{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:20:18Z","timestamp":1791199218211,"version":"4.1.0"},"reference-count":112,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R25GM133328 (SSK)"],"award-info":[{"award-number":["R25GM133328 (SSK)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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-\u03b1, 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.<\/jats:p>","DOI":"10.3390\/cancers17193225","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:22:47Z","timestamp":1759483367000},"page":"3225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cancer-Induced Cardiac Dysfunction: Mechanisms, Diagnostics, and Emerging Therapeutics in the Era of Onco-Cardiology"],"prefix":"10.3390","volume":"17","author":[{"given":"Sarama","family":"Saha","sequence":"first","affiliation":[{"name":"Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh 249203, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen K.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Maharishi Markandeshwar Medical College & Hospital, MMU, Solan 173229, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5280-3212","authenticated-orcid":false,"given":"Vasa","family":"Vemuri","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0071-0198","authenticated-orcid":false,"given":"Mariusz Z.","family":"Ratajczak","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Louisville, Louisville, KY 40202, USA"},{"name":"Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2415-3314","authenticated-orcid":false,"given":"Mahavir","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sham S.","family":"Kakar","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Louisville, Louisville, KY 40202, USA"},{"name":"Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","unstructured":"Global Cancer Observatory (2022). International Agency for Research on Cancer."},{"key":"ref_2","first-page":"394","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.trecan.2018.10.001","article-title":"Cancer cachexia: More than skeletal muscle wasting","volume":"4","author":"Schmidt","year":"2018","journal-title":"Trends Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1002\/jcsm.13629","article-title":"Sarcopenia is a prognostic factor of adverse effects and mortality in patients with tumour: A systematic review and meta-analysis","volume":"15","author":"Zhang","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1210\/endrev\/bnad015","article-title":"Update on adipose tissue and cancer","volume":"44","author":"Brown","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1001\/jama.2020.5493","article-title":"Systemic amyloidosis recognition, prognosis, and therapy: A systematic review","volume":"324","author":"Gertz","year":"2020","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1038\/s41586-023-05968-y","article-title":"The neuroscience of cancer","volume":"618","author":"Mancusi","year":"2023","journal-title":"Nature"},{"key":"ref_8","first-page":"1995","article-title":"Perspectives on cancer therapy-induced mucosal injury: Pathogenesis, measurement, epidemiology, and consequences for patients","volume":"100","author":"Sonis","year":"2004","journal-title":"Cancer Interdiscip. Int. J. Am. Cancer Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1002\/jcsm.12165","article-title":"Muscle strength in breast cancer patients receiving different treatment regimes","volume":"8","author":"Klassen","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103729","DOI":"10.1016\/j.cellimm.2017.12.003","article-title":"Cancer-associated fibroblasts in tumor microenvironment\u2013Accomplices in tumor malignancy","volume":"343","author":"Liao","year":"2019","journal-title":"Cell. Immun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1200\/JCO.2016.70.5400","article-title":"Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline","volume":"35","author":"Armenian","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_12","first-page":"1179546819866445","article-title":"Cancer therapy-related cardiac dysfunction: An overview for the clinician","volume":"29","author":"Perez","year":"2019","journal-title":"Clin. Med. Insights"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Karekar, P., Jensen, H.N., Russart, K.L., Ponnalagu, D., Seeley, S., Sanghvi, S., Smith, S.A., Pyter, L.M., Singh, H., and Gururaja Rao, S. (2021). Tumor-induced cardiac dysfunction: A potential role of ROS. Antioxidants, 10.","DOI":"10.3390\/antiox10081299"},{"key":"ref_14","first-page":"441","article-title":"Cardiomyopathy Prevention in Cancer Patients","volume":"37","author":"Barbar","year":"2019","journal-title":"Cardiol. Clin."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cozma, A., Sporis, N.D., Lazar, A.L., Buruiana, A., Ganea, A.M., Malinescu, T.V., Berechet, B.M., Fodor, A., Sitar-Taut, A.V., and Vlad, V.C. (2022). Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A Systematic Review. