Emergence, Development, and Future of Cardio-Oncology in China: Cardiohypersensitivity, Cardiotoxicity, and the Kounis Syndrome

Introduction

Cancer and cardiovascular disease are two major global killers. While cancer incidence rises in adults up to 74, cardiovascular disease overtakes it as the main cause of death above that age. Chemotherapy, radiation, and surgery are common cancer treatments, but chemotherapy can worsen cardiovascular health, showing acute and chronic symptoms. A report in the Chinese Medical Journal about a 60-year-old male with coronary artery disease and lung cancer who had an ST-segment elevation myocardial infarction after chemotherapy raises important points about cardiac toxicity, hypersensitivity, and the Kounis syndrome.

Cardiotoxicity and Cardiohypersensitivity: Definitions

Cardiotoxicity lacks a universal medical society consensus. It often refers to dose-dependent cardiovascular dysfunction with progressive toxic effects leading to fibrosis, a chronic, sometimes non-reversible process. Acute cardiotoxicity is from single or short-term exposure, subchronic is over more than a year but less than the organism’s lifetime, and chronic is over an extended period. Cardiohypersensitivity is an inflammatory, non-dose-dependent response, can occur anytime during treatment, even with low drug concentrations, and is often with IgE anti-drug antibodies. Cytostatic drugs can cause allergic reactions (types I – IV), and severe reactions like cardiac arrest and death have happened. Clinical and lab evidence suggests acute coronary syndromes, myocarditis, and arrhythmias after chemotherapy are due to cardiohypersensitivity, not toxicity. So, cardiohypersensitivity should be used with cardiac toxicity to describe chemotherapy’s adverse events.

Chemotherapy and Kounis Hypersensitivity Acute Coronary Syndrome

The patient in the Liu et al. report had chemotherapy with cisplatin and gemcitabine. On the 7th day of the second cycle, he had sudden chest pain and an ST-segment elevation myocardial infarction. Cardiohypersensitivity to platinum agents (like cisplatin) can cause severe reactions (5 – 20% of patients have type I hypersensitivity, including Kounis syndrome myocardial infarction). Anaphylaxis to gemcitabine is also reported.

Implications for Cancer and Cardiovascular Care

These findings show serious cardiovascular complications from cancer therapy are increasing, and treating cancer and cardiovascular diseases is closely linked. Specialized cardiovascular clinics for cancer patients are needed for pre-therapy assessment, monitoring, and treatment. Interdisciplinary cooperation (cardiologists, oncologists, etc.) is mandatory. Incorporating tests before, during, and after antineoplastic therapy to monitor cardiac adverse events is important. Several disciplines should be involved in identifying, diagnosing, preventing, and treating these complications. Cardio-oncology, onco-cardiology, immuno-oncology, and onco-immunology should be intertwined.

Conclusion

The report highlights the need for better understanding and management of cardiovascular issues in cancer patients. Definitions of cardiotoxicity and cardiohypersensitivity are crucial. The Kounis syndrome in the context of chemotherapy shows the complexity of treatment-related cardiac problems. Specialized care and interdisciplinary efforts are essential for improving patient outcomes.

doi.org/10.1097/CM9.0000000000000130

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