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Cancer treatments and cardiotoxicity: too much or too little?

Cardiovascular Pharmacotherapy

As a result of significant advances in cancer treatment in the last decade, many patients with cancer are now living with sufficient survival to develop the cardiovascular complications of their cancer treatment. There is a growing body of data describing the magnitude of risk of adverse cardiovascular events in the population of patients that received cancer treatment either in childhood, or as adults.

In the lecture by Bonnie Ky, (Philadelphia, USA) the audience learned that the risk of cardiotoxicity is associated with age, obesity/overweight, arterial hypertension and a reduced ejection fraction at baseline. Echocardiography is the most widely used imaging modality in the evaluation of these patients.

The monitoring of cardiotoxicity using imaging (addressed by M. Scherrer-Crosbie, Boston, USA) actually corresponds to the estimation of the ejection fraction, which is an imperfect index when using 2D echocardiography. At the present time, a reduction of ejection fraction > 10% is an indication to withdraw chemotherapy. The use of a contrast agent for better detection of endocardial borders can be considered to improve the “true” estimation of ejection fraction in the case of suboptimal images.

3D echocardiography should be preferred when available. However, early subclinical heart involvement induced by chemotherapy (as outlined by Thor Edvardsen) can be detected by estimating global longitudinal strain by Speckle Tracking Echocardiography. A value of global longitudinal strain lower than -19% is an accurate indicator of left ventricular systolic dysfunction and should be carefully taken into account.

Furthermore, radiotherapy also induces cardiotoxicity (as explained by B Cosyns, Belgium). Indeed, pericardial involvement (30% of the cases), wall motion abnormalities due to significant coronary artery stenosis, left ventricular systolic and/or diastolic dysfunction as well as valve heart disease (19-26%) can be identified by using echocardiography.

Lastly, as outlined by R Wassmuth (Berlin, Germany), cardiac magnetic resonance imaging can be very useful to obtain greater accuracy in the estimation of ejection fraction and also to detect late gadolinium enhancement.




Cancer treatments and cardiotoxicity: too much or too little?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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