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

Frontiers in Cardiovascular Medicine

article

Irma Bisceglia¹  Maria Laura Canale²  Giuseppina Gallucci³  Fabio Maria Turazza⁴  Chiara Lestuzzi⁵  Iris Parrini⁶  Giulia Russo⁷  Nicola Maurea⁸  Vincenzo Quagliariello⁸  Stefano Oliva⁹  Stefania Angela Di Fusco^1,10  Fabiana Lucà^1,11  Luigi Tarantini^1,12  Paolo Trambaiolo^1,13  Antonella Moreo^1,14  Giovanna Geraci^1,15  Domenico Gabrielli^1,16  Michele Massimo Gulizia^1,17  Fabrizio Oliva^1,18  Furio Colivicchi^1,10 

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

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

DOI  :  10.3389/fcvm.2022.821193

学科分类：地球科学(综合)

来源: Frontiers

【 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】

CC BY