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Bisceglia I, Canale ML, Gallucci G, Turazza FM, Lestuzzi C, Parrini I, Russo G, Maurea N, Quagliariello V, Oliva S, Di Fusco SA, Lucà F, Tarantini L, Trambaiolo P, Moreo A, Geraci G, Gabrielli D, Gulizia MM, Oliva F, Colivicchi F. Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story. Front Cardiovasc Med 2022; 9:821193. [PMID: 35155636 PMCID: PMC8831543 DOI: 10.3389/fcvm.2022.821193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022] Open
Abstract
The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced “endothelitis” triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. “Overlapping commonalities” between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a “syndemic.” Another challenging issue is the persistence of the symptoms, the so-called “long COVID” whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.
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Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido di Camaiore Lucca, Camaiore, Italy
| | - Giuseppina Gallucci
- Cardio-Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
- *Correspondence: Giuseppina Gallucci
| | - Fabio Maria Turazza
- Cardiology Department, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Lestuzzi
- Azienda Sanitaria Friuli Occidentale (ASFO) Cardiac and Cardio-Oncologic Rehabilitation Service at Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
| | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Giulia Russo
- Cardiovascular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) Trieste, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Vincenzo Quagliariello
- Cardiology Department, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Stefano Oliva
- Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Luigi Tarantini
- Divisione di Cardiologia, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio-Emilia, Reggio Emilia, Italy
| | | | - Antonella Moreo
- A. De Gasperis Cardio Center, Aziende Socio Sanitarie Territoriali (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Geraci
- Cardiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Domenico Gabrielli
- Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Oliva
- Dipartimento Cardiotoracovascolare, Cardiology 1-Cath Lab, Coronary Care Unit (CCU), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Ospedale San Filippo Neri, Rome, Italy
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