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231810948"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s12933-020-01052-1","article-title":"Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity","volume":"19","author":"Bendor","year":"2020","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.cardfail.2024.08.045","article-title":"Cardio-Oncology and Heart Failure: A Scientific Statement from the Heart Failure Society of America","volume":"31","author":"Bloom","year":"2025","journal-title":"J. Card. Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jchf.2023.08.026","article-title":"SGLT2 Inhibitor Use and Risk of Clinical Events in Patients with Cancer Therapy-Related Cardiac Dysfunction","volume":"12","author":"Avula","year":"2024","journal-title":"JACC Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12933-021-01346-y","article-title":"The SGLT-2 inhibitor empagliflozin improves myocardial strain, reduces cardiac fibrosis and pro-inflammatory cytokines in non-diabetic mice treated with doxorubicin","volume":"20","author":"Quagliariello","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1093\/eurheartj\/ehae188","article-title":"Rescue of cardiac dysfunction during chemotherapy in acute myeloid leukaemia by blocking IL-1\u03b1","volume":"45","author":"Zhou","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s10557-020-07071-0","article-title":"Inflammatory cytokines and chemokines as therapeutic targets in heart failure","volume":"34","author":"Hanna","year":"2020","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1093\/cvr\/cvad158","article-title":"TNF-\u03b1 protects from exacerbated myocarditis and cardiac death by suppressing expansion of activated heart-reactive CD4+ T cells","volume":"120","author":"Rolski","year":"2024","journal-title":"Cardiovasc. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.3892\/or.2017.5542","article-title":"Cancer-induced cardiac cachexia: Pathogenesis and impact of physical activity","volume":"37","author":"Belloum","year":"2017","journal-title":"Oncol. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s11897-021-00517-y","article-title":"New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management","volume":"18","author":"Cuomo","year":"2021","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/B978-0-12-420117-0.00001-3","article-title":"Reactive oxygen species in normal and tumor stem cells","volume":"122","author":"Zhou","year":"2014","journal-title":"Adv. Cancer Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00280-020-04103-2","article-title":"Reactive oxygen species in cancer: A paradox between pro- and anti-tumour activities","volume":"86","author":"Kohan","year":"2020","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"749","DOI":"10.4103\/1673-5374.249218","article-title":"Mitophagy links oxidative stress conditions and neurodegenerative diseases","volume":"14","author":"Shefa","year":"2019","journal-title":"Neural Regen. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.25122\/jml-2022-0322","article-title":"Chemotherapy-induced cardiotoxicity: A new perspective on the role of Digoxin, ATG7 activators, Resveratrol, and herbal drugs","volume":"16","author":"Alburghaif","year":"2023","journal-title":"J. Med. Life"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10557-016-6711-0","article-title":"Anthracycline Chemotherapy and Cardiotoxicity","volume":"31","author":"McGowan","year":"2017","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"760","DOI":"10.7150\/ijbs.65258","article-title":"Underlying the Mechanisms of Doxorubicin-Induced Acute Cardiotoxicity: Oxidative Stress and Cell Death","volume":"18","author":"Kong","year":"2022","journal-title":"Int. J. Biol. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13048-025-01636-z","article-title":"Ovarian cancer and the heart: Pathophysiology, chemotherapy-induced cardiotoxicity, and new therapeutic strategies","volume":"18","author":"Nair","year":"2025","journal-title":"J. Ovarian Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1073\/pnas.1821022116","article-title":"Ferroptosis as a target for protection against cardiomyopathy","volume":"116","author":"Fang","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Li, D., Yang, Y., Wang, S., He, X., Liu, M., Bai, B., Tian, C., Sun, R., Yu, T., and Chu, X. (2021). Role of acetylation in doxorubicin-induced cardiotoxicity. Redox Biol., 46.","DOI":"10.1016\/j.redox.2021.102089"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s12012-022-09721-1","article-title":"Doxorubicin-Induced Cardiotoxicity: An Overview on Pre-clinical Therapeutic Approaches","volume":"22","author":"Sheibani","year":"2022","journal-title":"Cardiovasc. Toxicol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Bindu, S., Mazumder, S., and Bandyopadhyay, U. (2020). Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem. Pharmacol., 180.","DOI":"10.1016\/j.bcp.2020.114147"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1038\/s41586-023-06114-4","article-title":"Tumour extracellular vesicles and particles induce liver metabolic dysfunction","volume":"618","author":"Wang","year":"2023","journal-title":"Nature"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/jpi.12360","article-title":"Melatonin as an antioxidant: Under promises but over delivers","volume":"61","author":"Reiter","year":"2016","journal-title":"J. Pineal Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1161\/CIRCULATIONAHA.115.020406","article-title":"Shared Risk Factors in Cardiovascular Disease and Cancer","volume":"133","author":"Koene","year":"2016","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"154123","DOI":"10.1016\/j.phymed.2022.154123","article-title":"Recent advances in potential of Fisetin in the management of myocardial ischemia-reperfusion injury\u2014A systematic review","volume":"101","author":"Prem","year":"2022","journal-title":"Phytomedicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1038\/nrm3801","article-title":"Cellular mechanisms and physiological consequences of redox-dependent signalling","volume":"15","author":"Finkel","year":"2014","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1152\/physiolgenomics.00041.2017","article-title":"Nrf2 at the heart of oxidative stress and cardiac protection","volume":"50","author":"Chen","year":"2018","journal-title":"Physiol. Genom."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1089\/ars.2017.7178","article-title":"SIRT1 and SIRT6 Signaling Pathways in Cardiovascular Disease Protection","volume":"28","author":"Servillo","year":"2018","journal-title":"Antioxid. Redox Signal."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1038\/cdd.2015.158","article-title":"Ferroptosis: Process and function","volume":"23","author":"Xie","year":"2016","journal-title":"Cell Death Differ."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/med.21599","article-title":"Inducible nitric oxide synthase: Regulation, structure, and inhibition","volume":"40","author":"Cinelli","year":"2020","journal-title":"Med. Res. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/s41392-023-01378-8","article-title":"Metabolic landscape in cardiac aging: Insights into molecular biology and therapeutic implications","volume":"8","author":"Xie","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1007\/s10741-023-10328-z","article-title":"ACEI\/ARB and beta-blocker therapies for preventing cardiotoxicity of antineoplastic agents in breast cancer: A systematic review and meta-analysis","volume":"28","author":"Gao","year":"2023","journal-title":"Heart Fail. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1093\/eurheartj\/ehab843","article-title":"Stematic review and meta-analysis of beta-blockers and renin-angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer","volume":"43","author":"Lewinter","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Goulas, K., Farmakis, D., Constantinidou, A., and Kadoglou, N.P.E. (2023). Cardioprotective Agents for the Primary Prevention of Trastuzumab-Associated Cardiotoxicity: A Systematic Review and Meta-Analysis. Pharmaceuticals, 16.","DOI":"10.3390\/ph16070983"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"112","DOI":"10.2174\/1574887118666230118102252","article-title":"Prophylactic Agents for Preventing Cardiotoxicity Induced Following Anticancer Agents: A Systematic Review and Meta-Analysis of Clinical Trials","volume":"18","author":"Keshavarzian","year":"2023","journal-title":"Rev. Recent Clin. Trials"},{"key":"ref_50","first-page":"CD008011","article-title":"Medical interventions for treating anthracycline-induced symptomatic and asymptomatic cardiotoxicity during and after treatment for childhood cancer","volume":"2016","author":"Cheuk","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1136\/postgradmedj-2015-133535","article-title":"Cardioprotective role of \u03b2-blockers and angiotensin antagonists in early-onset anthracyclines-induced cardiotoxicity in adult patients: A systematic review and meta-analysis","volume":"91","author":"Yun","year":"2015","journal-title":"Postgrad. Med. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s11739-020-02508-8","article-title":"Prevention of anthracycline-induced cardiotoxicity: A systematic review and meta-analysis","volume":"16","author":"Caspani","year":"2021","journal-title":"Int. Emerg. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1136\/heartjnl-2017-312103","article-title":"Anthracycline cardiotoxicity: An update on mechanisms, monitoring and prevention","volume":"104","author":"Henriksen","year":"2018","journal-title":"Heart"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1038\/jhh.2013.55","article-title":"Hypertension and kidneys: Unraveling complex molecular mechanisms underlying hypertensive renal damage","volume":"28","author":"Mennuni","year":"2014","journal-title":"J. Hum. Hypertens."