Clinical Diagnosis and Resources Prevention Area
Clinical Resources – Medical Resources
Division of Cardiology Carlo CIPOLLA, MD Director
STAFF Senior Deputy Directors: Maurizio Civelli, MD, Giuseppina Lamantia, MD Deputy Directors: Nicola Colombo, MD, Carlo Meroni, MD Senior Assistants: Alessandro Colombo, MD, Giulia Bacchiani, MD Consultant: Cesare Fiorentini, MD, PhD (University of Milan) Secretary: Fabio Farina Chief Nurse: Arnaldo Zanelotti Data Manager: Ines Tedeschi OTA: Maria Iannitelli Consultants Smoke Cessation Center: Elena Calvi, MD (Psychologist and Pneumologist), Natalia Pozzi (Fondazione Umberto Veronesi) Cardioncology Unit Staff Director: Daniela Cardinale, MD, PhD, FESC Senior Assistants: Alessandro Colombo, MD, Giulia Bacchiani, MD Consultant Doctor: Alexandra Gelfi, MD Fellows: Marta Beggiato, Damiano Pongan Data manager: Ines Tedeschi, DSc Secretary Assistant: Alessia Cattaneo Experimental Cardioncology Unit Staff Staff Scientist: Marco Giorgio Scientist: Mirella Trinei Fellow: Elisa Romanini
Activities 2012.
Cardiology Division’s activities relate to pre- and post-operative cardiologic assessment, respiratory function evaluations, general internal medicine consultations, antismoking activities, extensive clinical monitoring and therapy for internal wards and treatment of emergencies. The specific cardiological activity is strongly oriented to the diagnosis and therapy of cardiac disorders in order to detect and treat co morbidities (51% of IEO cancer patients present concomitant cardiovascular diseases) as well as potential or evident consequences of oncologic treatments - i.e. cardiotoxicity). Cardiological evaluations, either clinical or instrumental, are present in 165 scientific research protocols of the Institute. In 2012 the Division performed: a. cardiologic assessment of 16.665 internal and outpatients; b. complete echocardiographic and Doppler color evaluations in 3954 patients; c. respiratory physiopathology diagnostic and assistance (2343); d. 122 antismoking activities for patients and employees; e. clinical consultations and/or echocardiographic examinations for 18181 patients enrolled in different; f. overall 55639 written official cardiologic, cardioncologic and pneumologic reports. During 2012 1112 patients were treated in urgent emergency setting, 82% internal cases, 18% outpatients. Cardioncology Unit Cardioncology is a novel, interdisciplinary, rapidly evolving area of growing interest, based on a comprehensive approach for the management of cardiovascular problems of cancer patients, pre-existent or induced by anticancer therapy. The Cardioncology Unit of the IEO is the first created in Italy to deal with this need. The main clinical and research areas of the Unit are early diagnosis of cardiotoxicity, cardiac risk
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stratification, prevention, treatment and monitoring of cardiotoxicity during anticancer therapy, including both traditional and new biologic agents. Since the current standard diagnostic methods allow to detect cardiotoxicity only when a functional impairment has already occurred, this precluding any chance of preventing its development, the Cardioncology Unit of the IEO has created specific internal procedures, based on our almost twenty-year-long clinical and research experience. They include the assessment of cardiac biomarkers (Troponin I and NT-proBNP), and an early preventive therapy with ACE-inhibitors, in selected highrisk patients, namely those showing myocardial injury
during the oncologic treatment, revealed by the increase of Troponin I. This approach has proven to be effective in the prevention of the development of cardiotoxicity in more than 1,700 cancer patients, who we have followed-up for more than 7 years. Due to the increasing number of long-term cancer survivors, the aging of the population, as well as the increased incidence and prevalence of oncologic and cardiovascular diseases, the number of patients presenting oncologic and cardiologic co-morbidities are increasing. These patients are often excluded from intensive cardiologic treatment and/or interventions, and are often excluded from a first-line, aggressive - and therefore more effective - therapeutic
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