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STATE-OF-THE-ART PAPER

Cardiovascular Complications of Cancer Therapy

Incidence, Pathogenesis, Diagnosis, and Management

Edward T.H. Yeh, MD^_*,,_* and Courtney L. Bickford, PharmD, BCPS

^_* Department of Cardiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, Texas
Texas Heart Institute/St. Luke's Episcopal Hospital, Houston, Texas

Manuscript received August 7, 2008; revised manuscript received January 27, 2009, accepted February 6, 2009.

^_* Reprint requests and correspondence: Dr. Edward T. H. Yeh, The University of Texas M. D. Anderson Cancer Center, Department of Cardiology, 1400 Pressler Street, Room 11.5028, Houston, Texas 77030 (Email: etyeh{at}mdanderson.org).

Cancer treatment today employs a combination of chemotherapy, radiotherapy, and surgery to prolong life and provide cure. However, many of these treatments can cause cardiovascular complications such as heart failure, myocardial ischemia/infarction, hypertension, thromboembolism, and arrhythmias. In this article we review the incidence of cardiotoxicity caused by commonly used chemotherapeutic agents as well as discuss the pathogenesis, diagnosis, management, and prevention of these cardiovascular side effects. Cardiotoxicity related to anticancer treatment is important to recognize as it may have a significant impact on the overall prognosis and survival of cancer patients, and it is likely to remain a significant challenge for both cardiologists and oncologists in the future due to an increasing aging population of patients with cancer and the introduction of many new cancer therapies.

Key Words: cancer • cardiotoxicity • therapy • heart failure

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ACS = acute coronary syndrome   ATE = arterial thrombotic event   ATP = adenosine triphosphate   CMP = cardiomyopathy   CTCL = cutaneous T-cell lymphoma   DVT = deep vein thrombosis   FDA = Food and Drug Administration   HF = heart failure   HTN = hypertension   LMWH = low-molecular-weight heparin   LVD = left ventricular dysfunction   LVEF = left ventricular ejection fraction   MI = myocardial infarction   MUGA = multigated acquisition scan   PE = pulmonary embolism   VEGF = vascular endothelial growth factor   VTE = venous thromboembolism   5-FU = 5-fluorouracil

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