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Saha, S., Singh, P.K., Roy, P., and Kakar, S.S. (2022). Cardiac Cachexia: Unaddressed Aspect in Cancer Patients. Cells, 11.","DOI":"10.3390\/cells11060990"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/s41392-022-00974-4","article-title":"Microbiota in health and diseases","volume":"7","author":"Hou","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s12602-023-10105-2","article-title":"Anti-Inflammatory, Antioxidant, Metabolic and Gut Microbiota Modulation Activities of Probiotic in Cardiac Remodeling Condition: Evidence from Systematic Study and Meta-Analysis of Randomized Controlled Trials","volume":"5","author":"Taslim","year":"2023","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Barber, T.M., Kabisch, S., Pfeiffer, A.F.H., and Weickert, M.O. (2020). The Health Benefits of Dietary Fibre. Nutrients, 12.","DOI":"10.3390\/nu12103209"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"7563","DOI":"10.1080\/10408398.2023.2187212","article-title":"Anthocyanins-gut microbiota-health axis: A review","volume":"64","author":"Liang","year":"2024","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1038\/s41591-019-0509-0","article-title":"Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome","volume":"25","author":"Qi","year":"2019","journal-title":"Nat. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/bs.irn.2016.07.002","article-title":"Circadian Rhythm and the Gut Microbiome","volume":"131","author":"Voigt","year":"2016","journal-title":"Int. Rev. Neurobiol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Hassan, N.E., El-Masry, S.A., El Shebini, S.M., Ahmed, N.H., Mehanna, N.S., Abdel Wahed, M.M., and Amine, D. (2024). Effect of weight loss program using prebiotics and probiotics on body composition, physique, and metabolic products: Longitudinal intervention study. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-61130-2"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"100919","DOI":"10.1016\/j.focha.2025.100919","article-title":"A review on probiotics and dietary bioactives: Insights on metabolic well-being, gut microbiota, and inflammatory responses","volume":"6","author":"Mafe","year":"2025","journal-title":"Food Chem. Adv."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1008105","DOI":"10.37349\/eds.2025.1008105","article-title":"A narrative review on the role of gut microbiome, dietary strategies, and supplements in managing metabolic syndrome","volume":"3","author":"Bulut","year":"2025","journal-title":"Explor. Drug Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1113\/EP092052","article-title":"Synbiotic supplementation ameliorates anxiety and myocardial ischaemia-reperfusion injury in hyperglycaemic rats by modulating gut microbiota","volume":"109","author":"Bulut","year":"2024","journal-title":"Exp. Physiol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Zhang, S., Yang, Y., Lv, X., Liu, W., Zhu, S., Wang, Y., and Xu, H. (2023). Unraveling the intricate roles of exosomes in cardiovascular diseases: A comprehensive review of physiological significance and pathological implications. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242115677"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101849","DOI":"10.1016\/j.genrep.2023.101849","article-title":"Interoception, heart failure and exosomal cargo as potential biomarkers","volume":"33","author":"Vemuri","year":"2023","journal-title":"Gene Rep."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Pushpakumar, S., Singh, M., Zheng, Y., Akinterinwa, O.E., Mokshagundam, S.P.L., Sen, U., Kalra, D.K., and Tyagi, S.C. (2023). Renal Denervation Helps Preserve the Ejection Fraction by Preserving Endocardial-Endothelial Function during Heart Failure. Int. J. Mol. Sci., 24.","DOI":"10.20944\/preprints202303.0119.v1"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1111\/jvim.15762","article-title":"Extracellular vesicular microRNAs as potential biomarker for early detection of doxorubicin-induced cardiotoxicity","volume":"34","author":"Beaumier","year":"2020","journal-title":"J. Vet. Intern. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jcmg.2020.09.039","article-title":"Serial cardiovascular magnetic resonance strain measurements to identify cardiotoxicity in breast cancer: Comparison with echocardiography","volume":"14","author":"Houbois","year":"2021","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Lee, J.Y., Chung, J., Byun, Y., Kim, K.H., An, S.H., and Kwon, K. (2021). Mesenchymal stem cell-derived small extracellular vesicles protect cardiomyocytes from doxorubicin-induced cardiomyopathy by upregulating survivin expression via the miR-199a-3p-Akt-Sp1\/p53 signaling pathway. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22137102"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"25256","DOI":"10.18632\/aging.203743","article-title":"MicroRNA therapy confers anti-senescent effects on doxorubicin-related cardiotoxicity by intracellular and paracrine signaling","volume":"13","author":"Xia","year":"2021","journal-title":"Aging"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"125","DOI":"10.3892\/ijmm.2021.4958","article-title":"MicroRNA 133b alleviates doxorubicin induced cardiomyocyte apoptosis and cardiac fibrosis by targeting PTBP1 and TAGLN2","volume":"48","author":"Li","year":"2021","journal-title":"Int. J. Mol. