6th Iranian Joint Cardiovascular Congress

6<sup>th</sup> Iranian  Joint Cardiovascular Congress
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There is an increasing need for the management of cardiovascular problems of cancer patients, pre-existent or induced by anticancer therapy. Dr. Cardinale has been involved in this field since 1994. She found the Cardioncology Unit of the European Institute of Oncology (EIO), the first created in Italy to deal with this need. Since 2009, she is the Vice-President of the ICOS (International CardiOncology Society).

Her professional experience and investigational interests mainly focus on prevention, early detection, monitoring and treatment of cardiotoxicity, including both traditional and new biologic agents; screening of cardiotoxicity in patients with cardiac disease; malignant pericardial effusion evaluation and intrapericardial treatment.

Cardiotoxicity is a common complication that may compromise clinical effectiveness of anticancer therapy. The current standard for monitoring cardiac function detects cardiotoxicity only when a functional impairment has already occurred, not allowing for any early preventive strategies. Dr. Cardinale developed a different approach to identify it early on, coupled with a treatment to prevent its consequences. Based on her almost twenty-year-long clinical and research experience, she has created specific procedures, that include the assessment of cardiac biomarkers (Troponin I and NT-proBNP), and an early preventive therapy with ACE-inhibitors, in ed high-risk patients, namely those showing myocardial injury during the oncologic treatment, revealed by the increase of Troponin I. This approach has proved to be able to prevent the development of cardiotoxicity in more than 3500 cancer patients, followed at the EIO for more than 10 years. Notably, this approach has been included among the recommendations on cardiotoxicity by the European Society for Medical Oncology.

Anticancer therapy-induced cardiotoxicity can result in a cardiomyopathy generally considered to be irreversible, and leading to congestive heart failure and cardiac death. Clinical manifestations of cardiotoxicity may appear months or even years after the end of CT, and are preceded, in most cases, by asymptomatic left ventricular dysfunction. Inconsistent data concerning response to conventional pharmacologic heart failure therapy in this population have been reported in literature, probably due to the very large temporal range elapsed between the end of oncologic therapy and the beginning of the cardiologic treatment. However, the results of the studies conducted by Dr. Cardinale at EIO have shown that most patients receiving prompt and adequate treatment, including ACE-inhibitors, beta-blockers, diuretics, and anti-aldosterone agents, and closely monitored, experience a relevant improvement in clinical status and cardiac function, in some cases a complete recovery, and a better cardiologic prognosis.

Due to the increasing number of long-term cancer survivors, the ageing of the population, as well as the increased incidence and prevalence of oncologic and cardiovascular diseases, the number of patients presenting oncologic and cardiologic comorbidities are increasing. These patients are often excluded intensive cardiologic treatment and/or interventions, and, on the other hand, often excluded a first-line, aggressive – and therefore more effective – therapeutic oncologic strategy, because considered to be at too high a risk for cardiovascular complications. This behavior may lead to negative prognostic impact during the course of the two illnesses, as an integrated and multidisciplinary approach, involving both the cardiologist and the oncologist, may allow the patient to be effectively and safely treated. To achieve this aim, Dr. Cardinale and the EIO Cardioncology Unit have created a specific approach for these “frail” patients, to allow them to receive an effective oncologic therapy as well. This procedure provides a very close cardiac surveillance - including the assessment of cardiac biomarkers - and the sharing of all patients’ information with the oncologist at each step of the way. At present more than 350 patients, with pre-existing cardiac disease, have been treated successfully, without the worsening of the underlying cardiac condition and the occurrence of adverse cardiac events.

Milan, 21st November 2017