Letter to the Editor
Cardio-oncology guidelines, structural heart disease and Kounis syndrome in the upcoming guidelines
Recomendações de cardio-oncologia, doença cardíaca estrutural e síndrome de Kounis nas próximas recomendações
Nicholas G. Kounis
Department of Cardiology, University of Patras Medical School, Patras, Greece
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CV: cardiovascular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hélder Dores, Mafalda Antunes, Daniel Caldeira, Hugo V. Pereira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 1 => array:2 [ "nombre" => "Mafalda" "apellidos" => "Antunes" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caldeira" ] 3 => array:2 [ "nombre" => "Hugo V." "apellidos" => "Pereira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124001173?idApp=UINPBA00004E" "url" => "/08702551/0000004300000010/v1_202410020512/S0870255124001173/v1_202410020512/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Cardio-oncology guidelines, structural heart disease and Kounis syndrome in the upcoming guidelines" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "583" "paginaFinal" => "584" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Nicholas G. Kounis" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Nicholas G." "apellidos" => "Kounis" "email" => array:1 [ 0 => "ngkounis@otenet.gr" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, University of Patras Medical School, Patras, Greece" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendações de cardio-oncologia, doença cardíaca estrutural e síndrome de Kounis nas próximas recomendações" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Cardio-Oncology Study Group of the Portuguese Society of Cardiology and the Portuguese Association of Cardiovascular Intervention have collaborated to produce a position paper that addresses the topic of cardiac intervention in cancer patients, with an emphasis on percutaneous techniques.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors of this outstanding work underlined the scarcity of currently available evidence or recommendations for treating structural or coronary heart disease. Another important point to remember is that, possibly more so than in the general population, the manifestations of coronary artery disease in cancer patients are frequently caused by microvascular disease, classical atherosclerotic disease, vasospasm and hypersensitivity to cancer drugs leading to hypersensitivity-associated acute coronary syndrome, so-called Kounis syndrome (KS).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Furthermore, this subject is only touched upon in passing in the most recent (2022) European Society of Cardiology (ESC) guidelines on cardio-oncology,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> for which the ESC collaborated with the European Hematology Association, the European Society for Therapeutic Radiology and Oncology, and the International Cardio-Oncology Society. However, a noteworthy omission from the ESC guidelines is hypersensitivity reactions and the Kounis hypersensitivity-associated coronary syndrome, despite the fact that these conditions have been identified as serious side effects of cancer therapy in many reports in the medical literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">KS is an acute coronary syndrome that results from hypersensitivity or anaphylactic reactions. It can manifest as vasospastic angina (type 1), myocardial infarction (type 2), stent thrombosis with an occluding thrombus (type 3A), or stent restenosis (type 3B). Mast cells, which are best known for inducing hypersensitivity, are found in cardiac tissue and especially in the vulnerable shoulder region of atheroma of coronary arteries.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">During the hypersensitivity reaction, inflammatory mediators are released, with effects including vasoconstriction and coronary artery spasm facilitated by histamine, platelet-activating factor, and eicosanoids. In the US National Inpatient Sample, KS was associated with an in-hospital mortality of 7.0% as opposed to 0.4% in the anaphylaxis non-KS group.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Three entities resembling KS may involve the mesenteric, cerebral and peripheral arteries. One of the main differential diagnoses to take into account in KS is stress-induced cardiomyopathy, or Takotsubo syndrome, in patients taking anti-cancer therapy.<span class="elsevierStyleSup">6</span> Additionally, patients can have both of those entities present at the same time during the ATAK complex (adrenaline, Takotsubo, anaphylaxis, and Kounis syndrome).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to reduce morbidity and mortality in KS, prompt intervention is essential. The guidelines on acute coronary syndromes (ACS) should be followed when treating patients with ACS. Sadly, there are no precise instructions on how to handle ACS due to KS in these guidelines. Clinical challenges arise in the management of KS because certain medications used to treat the cardiac clinical picture can also worsen allergic signs and symptoms. Guidelines on hypersensitivity reactions to cancer chemotherapy have been released by the Spanish Multidisciplinary Research Network for Allergy Diseases, but they do not mention cardiotoxicity.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Instead, they emphasize the importance of diagnosis, management, and desensitization procedures. Similarly, a task force has been established by the European Network on Drug Allergy and the Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology to furnish information and suggestions concerning allergological research in the area of hypersensitivity reactions to chemotherapy, without making reference to cardiotoxicity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For the benefit of both researchers and practicing physicians, there needs to be close coordination and understanding among all these great organizations. Looking ahead, the ESC cardio-oncology guidelines, which are set to be released shortly, ought to take structural heart disease and KS into account.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventional cardiology in cancer patients: A position paper from the Portuguese Cardiovascular Intervention Association and the Portuguese Cardio-Oncology Study Group of the Portuguese Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Nobre Menezes" 1 => "M. Tavares da Silva" 2 => "A. Magalhães" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2023.04.013" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol." "fecha" => "2024" "volumen" => "43" "paginaInicial" => "35" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37482119" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kounis Syndrome-not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.G. Kounis" 1 => "I. Koniari" 2 => "D. Velissaris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4274/balkanmedj.galenos.2019.2019.5.62" "Revista" => array:6 [ "tituloSerie" => "Balkan Med J." "fecha" => "2019" "volumen" => "36" "paginaInicial" => "212" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31198019" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group" "etal" => true "autores" => array:3 [ 0 => "A.R. Lyon" 1 => "T. López-Fernández" 2 => "L.S. Couch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehac244" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J." "fecha" => "2022" "volumen" => "43" "paginaInicial" => "4229" "paginaFinal" => "4361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36017568" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mast cells in vulnerable atherosclerotic plaques-a view to a kill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.A. Lindstedt" 1 => "M.I. Mäyränpää" 2 => "P.T. Kovanen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1582-4934.2007.00052.x" "Revista" => array:6 [ "tituloSerie" => "J Cell Mol Med." "fecha" => "2007" "volumen" => "11" "paginaInicial" => "739" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17760836" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Desai" 1 => "T. Parekh" 2 => "U. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2019.06.002" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol." "fecha" => "2019" "volumen" => "292" "paginaInicial" => "35" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31204069" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adrenaline, Takotsubo, Anaphylaxis, and Kounis Syndrome (ATAK) Complex Unveiled: Integrating Takotsubo and Kounis Syndromes in the Context of Chemotherapy-Related Anaphylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Puri" 1 => "M.P. Kachhadia" 2 => "P. Sardana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.53145" "Revista" => array:5 [ "tituloSerie" => "Cureus." "fecha" => "2024" "volumen" => "16" "paginaInicial" => "e53145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38420090" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Vega" 1 => "T.W. Jimenez-Rodriguez" 2 => "R. Barranco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18176/jiaci.0712" "Revista" => array:6 [ "tituloSerie" => "J Investig Allergol Clin Immunol." "fecha" => "2021" "volumen" => "31" "paginaInicial" => "364" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34045179" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypersensitivity reactions to chemotherapy: an EAACI Position Paper" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Pagani" 1 => "S. Bavbek" 2 => "E. Alvarez-Cuesta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/all.15113" "Revista" => array:6 [ "tituloSerie" => "Allergy." "fecha" => "2022" "volumen" => "77" "paginaInicial" => "388" "paginaFinal" => "403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34587281" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004300000010/v1_202410020512/S0870255124001914/v1_202410020512/en/main.assets" "Apartado" => array:4 [ "identificador" => "93494" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004300000010/v1_202410020512/S0870255124001914/v1_202410020512/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124001914?idApp=UINPBA00004E" ]
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