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Cardio-Oncology

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Specialized, Comprehensive Care, Close to Home

Cardio-oncology is an emerging subspecialty addressing the complex interaction between cancer and the cardiovascular system. This involves monitoring, early detection, prevention and treatment of cardiotoxicity of cancer therapies. The development of newer therapies with lower or no cardiotoxicity, and careful planning of cancer therapy in patients with pre-existing cardiovascular disease to avoid overt cardiotoxicity and heart failure, are important aspects of this specialty.

The multispecialty WMCHealth Cardio-Oncology Program offers the highest quality consultative clinical services for cancer patients with cardiovascular issues, focusing on preventing, detecting and treating cardiotoxicity of cancer chemotherapy for inpatients and outpatients with known or no prior cardiovascular disease.

Chemotherapy’s Effects on the Cardiovascular System

The increased prevalence of cancer survivors, including children, is due in large part to chemotherapeutic agents that may have severe side effects. For example, CAR T-cell therapy is a cutting-edge treatment genetically personalized for each patient. It kills cancer cells with very high efficiency. However, it causes a short-term but complex reaction that can affect the central nervous and respiratory systems, and the heart. Westchester Medical Center’s multidisciplinary team is deeply experienced in anticipating and successfully treating these reactions.

Overall, a significant proportion of cancer survivors live with long-term adverse effects of cancer therapy involving multiple organ systems. The spectrum of cardiovascular complications of cancer therapy is wide and includes left ventricular (LV) dysfunction, congestive heart failure (CHF), coronary vasospasm, angina, myocardial infarction, arrhythmias, systemic hypertension, pericardial effusion, pulmonary fibrosis and pulmonary hypertension. The risk of cardiotoxicity is higher in patients with pre-existing cardiovascular diseases.

Cancers can affect the cardiovascular system in multiple ways. Tumors arising from the lungs, breast, esophagus and other mediastinal structures or those metastasizing to lungs or mediastinum can directly invade or compress the heart, great vessels or the pericardial space. Malignancies of plasma cells can result in deposition of immunoglobulins or their fragments in multiple organs, including the heart, leading to myocardial dysfunction, heart failure and arrhythmias. Cancers can affect the coagulation cascade, resulting in hypercoagulability and thromboembolic disorders. A multispecialty comprehensive approach is therefore required to address these aspects of cardio-oncology.

A Multispecialty Approach to Cardio-Oncology

The WMCHealth Cardio-Oncology Program represents a comprehensive clinical, academic, educational and scientific collaboration involving the oncology services, molecular and cell biology, pathology and subspecialties of cardiovascular medicine such as electrophysiology, cardiac catheterization and cardiac surgery. The program centers on patient care, patient needs and patient respect and its team provides a comprehensive Cancer Survivorship Care Plan, detailing treatment regimens for all aspects of well-being.

Program Director Diwakar Jain, MD, FACC, MASNC, FSNMMI, is internationally renowned in the fields of nuclear cardiology and molecular cardiovascular imaging; behavior, mental stress and heart disease; and cardio-oncology.

Diagnostic Techniques

Echocardiography has been used to track changes in heart function over time. More recently, myocardial strain imaging using ultrasound has been found to be very useful for detecting adverse effects of cardiotoxic chemotherapy at an early stage. Global Longitudinal Strain Imaging of the heart is an important diagnostic tool for early detection and prevention of cardiotoxicity of cancer chemotherapy. Abnormal amounts of fluid can collect around the heart in patients with cancers, and can be life-threatening. Echocardiography can readily detect this condition. Westchester Medical Center has state-of-the art echocardiography labs to serve adult and pediatric patients.

Advanced Cardiovascular Imaging

Cardiac imaging also can be performed using radiopharmaceuticals in conjunction with a treadmill exercise test or chemical stress test to detect coronary artery disease and identify patients who can benefit from advanced procedures. This test can avoid invasive tests such as coronary angiography in patients who do not have underlying coronary artery disease. Nuclear- imaging tests also can study heart function; subtle deterioration of cardiac function is often the first indication of cardiotoxicity. Westchester Medical Center has state-of-the-art nuclear cardiovascular imaging labs to serve inpatients as well as outpatients.

Magnetic Resonance Imaging (Cardiac MRI)

Magnetic resonance provides detailed anatomical information about chambers, valves and the pericardial space surrounding the heart. Images can detect myocardial scarring resulting from old myocardial infarction, and radiation-induced and chemotherapy-induced injury to the heart muscle. T1 Imaging of the heart can detect and characterize abnormalities of the myocardial tissues. Westchester Medical Center has state-of-the-art cardiovascular MR imaging labs to serve inpatients as well as outpatients.

Exercise Stress-Testing

Impaired functional capacity may be an early indication of heart disease. Exercise stress-testing often is combined with heart imaging through echocardiography, or nuclear imaging of the heart, to secure additional information about the valves, coronary arteries and heart function.

The Next Frontier

Westchester Medical Center is poised to extend the Cardio-Oncology Program to WMCHealth hospitals and outpatient facilities across the Hudson Valley. Westchester Medical Center also intends to initiate research studies to enhance understanding of the mechanism of cardiotoxicity of various cancer therapeutic agents and develop novel approaches to prevent cardiotoxicity.

Appointments, Referrals and Information

Program Coordinator
Ana Sanchez Diaz
914.473.3671
Ana.Sanchez-Diaz@WMCHealth.org

Westchester Medical Center Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595
Phone: 866.WMC.HEART or 866.962.4327
Fax: 914.493.2828
Cardio-Oncology@WMCHealth.org

Learn more about the Cardio-Oncology Program at Westchester Medical Center.