Cardio-oncology: the new frontier of clinical and preventive cardiology

Even if cancer and cardiovascular diseases are considered two distinct diseases, an intricate interconnection between these conditions has been established. Increased risk of malignancy has been identified in patients with cardiovascular disease, as well as a greater propensity to the development of cardiovascular diseases has been observed in patients with cancer. The development of cardiotoxicity following exposure to certain anticancer drugs only partially explains this relationship. Shared risk factors and common pathogenic mechanisms suggest the existence of a common biology and a complex interplay between these two conditions. Due to improving longevity and therapeutic advances, the number of patients affected or potentially at risk of developing these two diseases is constantly increasing and currently, several drugs against cancer from anthracyclines to checkpoint inhibitors, can also cause a wide range of unexpected cardiovascular side effects. Management of these issues in clinical practice is an emerging challenge for cardiologists and oncologists, and led to the development of a new dedicated discipline called cardio-oncology. Surveillance and prevention strategies as well as interventions to reduce cardiovascular risk and prevent cardiotoxicities are the primary objectives of cardio-oncology. In this review, we explore the etiopathogenesis common to cardiovascular disease and cancer and the complex interplay between them. We also report the main characteristics of the drugs responsible for cardiotoxicity, highlighting the available strategies for optimal patient management based on a multidisciplinary approach in the cardio-oncology setting

Left ventricular systolic dysfunction in chronic kidney disease: from asymptomatic changes in geometry and function to overt heart failure.

A bidirectional relationship between kidney and heart function is present in all stages of cardiac and renal disease, from the asymptomatic phase of left ventricular systolic dysfunction to overt heart failure, as well as from the initial reduction of glomerular filtration rate to end-stage kidney disease, respectively. The simultaneous presence of both diseases has a significant impact on prognosis and requires specific therapeutic strategies. The early recognition of abnormalities of renal and myocardial function may have a relevant influence on management of combination of these conditions

Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure:An Analysis From GISSI-HF

AbstractBackgroundData on the natural change in renal function in patients with chronic heart failure (HF) are limited.Methods and ResultsEstimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68 mL • min−1 • 1.73 m−2. Change in eGFR in the 1st year was −1.5 ± 16 mL • min−1 • 1.73 m−2, and over 36 months it was −3.7 ± 18 mL • min−1 • 1.73 m−2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15 mL • min−1 • 1.73 m−2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P < .001) per 10 mL • min−1 • 1.73 m−2 decrease, as well as every 10 mL • min−1 • 1.73 m−2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P < .001). A deterioration in eGFR >15 mL • min−1 • 1.73 m−2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P < .001).ConclusionsMean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates

Prevalence and prognostic impact of non-cardiac co-morbidities in heart failure outpatients with preserved and reduced ejection fraction: a community-based study

Aim: To assess adverse outcomes attributable to non-cardiac co-morbidities and to compare their effects by left ventricular ejection fraction (LVEF) group [LVEF <50% (heart failure with reduced ejection fraction, HFrEF), LVEF 6550% (heart failure with preserved ejection fraction, HFpEF)] in a contemporary, unselected chronic heart failure population. Methods and results: This community-based cohort enrolled patients from October 2009 to December 2013. Adjusted hazard ratio (HR) and the population attributable fraction (PAF) were used to compare the contribution of 15 non-cardiac co-morbidities to adverse outcome. Overall, 2314 patients (mean age 77 \ub110 years, 57% men) were recruited [n = 941 (41%) HFrEF, n = 1373 (59%) HFpEF]. Non-cardiac co-morbidity rates were similarly high, except for obesity and hypertension which were more prevalent in HFpEF. At a median follow-up of 31 (interquartile range 16\u201341) months, 472 (20%) patients died. Adjusted mortality rates were not significantly different between the HFrEF and HFpEF groups. After adjustment, an increasing number of non-cardiac co-morbidities was associated with a higher risk for all-cause mortality [HR 1.25; 95% confidence interval (CI) 1.10\u20131.26; P < 0.001], all-cause hospitalization (HR 1.17; 95% CI 1.12\u20131.23; P < 0.001), heart failure hospitalization (HR 1.28; 95% CI 1.19\u20131.38; P < 0.001), non-cardiovascular hospitalization (HR 1.16; 95% CI 1.11\u20131.22; P < 0.001). The co-morbidities contributing to high PAF were: anaemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and peripheral artery disease. These findings were similar for HFrEF and HFpEF. Interaction analysis yielded similar results. Conclusions: In a contemporary community population with chronic heart failure, non-cardiac co-morbidities confer a similar contribution to outcomes in HFrEF and HFpEF. These observations suggest that quality improvement initiatives aimed at optimizing co-morbidities may be similarly effective in HFrEF and HFpEF

Is it time to calculate renal function in non valvular atrial fibrillation patients to stratify the risk of future events?

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Murge and Pre-murge in southern Italy: the last piece of Adria, the (almost) lost continent, attempting to became an aUGGp candidate (MurGEOpark)

In 2019, the executive of the Alta Murgia National Park (southeastern Italy) decided to propose its territory as possible inclusion in the network of the UNESCO Global Geoparks. Since then, in cooperation with the Department of Earth and Environmental Sciences (Aldo Moro University of Bari) and SIGEA, it is working to candidate the area as an aUGGp (called “MurGEOpark”). The MurGEOpark comprises the Alta Murgia area, where a Cretaceous sector of the Apulia Carbonate Platform crops out, and the adjacent Pre-Murge area, where the southwestward lateral continuation of the same platform, being flexed toward the southern Apennines mountain chain, is thinly covered by Plio-Quaternary foredeep deposits. The worldwide geological uniqueness is that the area is the only in situ remnant of the AdriaPlate, the old continent almost entirely squeezed between Africa and Europe. In such a contest, AltaMurgia is a virtually undeformed sector of Adria (the Apulia Foreland), while other territories of theplate are, and/or were, involved in the subduction/collision processes. In the MurGEOpark, the crustof Adria is still rooted to its mantle, and the Cretaceous evolution of the continent is spectacularlyrecorded in Alta Murgia thanks to the limestone succession of one of the largest peri-Tethyancarbonate platform (the Apulia Carbonate Platform). The MurGEOpark comprises also the Pre-Murge area, which represents the outer south-Apennines foredeep, whose Plio-Quaternaryevolution is spectacularly exposed thanks to an “anomalous” regional middle-late Quaternary uplift.The international value of the proposal is enriched by the presence of several geological singularities such as two paleontological jewels of very different age: a Neanderthal skeletonpreserved in speleothems within a karst cave, and one of the largest surfaces in the world withupper Cretaceous dinosaur tracks (about 25.000 footprints). Moreover, the close relationships between man and geology are spectacularly documented in the MurGEOpark: among the others, the use and conservation of water in a karst area, the prehistoric and ancestral choices ofurbanization, karst caves traditionally used as religious sites, etc. All these examples demonstratehow the MurGEOpark could offer a good opportunity to spread the geological culture to a wide and diverse audienc