic RT may eventually develop radiation-induced cardiac dysfunction (RICD) secondary to collateral heart dose. This article reviews factors contributing to a thoracic cancer patient's risk for RICD, including RT dose to the heart and/or cardiac substructures, other anticancer treatments, and a patient's cardiometabolic health. It is also discussed how automated tracking of these factors within electronic medical record environments may aid radiation oncologists and other treating physicians in their ability to prevent, detect, and/or treat RICD in this expanding patient population.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Cardioprotection of High-Risk Individuals.
Heart Fail Clin2022 Jul;18(3):385-402. doi: S1551-7136(22)00002-2.
Upshaw Jenica N, Mohanty Sharanya, Rastogi Akash,
Abstract
Targeting cardioprotective strategies to patients at the highest risk for cardiac events can help maximize therapeutic benefits. Dexrazoxane, liposomal formulations, continuous infusions, and neurohormonal antagonists may be useful for cardioprotection for anthracycline-treated patients at the highest risk for heart failure. Prevalent cardiovascular disease is a risk factor for cardiac events with many cancer therapies, including anthracyclines, anti-human-epidermal growth factor receptor-2 therapy, radiation, and BCR-Abl tyrosine kinase inhibitors, and may be a risk factor for cardiac events with other therapies. Although evidence for cardioprotective strategies is sparse for nonanthracycline therapies, optimizing cardiac risk factors and prevalent cardiovascular disease may improve outcomes.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Arrhythmic Complications Associated with Cancer Therapies.
Heart Fail Clin2022 Jul;18(3):375-383. doi: S1551-7136(22)00007-1.
Pothineni Naga Venkata K, Van Besien Herman, Fradley Michael G,
Abstract
Over the last several decades, advancements in cancer screening and treatment have significantly improved cancer mortality and overall quality of life. Unfortunately, non-cancer-related side effects, including cardiovascular toxicities can impact the continued delivery of these treatments. Arrhythmias are an increasingly recognized class of cardiotoxicity that can occur as a direct consequence of the treatment or secondary to another type of toxicity such as heart failure, myocarditis, or ischemia. Atrial arrhythmias, particularly atrial fibrillation (AF) are most commonly encountered, however, ventricular- and bradyarrhythmias can also occur, albeit at lower rates. Treatment strategies tailored to patients with cancer are essential to allow for the safe delivery of the cancer treatment without affecting short- or long-term oncologic or cardiovascular outcomes.
Copyright © 2022 Elsevier Inc. All rights reserved.
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