Abstract
Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.
Highlights
In early 2020, the World Health Organization (WHO) designated the new, highly contagious, and unnervingly fatal disease COVID-19 caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a global pandemic
Recent studies emerging in parallel in the pandemic and in cardio-oncology indicate that the RV may play an important role in the prognosis of patients with COVID-19 or CVT from cancer therapy; RV failure generally associates with worse outcomes in a variety of populations, and patients with COVID-19 or CVT from cancer therapies may be no different [35,36,37,38]
The myriad of overlap of CV toxicities, pathophysiology, and innovative management in COVID-19 and cardio-oncology provide multiple paths for exploration that could lead to greater understanding of both COVID-19 and CVT noted in cardiooncology (Figure 1)
Summary
In early 2020, the World Health Organization (WHO) designated the new, highly contagious, and unnervingly fatal disease COVID-19 caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a global pandemic. While cancer therapies and SARSCoV-2 are two very different entities, the havoc they both wreak on the cardiovascular system is thought-provoking In this perspective, we share the overarching viewpoint that these commonalities exist and are intriguing, and the dynamic research efforts surrounding COVID-19 may be able to inform new understanding and avenues for investigation in cardio-oncology. Development of novel concepts, paradigms, and drug utilization trends based on observations identified in CVT related to COVID-19 may help advance research and clinical practice in cardio-oncology. To this end, we first present cardiovascular toxicities common to COVID-19 and cardiooncology, we expound on underlying pathophysiology. When present, elevated cardiac biomarkers such as brain natriuretic peptide and serum troponin have been associated with increased mortality in patients with COVID-19 [18]
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