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e333","DOI":"10.1093\/ehjci\/jeac106","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC)","volume":"23","author":"Lyon","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imag."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1177\/1474515119856207","article-title":"Risk prediction tools in cardiovascular disease prevention: A report from the ESC Prevention of CVD Programme led by the European Association of Preventive Cardiology (EAPC) in collaboration with the Acute Cardiovascular Care Association (ACCA) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP)","volume":"18","author":"Rossello","year":"2019","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jaccao.2020.09.006","article-title":"Genetics of anthracycline cardiomyopathy in cancer survivors","volume":"2","author":"Bhatia","year":"2020","journal-title":"JACC CardioOncol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1161\/CIRCULATIONAHA.118.037934","article-title":"Genetic variants associated with cancer therapy-induced cardiomyopathy","volume":"140","author":"Kim","year":"2019","journal-title":"Circulation"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3915","DOI":"10.1093\/eurheartj\/ehab362","article-title":"Anticancer drug-induced life-threatening ventricular arrhythmias: A World Health Organization pharmacovigilance study","volume":"42","author":"Salem","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e007724","DOI":"10.1161\/JAHA.117.007724","article-title":"Incidence, diagnosis, and management of QT prolongation induced by cancer therapies: A systematic review","volume":"6","author":"Gilbert","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1200\/JCO.2015.65.7916","article-title":"Role of troponins I and T and N-terminal prohormone of brain natriuretic peptide in monitoring cardiac safety of patients with early-stage human epidermal growth factor receptor 2-positive breast cancer receiving trastuzumab: A herceptin adjuvant study cardiac marker substudy","volume":"35","author":"Zardavas","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e014708","DOI":"10.1161\/JAHA.119.014708","article-title":"Changes in cardiovascular biomarkers with breast cancer therapy and associations with cardiac dysfunction","volume":"9","author":"DeMichele","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.jcmg.2018.06.003","article-title":"Multi-modality imaging in the assessment of cardiovascular toxicity in the cancer patient","volume":"11","author":"Plana","year":"2018","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.jcmg.2018.01.015","article-title":"Abnormalities in 3-dimensional left ventricular mechanics with anthracycline chemotherapy are associated with systolic and diastolic dysfunction","volume":"11","author":"Zhang","year":"2018","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1007\/s10554-019-01648-z","article-title":"Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: A prospective observational study","volume":"35","author":"Dhir","year":"2019","journal-title":"Int. J. Cardiovasc. Imag."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jcmg.2018.03.003","article-title":"Single versus standard multiview assessment of global longitudinal strain for the diagnosis of cardiotoxicity during cancer therapy","volume":"11","author":"Thavendiranathan","year":"2018","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.jcmg.2015.11.024","article-title":"Noninvasive measures of ventricular\u2013arterial coupling and circumferential strain predict cancer therapeutics\u2013related cardiac dysfunction","volume":"9","author":"Narayan","year":"2016","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.jaccao.2021.09.010","article-title":"Cardiac computed tomography in cardio-oncology","volume":"3","author":"Yang","year":"2021","journal-title":"JACC Cardio Oncol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1016\/j.jacc.2018.08.2166","article-title":"Cardiorespiratory fitness and mortality in healthy men and women","volume":"72","author":"Imboden","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00246-017-1787-2","article-title":"Systematic Literature Review on the Incidence and Prevalence of Heart Failure in Children and Adolescents","volume":"39","author":"Shaddy","year":"2018","journal-title":"Pediatr. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1542\/pir.2016-0168","article-title":"Congestive Heart Failure in Children","volume":"40","author":"Price","year":"2019","journal-title":"Pediatr. Rev."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1161\/CIRCULATIONAHA.121.055816","article-title":"Electrocardiographic manifestations of immune checkpoint inhibitor myocarditis","volume":"144","author":"Power","year":"2021","journal-title":"Circulation"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.119.044703","article-title":"Major adverse cardiovascular events and the timing and dose of corticosteroids in immune checkpoint inhibitor-associated myocarditis","volume":"141","author":"Zhang","year":"2020","journal-title":"Circulation"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jaccao.2020.02.011","article-title":"CAR T cell therapy-related cardiovascular outcomes and management: Systemic disease or direct cardiotoxicity?","volume":"2","author":"Ghosh","year":"2020","journal-title":"JACC CardioOncol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","article-title":"International expert consensus document on Takotsubo syndrome (part I): Clinical characteristics, diagnostic criteria, and pathophysiology","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Kelm, N.Q., Straughn, A.R., and Kakar, S.S. (2020). Withaferin A attenuates ovarian cancer-induced cardiac cachexia. