Cardiac dysfunction in cancer patients: beyond direct cardiomyocyte damage of anticancer drugs. Novel cardio-oncology insights from the joint 2019 meeting of the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart.

In the Western countries cardiovascular disease and cancer are the leading causes of death in the ageing population. Recent epidemiological data suggest that cancer is more frequent in patients with prevalent or incident cardiovascular disease, in particular heart failure. Indeed, there is a tight link in terms of shared risk factors and mechanisms between heart failure and cancer. Heart failure induced by anticancer therapies has been extensively studied, primarily focusing on the toxic effects that antitumor treatments exert on cardiomyocytes. In this Cardio-Oncology update, members of the ESC WGs of Myocardial Function and of Cellular Biology of the Heart discuss novel evidence interconnecting cardiac dysfunction and cancer via pathways in which cardiomyocytes may be involved, but are not central. In particular, the multiple roles of cardiac stromal cells (endothelial cells, fibroblasts) and inflammatory cells are highlighted. Also, the gut microbiota is depicted as a new player at the crossroads between heart failure and cancer. Finally, the role of non-coding RNAs in Cardio-Oncology is also addressed. All these insights are expected to fuel additional research efforts in the field of Cardio-Oncology.