Mecanismos fisiopatológicos, métodos diagnósticos e estratégias cardioprotetoras da cardiotoxicidade induzida por antraciclinas em pacientes oncológicos: revisão narrativa da literatura

Abstract

Chemotherapy-induced cardiotoxicity constitutes a highly significant adverse effect in clinical oncology, presenting as a broad spectrum of cardiovascular impairment with direct impact on morbidity, mortality, and the quality of life of cancer patients. Among antineoplastic agents, anthracyclines stand out, as their toxicity results from cumulative dosing and multiple pathophysiological mechanisms, ultimately leading to ventricular dysfunction and heart failure. Early identification through complementary diagnostic methods is essential for the implementation of effective therapeutic strategies and for preventing unfavorable clinical outcomes. This study aimed to review, in the scientific literature, the characteristics of anthracycline-induced cardiotoxicity, considering the main pathophysiological mechanisms involved, the diagnostic methods employed, and the currently recommended cardioprotective in oncology patients. This is a narrative literature review conducted in the Virtual Health Library (VHL) databases Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, and SCOPUS, guided by the following research question: “What evidence is available in the literature regarding anthracycline-induced cardiotoxicity?” Initially, 18,124 articles were identified; after applying eligibility criteria, 29 studies were selected for analysis. The mechanisms associated with anthracycline-induced cardiotoxicity include oxidative stress, mitochondrial dysfunction, free radical generation, cardiomyocyte apoptosis, and impairment of myocardial function, ultimately resulting in heart failure and arrhythmias. Diagnostic evaluation and monitoring include serum measurements of troponin and pro-BNP, echocardiography with assessment of left ventricular ejection fraction and strain, as well as cardiac magnetic resonance imaging. The most established therapeutic strategies comprise the use of angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), beta-blockers, dexrazoxane, and lifestyle interventions. Early detection of signs suggestive of cardiotoxicity and comprehensive understanding of the topic are essential for clinical management and for preserving the safety and well-being of patients undergoing treatment with anthracyclines.