Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Lozahic, Caroline; Maddock, Helen; Sandhu, Hardip

doi:10.3389/fcvm.2021.634291

Cited by 7 publications

(7 citation statements)

References 105 publications

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“…These pathways tend to HF decompensation and an increased risk of arrhythmia and ischemia. Additionally, medication interactions with SARS-CoV-2-targeted drugs may enhance the risk of developing cardiomyopathy, arrhythmias, and sudden death in individuals with underlying cardiovascular disease [ 11 , 12 ]. Secondary to the infection, the inflammatory state and cytokine production increase blood viscosity and coagulability, create endothelial dysfunction, and promote electrolyte and hemodynamic imbalance [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

Citu

Cîtu

Gorun

et al. 2022

JCM

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During the COVID-19 pandemic, it was observed that patients with heart disease are more likely to be hospitalized and develop severe COVID-19. Cardiac disease takes the top position among patient comorbidities, heart failure (HF) prevalence reaching almost 5% in the general population older than 35 years in Romania. This retrospective study aimed to determine the potential use of the NYHA classification for HF in hospitalized patients with COVID-19 as prognostic tool for in-hospital mortality, length of hospitalization, and probability of rehospitalization for HF decompensation. We observed that patients with advanced HF had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as NYHA I and II. However, regardless of existing diseases, NYHA III, and, especially, NYHA IV, patients were at greatest risk for mortality following SARS-CoV-2 infection. They required significantly longer durations of hospitalization, ICU admission for mechanical ventilation, and developed multiple severe complications. NYHA IV patients required a median duration of 20 days of hospitalization, and their in-hospital mortality was as high as 47.8%. Cardiac biomarkers were significantly altered in patients with SARS-CoV-2 and advanced HF. Although the study sample was small, all patients with NYHA IV who recovered from COVID-19 required a rehospitalization in the following month, and 65.2% of the patients at initial presentation died during the next six months. The most significant risk factor for mortality was the development of severe in-hospital complications (OR = 4.38), while ICU admission was the strongest predictor for rehospitalization (OR = 5.19). Our result highlights that HF patients continue to be vulnerable post SARS-CoV-2 infection. Physicians and policymakers should consider this population’s high likelihood of hospital readmissions when making discharge, hospital capacity planning, and post-discharge patient monitoring choices.

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Section: Introductionmentioning

confidence: 99%

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

Citu

Cîtu

Gorun

et al. 2022

JCM

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“…• Overlap phenomena exist between COVID-19, tumor complications and cardiovascular effects of cancer treatments (32). • COVID-19-and anticancer drug-induced myocardial damage might have an additional effect leading to a rise in cardiovascular adverse outcomes through a "two-hit" model (33).…”

Section: Covid-19 and Cardio-oncologymentioning

confidence: 99%

“…It should be emphasized that in this population, the increased troponin assumes an even more intriguing significance since it may be also indicative of subclinical cardiotoxicity induced by treatments with anthracyclines and/or anti-HER2 agents, and it can be observed in patients receiving tyrosine kinase inhibitors at high prothrombotic risk or fluoropyrimidines. Studies are needed to define whether cardiac injury deriving from SARS-CoV-2 infection and from anticancer drugs might have an additional effect leading to a rise in cardiovascular adverse outcome through a "two-hit" model, both in cancer patients and survivors (33). A recent analysis of an AHA COVID-19-based CVD registry did not show a significant difference of in-hospital mortality among cancer patients with or without preexisting CVD, on the other hand (and in contrast to previous studies), a strong independent association of oncologic treatment with in-hospital morbidity was observed.…”

Section: Cardio-oncology and Covid-19mentioning

confidence: 99%

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

Bisceglia

Canale

Gallucci

et al. 2022

Front. Cardiovasc. Med.

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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.

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“…The Cardioonc patients are even more prone to blunted immune response and multi-organ failure are less likely to hemodynamically compensate in the setting of active infection. 11 When we considered death as a competing risk for stroke, acute heart failure and acute myocardial infarctions, the patients in the Cardioonc (-) cohort had a reduced risk for all three events. These ndings suggest that death served as a competing risk for cardiovascular events from occurring, when compared patients who were in CVD (-) cohort.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Active Cancers and Pre-Existing Cardiovascular Diseases Infected with SARS-CoV-2

Patel

Chapman

Neumann

et al. 2023

Preprint

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Objective To determine the impact of acute SARS-CoV-2 infection on patient with concomitant active cancer and CVD. Methods The researchers extracted and analyzed data from the National COVID Cohort Collaborative (N3C) database between January 1, 2020, and July 22, 2022. They included only patients with acute SARS-CoV-2 infection, defined as a positive test by PCR 21 days before and 5 days after the day of index hospitalization. Active cancers were defined as last cancer drug administered within 30 days of index admission. The “Cardioonc” group consisted of patients with CVD and active cancers. The cohort was divided into four groups: (1) CVD (-), (2) CVD (+), (3) Cardioonc (-), and (4) Cardioonc (+), where (-) or (+) denotes acute SARS-CoV-2 infection status. The primary outcome of the study was major adverse cardiovascular events (MACE), including acute stroke, acute heart failure, myocardial infarction, or all-cause mortality. The researchers analyzed the outcomes by different phases of the pandemic and performed competing-risk analysis for other MACE components and death as a competing event. Results The study analyzed 418,306 patients, of which 74%, 10%, 15.7%, and 0.3% had CVD (-), CVD (+), Cardioonc (-), and Cardioonc (+), respectively. The Cardioonc (+) group had the highest MACE events in all four phases of the pandemic. Compared to CVD (-), the Cardioonc (+) group had an odds ratio of 1.66 for MACE. However, during the Omicron era, there was a statistically significant increased risk for MACE in the Cardioonc (+) group compared to CVD (-). Competing risk analysis showed that all-cause mortality was significantly higher in the Cardioonc (+) group and limited other MACE events from occurring. When the researchers identified specific cancer types, patients with colon cancer had higher MACE. Conclusion In conclusion, the study found that patients with both CVD and active cancer suffered relatively worse outcomes when they had acute SARS-CoV-2 infection during early and alpha surges in the United States. These findings highlight the need for improved management strategies and further research to better understand the impact of the virus on vulnerable populations during the COVID-19 pandemic.

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Anti-cancer Therapy Leads to Increased Cardiovascular Susceptibility to COVID-19

Cited by 7 publications

References 105 publications

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

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

Outcomes of Patients with Active Cancers and Pre-Existing Cardiovascular Diseases Infected with SARS-CoV-2

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