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0236680"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s10555-020-09869-8","article-title":"How progressive cancer endangers the heart: An intriguing and underestimated problem","volume":"39","author":"Ausoni","year":"2020","journal-title":"Cancer Metastasis Rev."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1038\/248145a0","article-title":"Regeneration of the ventricular myocardium in amphibians","volume":"248","author":"Becker","year":"1974","journal-title":"Nature"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1161\/CIRCRESAHA.115.307017","article-title":"Functional recovery of a human neonatal heart after severe myocardial infarction","volume":"118","author":"Haubner","year":"2016","journal-title":"Circ. Res."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1126\/science.1164680","article-title":"Evidence for cardiomyocyte renewal in humans","volume":"324","author":"Buchholz","year":"2009","journal-title":"Science"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1038\/nature11682","article-title":"Mammalian heart renewal by pre-existing cardiomyocytes","volume":"493","author":"Senyo","year":"2013","journal-title":"Nature"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1073\/pnas.1214608110","article-title":"Cardiomyocyte proliferation contributes to heart growth in young humans","volume":"110","author":"Mollova","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4252\/wjsc.v14.i1.1","article-title":"Cardiac stem cells: Current knowledge and future prospects","volume":"14","author":"Mehanna","year":"2022","journal-title":"World J. Stem Cells"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1161\/CIRCULATIONAHA.119.045566","article-title":"Heart Regeneration by Endogenous Stem Cells and Cardiomyocyte Proliferation: Controversy, Fallacy, and Progress","volume":"142","author":"He","year":"2020","journal-title":"Circulation"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/S0092-8674(03)00687-1","article-title":"Adult cardiac stem cells are multipotent and support myocardial regeneration","volume":"114","author":"Beltrami","year":"2003","journal-title":"Cell"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1161\/CIRCRESAHA.116.309710","article-title":"The elusive progenitor cell in cardiac regeneration: Slip slidin away","volume":"120","author":"Cai","year":"2017","journal-title":"Circ. Res."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"12313","DOI":"10.1073\/pnas.2132126100","article-title":"Cardiac progenitor cells from adult myocardium: Homing, differentiation, and fusion after infarction","volume":"100","author":"Oh","year":"2003","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2931","DOI":"10.1161\/CIRCULATIONAHA.118.035210","article-title":"Genetic lineage tracing of Sca-1+ cells reveals endothelial but not myogenic contribution to the murine heart","volume":"138","author":"Vagnozzi","year":"2018","journal-title":"Circulation"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1089\/scd.2015.0272","article-title":"Abcg2-labeled cells contribute to different cell populations in the embryonic and adult heart","volume":"25","author":"Doyle","year":"2016","journal-title":"Stem Cells Dev."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13287-016-0355-7","article-title":"Bmi1+ cardiac progenitor cells contribute to myocardial repair following acute injury","volume":"7","author":"Herrero","year":"2016","journal-title":"Stem Cell Res. Ther."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1161\/CIRCULATIONAHA.118.035200","article-title":"Cardiac Sca-1+ cells are not intrinsic stem cells for myocardial development, renewal, and repair","volume":"138","author":"Zhang","year":"2018","journal-title":"Circulation"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"e70146","DOI":"10.14814\/phy2.70146","article-title":"Interoception, cardiac health, and heart failure: The potential for artificial intelligence (AI)-driven diagnosis and treatment","volume":"13","author":"Singh","year":"2025","journal-title":"Physiol. Rep."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3225\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:13:04Z","timestamp":1759983184000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":112,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193225"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193225","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}