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Review

Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology

1
Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India
2
Department of Biochemistry, Maharishi Markandeshwar Medical College & Hospital, MMU, Solan 173229, India
3
Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India
4
Department of Physiology, University of Louisville, Louisville, KY 40202, USA
5
Department of Medicine, University of Louisville, Louisville, KY 40202, USA
6
Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(19), 3225; https://doi.org/10.3390/cancers17193225
Submission received: 10 September 2025 / Revised: 29 September 2025 / Accepted: 30 September 2025 / Published: 3 October 2025
(This article belongs to the Special Issue Cancer Induced Organ Dysfunctions (Cachexia))

Simple Summary

Cancer is not confined to the organ or tissue where it originates but rather exerts widespread effects throughout the body. One of the most challenging manifestations is cancer-induced organ dysfunction, particularly cachexia, a complex syndrome that extends beyond the direct toxicities of treatment. Tumors are known to release cytokines, reactive oxygen species (ROS), and neurohormonal signals that trigger systemic inflammation, metabolic stress, and tissue damage. This inflammatory cascade can significantly impact the heart, contributing to myocardial atrophy, fibrosis, and impaired cardiac function. Chemotherapy has long been recognized as a primary driver of cardiovascular toxicity. Therefore, continuous and comprehensive cardiac monitoring is essential throughout cancer treatment. Echocardiography (ECG), especially with strain imaging, remains the frontline tool for assessing cardiac function, while cardiac Magnetic Resonance Imaging (MRI) offers high-resolution insights into structural and functional changes. Current management strategies combine established cardioprotective agents such as ACE inhibitors, beta-blockers, and statins with emerging approaches, including antioxidants and novel targeted therapies. Promising preclinical research into compounds like Withaferin A (WFA) suggests potential for preventing or mitigating imminent cardiac damage. Addressing cancer-induced cachexia and its cardiovascular consequences requires a multidisciplinary approach, supported by ongoing research and personalized treatment strategies.

Abstract

Cancer-induced cardiac dysfunction has become a major clinical challenge as advances in cancer therapies continue to extend patient survival. Once regarded as a secondary concern, cardiotoxicity is now recognized as a leading contributor to morbidity and mortality among cancer patients and survivors. Its pathophysiology is multifactorial, involving systemic inflammation (e.g., TNF-α, IL-6), oxidative stress driven by reactive oxygen species (ROS), neurohormonal imbalances (e.g., angiotensin II, endothelin-1), and metabolic disturbances. These mechanisms collectively promote cardiomyocyte apoptosis, atrophy, mitochondrial dysfunction, and impaired cardiac output. Cardiac complications may arise directly from cancer itself or as adverse effects of oncologic therapies such as anthracyclines, trastuzumab, and immune checkpoint inhibitors. These agents have been linked to heart failure (HF), systolic dysfunction, and cardiac atrophy, often progressing insidiously and underscoring the importance of early detection and careful monitoring. Current preventive and therapeutic strategies include pharmacological interventions such as ACE inhibitors, beta-blockers, statins, dexrazoxane, and endothelin receptor antagonists like atrasentan. Emerging compounds, particularly Withaferin A (WFA), have shown potential through their anti-inflammatory and cardiac protective properties. In addition, antioxidants and lifestyle modifications may provide supplementary cardioprotective benefits, while interventional cardiology procedures are increasingly considered in selected patients. Despite encouraging progress, standardized treatment protocols and robust long-term outcome data remain limited. Given the heterogeneity of cancer types and cardiovascular responses, a personalized and multidisciplinary approach is essential. Continued research and close collaboration between oncologists, cardiologists, and basic scientists will be the key to advancing care, reducing treatment-related morbidity, and ensuring that improvements in cancer survival are matched by preservation of cardiovascular health.
Keywords: cancer, cachexia, cardiac dysfunction cancer, cachexia, cardiac dysfunction

Share and Cite

MDPI and ACS Style

Saha, S.; Singh, P.K.; Roy, P.; Vemuri, V.; Ratajczak, M.Z.; Singh, M.; Kakar, S.S. Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology. Cancers 2025, 17, 3225. https://doi.org/10.3390/cancers17193225

AMA Style

Saha S, Singh PK, Roy P, Vemuri V, Ratajczak MZ, Singh M, Kakar SS. Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology. Cancers. 2025; 17(19):3225. https://doi.org/10.3390/cancers17193225

Chicago/Turabian Style

Saha, Sarama, Praveen K. Singh, Partha Roy, Vasa Vemuri, Mariusz Z. Ratajczak, Mahavir Singh, and Sham S. Kakar. 2025. "Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology" Cancers 17, no. 19: 3225. https://doi.org/10.3390/cancers17193225

APA Style

Saha, S., Singh, P. K., Roy, P., Vemuri, V., Ratajczak, M. Z., Singh, M., & Kakar, S. S. (2025). Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology. Cancers, 17(19), 3225. https://doi.org/10.3390/cancers17193225

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