Hypertensive remodelling as a testable myocardial vulnerability phenotype in anthracycline cardiotoxicity: imaging, biomarkers, and an early-detection research framework
DOI:
https://doi.org/10.66636/gmj.v1.i3.a185Keywords:
Hypertension, Anthracyclines, Cardiotoxicity, Ventricular remodeling, Echocardiography, Magnetic resonance imagingAbstract
Hypertension is the most common cardiovascular comorbidity in cancer populations, yet cardio-oncology risk-prediction tools capture it only as a binary variable. This narrative review examines whether hypertensive heart disease and anthracycline-type cancer therapy-related cardiac dysfunction (CTRCD) share a clinically silent, left ventricular ejection fraction-preserved phenotype of coronary microvascular dysfunction and diffuse interstitial fibrosis, and whether graded hypertensive remodelling should be treated as a testable pre-treatment vulnerability substrate rather than a comorbidity to adjust away. Synthesising human and large-animal evidence identified non-systematically through PubMed/MEDLINE and Google Scholar and reported using the SANRA framework, we find that although hypertension confounds this relationship, controlled large-animal data support the biological plausibility that pre-existing pressure overload unmasks a latent metabolic vulnerability on low-dose anthracycline exposure, an interaction still awaiting human validation. The two fields have independently converged on overlapping detection tools — global longitudinal strain, cardiac magnetic resonance tissue characterisation and extracellular volume, and a partly shared biomarker panel — but this convergence is argued specifically for the hypertension–anthracycline axis and does not extend uniformly to HER2-targeted, immune-mediated, vascular, or radiation-related mechanisms. We propose a prospective research agenda testing whether graded remodelling severity improves CTRCD prediction; no change to current practice is recommended.
Keywords: hypertension; anthracyclines; cardiotoxicity; ventricular remodelling; echocardiography; magnetic resonance imaging
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