ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008 (ending).

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Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2008 (ending)

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2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS).

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Background: Cardiotoxicity is an important and a common complication of cancer chemotherapeutic drugs. It may not only be associated with significant morbidity and mortality but also often becomes a limiting factor in adequate anti-cancer treatment. Several pharmacological agents are being evaluated for their efficacy in preventing cardiotoxicity of the cancer drugs.

Material and methods: Ninety patients with hematological malignancies undergoing chemotherapy and/or autologous hematopoietic stem cell transplantation (HSCT) were recruited in this study and were randomized to receive a combination of enalapril and cardvedilol (intervention arm) or no intervention (control arm). Comprehensive echocardiography and cardiac magnetic resonance imaging (MRI) were performed at baseline and at 6 months after randomization. The primary efficacy endpoint was the absolute change from baseline in left ventricular ejection fraction (LVEF).

Results: The mean age of the study subjects was 50 ± 13 years. By the end of the 6 months, there was a significant fall in LVEF in controls (3.28% absolute reduction from baseline) but no change was seen in the intervention group. As a result, at 6 months, LVEF was significantly lower in the control group in comparison to the intervention group (an absolute difference of 3.1% by echocardiography and 3.4% by cardiac MRI, p = 0.035 and 0.09, respectively). The beneficial effect was seen almost exclusively in patients receiving chemotherapy alone (absolute difference in LVEF of 6.38% at 6 months, p = 0.025) and not in those undergoing HSCT (absolute difference of 1.01%, p = 0.56). In addition, compared to controls, patients in the intervention group had a lower incidence of the combined event of death or heart failure (6.7% vs. 22%, p = 0.036) and of death, heart failure, or a final LVEF <45% (6.7% vs. 24.4%, p = 0.02).

Conclusions: The present trial showed that a combination of enalapril and carvedilol might prevent cardiotoxicity in patients undergoing chemotherapy for hematological malignancies.

Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies. The OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies)

Aims Anticancer therapies have extended the lives of millions of patients with malignancies, but for some this benefit is tempered by adverse cardiovascular (CV) effects. Cardiotoxicity may occur early or late after treatment initiation or termination. The extent of this cardiotoxicity is variable, depending on the type of drug used, combination with other drugs, mediastinal radiotherapy, the presence of CV risk factors, and comorbidities. A recent position paper from the European Society of Cardiology addressed the management of CV monitoring and management of patients treated for cancer. Methods and results The current document is focused on the basis of the Cardio-Oncology (C-O) Services, presenting their rationale, organization, and implementation. C-O Services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardiotoxicity and/or with concomitant CV diseases. These services require a multidisciplinary approach, with the aims of promoting CV health and facilitating the most effective cancer therapy. Conclusion The expected growing volume of patients with cancer at risk of developing/worsening CV disease, the advent of new technological opportunities to refine diagnosis, and the necessity of early recognition of cancer therapy-related toxicity mandate an integrative multidisciplinary approach and care in a specialized environment. This document from the ESC Cardio-Oncology council proposes the grounds for creating C-O Services in Europe based on expert opinion.

Cardio-Oncology Services: rationale, organization, and implementation A report from the ESC Cardio-Oncology council

Improvements in early detection and treatment have markedly reduced cancer-related mortality. However survival not only depends on effectively cure cancer, but prevention, diagnosis and treatment of cancer-related complications is also needed. Cardiovascular toxicity is a widespread problem across many classes of therapeutic schemes, however scientific evidence in the management of cardiovascular complications of onco-hematological patients is scarce, as these patients have been systematically excluded from clinical trials and current recommendations are based on expert consensus. Multidisciplinary teams are mandatory to decrease morbidity and mortality from both cardiotoxicity and cancer itself. An excessive concern for the occurrence of cardiovascular toxicity, can avoid potentially curative therapies, while underestimating this risk, increases long-term mortality of cancer survivors. The objective of this consensus document, developed in collaboration of the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology and the Spanish Society of Hematology, is to update the necessary concepts and expertise on cardio-onco-hematology that enable its application in daily clinical practice and to promote the development of local multidisciplinary teams, to improve the cardiovascular health of patients with cancer.

Cardio-Onco-Hematology in Clinical Practice. Position Paper and Recommendations.

Resumen Los avances en la deteccion precoz y el tratamiento del cancer han reducido de manera significativa la mortalidad de los pacientes. Sin embargo, mejorar el pronostico no es solo curar el tumor, sino prevenir, diagnosticar y tratar eficazmente las complicaciones derivadas de las terapias onco-hematologicas. La toxicidad cardiovascular es un problema ampliamente reconocido con multiples esquemas terapeuticos; sin embargo, la evidencia cientifica en el manejo de las complicaciones cardiovasculares de pacientes onco-hematologicos es escasa, pues sistematicamente se ha excluido de los ensayos clinicos a estos enfermos y las recomendaciones actuales estan basadas en consensos de expertos. Es imprescindible crear equipos multidisciplinarios locales para optimizar los resultados en salud de los supervivientes al cancer. Una preocupacion excesiva por la aparicion de toxicidad cardiovascular puede impedir terapias potencialmente curativas, mientras que la subestimacion de este riesgo compromete el pronostico vital a largo plazo. El objetivo de este documento, elaborado en colaboracion con la Sociedad Espanola de Cardiologia, la Sociedad Espanola de Oncologia Medica, la Sociedad Espanola de Oncologia Radioterapica y la Sociedad Espanola de Hematologia, es actualizar los conocimientos aplicables a la practica clinica diaria de la cardio-onco-hematologia y promover el desarrollo de equipos multidisciplinarios locales que mejoren la salud cardiovascular de los pacientes con cancer.

Ana Santaballa Beltrán

Papers

Cardio-Onco-Hematology in Clinical Practice. Position Paper and Recommendations.

Cardio-Onco-Hematología en la práctica clínica. Documento de consenso y recomendaciones