Journal of Clinical PracticeJournal of Clinical PracticeКлиническая практика2220-30952618-8627Eco-Vector1098010.17816/clinpract10130-40Original Study ArticlesОригинальные исследованияResearch ArticleCardiooncology. Basic principles of prevention and treatment of cardiotoxicity in cancer patientsКардиоонкология. Основные принципы профилактики и лечения кардиотоксичности на фоне химиотерапии у онкологических пациентовPlokhovaEkaterina V.ПлоховаЕкатерина Владимировна
Russian Federation

к.м.н, врач-кардиолог кардиологического отделения ФНКЦ ФМБА России

evplokhova@gmail.comDoundouaDavid P.ДундуаДавид Петрович
Russian Federation

д.м.н., руководитель кардиологического центра ФНКЦ ФМБА России

david.doundoua@gmail.comFederal Research and Clinical Center FMBAФедеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России25042019101Клиническая практика30400102201911022019Copyright ©; 2019, Plokhova E.V., Doundoua D.P.Copyright ©; 2019, Плохова Е.В., Дундуа Д.П.2019Plokhova E.V., Doundoua D.P.Плохова Е.В., Дундуа Д.П.https://creativecommons.org/licenses/by-nc-nd/4.0https://clinpractice.ru/clinpractice/article/view/10980

Advances in the diagnostics and treatment of cancer have led to improved survival of patients and decreased mortality. Cardiovascular complications (CVC) however, are among the most frequent side effects of anticancer treatment, which can have an adverse effect on the prognosis. This may be the result of cardiotoxicity, which involves direct effects of the radiation therapy and /or chemotherapy on the heart function and structure. Heart failure with cancer therapy was associated with a 3.5-fold increase in the risk of mortality compared with idiopathic cardiomyopathy. The cardiotoxicity risk assessment is often difficult, due to the different susceptibility of patients to drugs and their combinations, and coadministration of radiation therapy. Therefore, the likelihood of development and the time of occurrence of cardiotoxicity may vary and not always depend on the initial risk. Strategies for managing such patients are in most cases based on the expert opinion. This article provides recommendations for the prevention and therapy of cardiotoxicity, set out in the consensus of the European Society of Cardiology 2016.

Современные методы диагностики и лечения онкологических заболеваний привели к улучшению выживаемости пациентов и снижению смертности от рака. Тем не менее, осложнения противоопухолевой терапии нередко способны оказать неблагоприятное воздействие на сердечно-сосудистую систему. В результате прямого влияния лучевой терапии, химиотерапии на сердце происходит повреждение кардиомиоцитов, эндокарда и клапанов сердца, развитие дисфункции миокарда и/или сердечной недостаточности, которое определяется как кардиотоксичность. Сердечная недостаточность на фоне терапии рака была связана с 3,5-кратным увеличением риска смертности в сравнении с таковой при идиопатической кардиомиопатии. При этом определение риска кардиотоксичности зачастую представляется сложной задачей, что обусловлено различной восприимчивостью пациентов к тем или иным препаратам, назначением комбинированной противоопухолевой терапии, а также сочетанием с лучевой терапией. Поэтому вероятность и сроки развития кардиотоксичности могут варьировать и не всегда зависят от исходного риска. Рекомендации по ведению таких пациентов в большинстве случаев основаны на мнении экспертов. В данной статье приведены рекомендации по профилактике и терапии кардиотоксичности, изложенные в согласительном документе Европейского общества кардиологов 2016 г.

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