Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story

Frontiers in Cardiovascular Medicine

Stefano Oliva¹  Stefania Angela Di Fusco²  Furio Colivicchi²  Fabiana Lucà³  Luigi Tarantini⁴  Paolo Trambaiolo⁵  Antonella Moreo⁶  Giovanna Geraci⁷  Domenico Gabrielli⁸  Michele Massimo Gulizia⁹  Fabrizio Oliva^1,10  Chiara Lestuzzi^1,11  Giuseppina Gallucci^1,12  Nicola Maurea^1,13  Vincenzo Quagliariello^1,13  Fabio Maria Turazza^1,14  Maria Laura Canale^1,15  Iris Parrini^1,16  Giulia Russo^1,17  Irma Bisceglia^1,18 

[1] 0Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy;1Clinical and Rehabilitation Cardiology Department, Ospedale San Filippo Neri, Rome, Italy;2Cardiology Department, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy;3Divisione di Cardiologia, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio-Emilia, Reggio Emilia, Italy;4Cardiology Department, Sandro Pertini Hospital, Rome, Italy;5A. De Gasperis Cardio Center, Aziende Socio Sanitarie Territoriali (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy;6Cardiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy;7Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy;8Cardiology Department, Garibaldi Hospital, Catania, Italy;9Dipartimento Cardiotoracovascolare, Cardiology 1-Cath Lab, Coronary Care Unit (CCU), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;Azienda Sanitaria Friuli Occidentale (ASFO) Cardiac and Cardio-Oncologic Rehabilitation Service at Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy;Cardio-Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Referral Cancer Center of Basilicata, Rionero in Vulture, Italy;Cardiology Department, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy;Cardiology Department, National Cancer Institute Foundation, Milan, Italy;Cardiology Department, Nuovo Ospedale Versilia Lido di Camaiore Lucca, Camaiore, Italy;Cardiology Department, Ospedale Mauriziano Umberto I, Turin, Italy;Cardiovascular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) Trieste, Trieste, Italy;Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy;

关键词: SARS-CoV-2;    COVID-19;    cancer;    cardiovascular disease;    cardiotoxicity;    syndemic;   

DOI  :  10.3389/fcvm.2022.821193

来源: DOAJ

【 摘 要 】

The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced “endothelitis” triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. “Overlapping commonalities” between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a “syndemic.” Another challenging issue is the persistence of the symptoms, the so-called “long COVID” whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.

【 授权许可】

Unknown