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Co-morbidity (HFrEF and HFpEF): cancer

Advancements in the treatment of malignant diseases in recent years have led to a spectacular improvement in prognosis. However, some cancer patients experience severe treatment-related side effects of which cardiovascular complications and in particular cardiac dysfunction and heart failure are among the most important issues of survivorship, and may result in substantially increased long-term mortality and morbidity. Cardiac dysfunction and heart failure may occur acutely, that is, during cancer treatment—and therefore negatively impact oncological treatment options—or late after cancer treatment, and lead to substantial morbidity in cancer survivors. Although some cancer drugs may acutely, and typically only temporary, induce diastolic dysfunction as do the anthracyclines, most cause systolic dysfunction. One exception to this rule are survivors of paediatric cancer, who years after exposure to anthracyclines and after having gone through a dilated cardiomyopathy-like phenotype, typically develop heart failure with reduced ejection fraction due to restrictive cardiomyopathy without left ventricular dilation. Similarly, adult patients after mediastinal radiation may develop restrictive cardiomyopathy and heart failure with preserved ejection fraction.