No abstract

Cardiotoxicity is the most dramatic complication of cancer therapies, and it results in the cessation of potentially life-saving antitumor treatment regimens and a poor survival prognosis in a nonnegligible proportion of patients. Angiotensin converting enzyme inhibitors (ACEIs) and β-blockers are effective in the treatment of cancer therapy-related cardiac dysfunction (CTRCD), whereas their roles in the prevention of cardiotoxicity are unclear. Sacubitril/valsartan, which is an angiotensin receptor-neprilysin inhibitor, has been shown to be advantageous over ACEIs in heart failure patients with reduced ejection fraction for further the reduction of cardiovascular death or rehospitalization. However, patients with CTRCD were excluded from pivotal trials involving sacubitril/valsartan. Although several small observational studies have observed excellent performance in improving cardiac structure and function in patients with CTRCD, large-scale prospective clinical studies are required to confirm these results. In this review, we described the contemporary literature concerning the potential benefit of sacubitril/valsartan in the cardio-oncology setting.

Cardiotoxicity is the most dramatic complications of cancer therapies, leading to halt in potentially life-saving anti-tumor treatment regimens and a poor survival prognosis in a non-negligible percentage of patients. Angiotensin converting enzyme inhibitors (ACEIs) and β-blockers are effective in the treatment of the cancer therapy–related cardiac dysfunction (CTRCD), while their roles in the prevention of cardiotoxicity are unclear. Sacubitril/valsartan was advantageous over ACEI in heart failure patients for further reduction of cardiovascular death or heart failure re-hospitalization. However, there is short of well-established testimony of its efficacy and safety in the prevention and treatment of CTRCD in the cardio-oncology setting. Although some small observational studies found a good performance of sacubitril/valsartan in patients with CTRCD, large-scale prospective clinical studies are required to confirm its excellent results. In this paper, we review the potential benefit of sacubitril/valsartan in human subjects with CTRCD.

Background Acute coronary syndrome (ACS) is one of the leading causes of death and is often accompanied by hypertension. Methods We investigated whether hypertension affects the metabolism of patients with ACS. Serum samples were provided from healthy controls (HCs; n=26), patients with ACS (n=20), or those patients with ACS complicated with hypertension (HTN, n=21), and all were subjected to non-targeted metabolomics analyses based on gas chromatography-mass spectrometry (GC/MS). Differential metabolites were screened using principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA). Kyoto Encyclopedia of Genes and Genomes (KEGG) provided metabolic pathways related to these metabolites. Results Compared to those in the HC group, 12 metabolites were significantly upregulated and 6 significantly downregulated in the ACS group; among these, L-cystine and isocitric acid showed the most obvious differences, respectively. Compared to those in the ACS group, 3 metabolites were significantly upregulated and 2 metabolites were significantly downregulated in the ACS-HTN group, among which oleic acid and chenodeoxycholic acid showed the most marked difference, respectively. The five most prominent metabolic pathways involved in differential metabolites between the ACS and HC groups were arginine biosynthesis; oxidative phosphorylation; alanine, aspartate and glutamate metabolism; citrate cycle; and glucagon signaling pathway. The metabolic pathways between the ACS and ACS-HTN groups were steroid biosynthesis, fatty acid biosynthesis, arginine biosynthesis, primary bile acid biosynthesis, and tyrosine metabolism. Conclusions A comprehensive study of the changes in circulatory metabolomics and the influence of HTN was conducted in patients with ACS. A serum metabolomics test can be used to identify differentially metabolized molecules and allow the classification of patients with ACS or those complicated with HTN.