Evaluating the Severity of Coronary Artery Disease in Patients Treated with Chemotherapy: The Further Need for Cardio-Oncology

Cardiovascular toxicity related to cancer therapies has been recognized for years. The number and types of toxicities have increased rapidly due to several factors including new and improved therapies and treatment regimens which have resulted in patients living longer. This is the basis for the burgeoning field of cardio-oncology to help identify cardiotoxicities and aim to minimize adverse outcomes.

Cardiomyopathies related to anthracyclines, which are typically irreversible, and trastuzumab, typically reversible, as well as more recently recognized cardiotoxicities including myocarditis related to immune checkpoint inhibitors have made the evaluation of concomitant cardiac disease critical in the care of patients being treated for cancer. ^, Coronary artery disease (CAD) is also a consequence of cancer therapies and adverse coronary events such as myocardial infarction and thrombosis can complicate treatment and result in poor outcomes. Thus, further understanding of the adverse effects of specific therapies is crucial to assessing patients’ clinical statuses and making decisions on treatment strategies in order to maximize overall outcomes, both oncologic and cardiac. CAD and has been associated with radiation therapy. ^, The risk and anatomic severity of CAD related to radiotherapy treatment has been described. ^, In a study of 152 thoracic cancer survivors who underwent radiotherapy, the investigators observed that the study patients had higher SYNTAX scores and were at a higher risk of developing anatomically severe CAD, independent of chemotherapy. While although CAD is known to be present in patients being treated with chemotherapy, independent of radiotherapy, the association between anatomic severity of CAD and chemotherapy is less well known.

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