Cancer and cardiovascular diseases, including heart failure (HF), are the main causes of death in Western countries. Several anticancer drugs and radiotherapy have adverse effects on the cardiovascular system, promoting left ventricular dysfunction and ultimately HF. Nonetheless, the relationship between cancer and HF is likely not unidirectional. Indeed, cancer and HF share common risk factors, and both have a bidirectional relationship with systemic inflammation, metabolic disturbances, and neurohormonal and immune activation. Few studies have assessed the impact of untreated cancer on the heart. The presence of an active cancer has been associated with elevated cardiac biomarkers, an initial impairment of left ventricular structure and function, autonomic dysfunction, and reduced exercise tolerance. In turn, these conditions might increase the risk of cardiac damage from chemotherapy and radiotherapy. HF drugs such as beta-blockers or inhibitors of the renin-angiotensin-aldosterone system might exert a protective effect on the heart even before the start of cancer therapies. In this review, we recapitulate the evidence of cardiac involvement in cancer patients naïve from chemotherapy and radiotherapy and no history of cardiac disease. We also focus on the perspectives for an early diagnosis and treatment to prevent the progression to cardiac dysfunction and clinical HF, and the potential benefits of cardioactive drugs on cancer progression.

中文翻译：

---

癌症患者化疗前的亚临床心脏损伤。

癌症和心血管疾病，包括心力衰竭 (HF)，是西方国家的主要死亡原因。几种抗癌药物和放疗对心血管系统有不良影响，促进左心室功能障碍并最终导致心衰。尽管如此，癌症和 HF 之间的关系可能不是单向的。事实上，癌症和 HF 具有共同的危险因素，并且都与全身炎症、代谢紊乱以及神经激素和免疫激活具有双向关系。很少有研究评估未经治疗的癌症对心脏的影响。活动性癌症的存在与心脏生物标志物升高、左心室结构和功能的初始损害、自主神经功能障碍和运动耐量降低有关。反过来，这些情况可能会增加化疗和放疗导致心脏损伤的风险。甚至在癌症治疗开始之前，HF 药物（例如 β 受体阻滞剂或肾素-血管紧张素-醛固酮系统抑制剂）就可能对心脏产生保护作用。在这篇综述中，我们概括了癌症患者心脏受累的证据，这些患者从未接受过化疗和放疗，并且没有心脏病史。我们还关注早期诊断和治疗的观点，以预防心功能不全和临床心衰的进展，以及心脏活性药物对癌症进展的潜在益处。甚至在癌症治疗开始之前，HF 药物（例如 β 受体阻滞剂或肾素-血管紧张素-醛固酮系统抑制剂）就可能对心脏产生保护作用。在这篇综述中，我们概括了癌症患者心脏受累的证据，这些患者从未接受过化疗和放疗，并且没有心脏病史。我们还关注早期诊断和治疗的观点，以预防心功能不全和临床心衰的进展，以及心脏活性药物对癌症进展的潜在益处。甚至在癌症治疗开始之前，HF 药物（例如 β 受体阻滞剂或肾素-血管紧张素-醛固酮系统抑制剂）就可能对心脏产生保护作用。在这篇综述中，我们概括了癌症患者心脏受累的证据，这些患者从未接受过化疗和放疗，并且没有心脏病史。我们还关注早期诊断和治疗的观点，以预防心功能不全和临床心衰的进展，以及心脏活性药物对癌症进展的潜在益处。