A Potential Bidirectional Interaction Between Heart Failure and Cancer Progression: Insights From Two Rapidly Fatal...

The interaction between malignancy and cardiovascular disease is increasingly recognized in cardio-oncology. While cancer therapy-related cardiac dysfunction is well established, a potential bidirectional relationship between heart failure (HF) and cancer progression remains underexplored. We present the cases of two patients without known cardiovascular disease who developed new-onset HF in temporal association with rapidly progressive metastatic malignancies. A 65-year-old man with metastatic pancreatic adenocarcinoma developed severe left ventricular (LV) systolic dysfunction with a left ventricular ejection fraction (LVEF) of 30%, apical akinesis, and suspected LV thrombus after a previously normal cardiac evaluation. A 44-year-old man with metastatic esophageal squamous cell carcinoma developed severe LV systolic dysfunction (LVEF 25-30%) with global hypokinesia, also following a normal baseline cardiac assessment. In both cases, baseline electrocardiography, troponin levels, and echocardiography were normal, whereas B-type natriuretic peptide (BNP) levels became elevated during rapid tumor progression. Both patients experienced rapid clinical deterioration and died within weeks of diagnosis. These cases highlight a potential interaction between aggressive malignancy and cardiac dysfunction, possibly mediated by inflammatory, metabolic, and neurohormonal mechanisms. Conversely, HF may adversely affect oncologic outcomes by reducing physiological reserve and limiting therapeutic options. Although causality cannot be established from these observations, new-onset HF occurring alongside rapidly progressive malignancy may represent an underrecognized clinical phenomenon with important prognostic implications.