Cancer therapies save lives but can harm the heart. As survival improves, more patients experience cancer‑therapy‑related cardiac dysfunction (CTRCD) – a spectrum of myocardial injury, cardiomyopathy and heart failure (HF). Awareness across specialties is vital.
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What is CTRCD? CTRCD captures cardiac injury, ventricular dysfunction and symptomatic HF due to chemo, targeted agents, immunotherapies or radiation therapy. Symptomatic CTRCD means overt HF; it’s more common in (but not limited to) older patients with pre‑existing cardiovascular disease.
How common is CTRCD? A recent meta‑analysis found CTRCD incidence ~63 per 1000 person‑years among cancer patients. Severe symptomatic HF occurs in ≈0.5–3 % of patients during treatment, but profoundly worsen the the prognosis of cancer patients
Which therapies are cardiotoxic? Anthracyclines, HER2‑targeted agents, proteasome inhibitors, tyrosine‑kinase inhibitors, immune checkpoint inhibitors and thoracic radiation all increase CTRCD. Risk rises with cumulative anthracycline dose and combination therapy (e.g., trastuzumab + doxorubicin).
Risk stratification. The consensus endorses the HFA‑ICOS risk score to categorise patients BEFORE cancer therapy: onlinelibrary.wiley.com/doi/10.1002/ej…
Assess:
1️⃣ Existing CV disease (HF, cardiomyopathy, prior MI)
2️⃣ Baseline biomarkers (troponin, BNP/NT‑proBNP)
3️⃣ Age, hypertension, diabetes, chronic kidney disease
4️⃣ Previous cardiotoxic therapy (anthracyclines, left‑chest RT)
5️⃣ Lifestyle factors (smoking, obesity)
Assess:
1️⃣ Existing CV disease (HF, cardiomyopathy, prior MI)
2️⃣ Baseline biomarkers (troponin, BNP/NT‑proBNP)
3️⃣ Age, hypertension, diabetes, chronic kidney disease
4️⃣ Previous cardiotoxic therapy (anthracyclines, left‑chest RT)
5️⃣ Lifestyle factors (smoking, obesity)
Early detection:
Obtain baseline ECG, echocardiography (including 3‑D LVEF and global longitudinal strain) and cardiac biomarkers ( NT-proBNP and Troponin I).
Patients with low or low‑normal LVEF (<50 % or 50–54 %) need closer monitoring; use cardiac MRI when echo windows are poor
Obtain baseline ECG, echocardiography (including 3‑D LVEF and global longitudinal strain) and cardiac biomarkers ( NT-proBNP and Troponin I).
Patients with low or low‑normal LVEF (<50 % or 50–54 %) need closer monitoring; use cardiac MRI when echo windows are poor
Lifestyle counts:
Encourage intentional weight control (target BMI 20–25), smoking cessation, a Mediterranean‑style diet and at least 150 min/week of moderate‑intensity exercise plus resistance training
These measures reduce hypertension, diabetes and obesity – all additive risk factors
Encourage intentional weight control (target BMI 20–25), smoking cessation, a Mediterranean‑style diet and at least 150 min/week of moderate‑intensity exercise plus resistance training
These measures reduce hypertension, diabetes and obesity – all additive risk factors
Pharmacologic prevention:
💊Use ACE inhibitors/ARBs, β‑blockers and mineralocorticoid receptor antagonists to attenuate LVEF decline in high‑risk patients.
💊SGLT2 inhibitors and ARNI show promise but need more evidence - there are ongoing trials currently.
💊In very high‑risk anthracycline regimens, use dexrazoxane or liposomal anthracyclines.
💊Use ACE inhibitors/ARBs, β‑blockers and mineralocorticoid receptor antagonists to attenuate LVEF decline in high‑risk patients.
💊SGLT2 inhibitors and ARNI show promise but need more evidence - there are ongoing trials currently.
💊In very high‑risk anthracycline regimens, use dexrazoxane or liposomal anthracyclines.
📆 Monitoring & management. Surveillance intervals depend on risk: from every cycle in very‑high‑risk patients to periodic checks in low‑risk patients.
🩺Treat early declines per HF guidelines using ACEi/ARB, β‑blockers, MRAs, SGLT2 inhibitors and neprilysin inhibitors; decisions on continuing cancer therapy should be multidisciplinary.
🩺Treat early declines per HF guidelines using ACEi/ARB, β‑blockers, MRAs, SGLT2 inhibitors and neprilysin inhibitors; decisions on continuing cancer therapy should be multidisciplinary.
🤝 Take‑home message:
CTRCD prevention demands a team approach.
🩺General physicians and primary care clinicians must optimise CV risk factors in cancer survivors.
🩺emergency doctors should recognise acute presentations of cardiac side effects of treatment;
🩺oncologists and cardiologists must collaborate on risk stratification, surveillance and cardioprotective strategies.
Early detection and holistic care keep hearts and cancer treatments on track💝
CTRCD prevention demands a team approach.
🩺General physicians and primary care clinicians must optimise CV risk factors in cancer survivors.
🩺emergency doctors should recognise acute presentations of cardiac side effects of treatment;
🩺oncologists and cardiologists must collaborate on risk stratification, surveillance and cardioprotective strategies.
Early detection and holistic care keep hearts and cancer treatments on track💝
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