Hematologic/Oncologic cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

Marked improvement in the accuracy and sensitivity of current diagnostic techniques for cardiac diseases have contributed to the identification of haematologic and oncologic diseases as a possible aetiology of cardiomyopathy (CM). If undiagnosed, the CM may progress to HF and eventually death. This type of CM is exceedingly rare and a precise understanding of its natural cause, pathophysiology, diagnosis and management is undermined by the lack of supporting clinical evidence. Cancer as a direct cause of CM remains controversial. Differentiating cancer-associated CM from chemotherapy-induced CM is difficult since diagnosis of CM is nearly always made after the initiation chemotherapy. Hematologic diseases on the other hand have been classified under restrictive cardiomyopathy (RCM) or dilated cardiomyopathy (DCM) yet they are a distinct clinical entity uniquely characterized by cardiac chamber (atrial and/or ventricular) dilation, diastolic dysfunction and preserved systolic function. Oncologic or haematologic CM has an ominous prognosis although diagnosis is incidental or delayed making management difficult. There is a need to better understand the role of oncologic and/or haematologic diseases in the pathogenesis of CM aimed to improve diagnosis and development of aetiology-specific therapy. Similarly, this review provides an overview of CM in oncology and haematology patients including pathophysiology, presentation, diagnosis and treatment.