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Challenges in cardiac oncology

The Friday morning session on challenges in cardiac oncology was very well attended and no seats were free. Prof. Pio Caso from Naples, Italy and the author of this summary, Prof. Thor Edvardsen, Oslo, Norway, chaired the session.

The first speaker was Associate Professor Ruxandra Jurcut from Bucharest, Romania. She presented a comprehensive overview over the topic of cardiotoxicity and stressed that this is a widespread health problem. She demonstrated how different cancer drugs like anthracyclines, among many, and radiotherapy can cause damage in the myocardium, pericardium, valves, coronaries and conduction system. Furthermore, she spoke about how we as imagers, can reveal these problems during and after cancer therapy.  

The next two presentations addressed the apparent inconsistencies between ejection fraction (EF) and strain imaging. Dr Dania Mothy from Limoges, France, was one the authors of the recent ESC position document on cardiovascular toxicity. She demonstrated the limitations of EF, like load dependence, technical challenges, tracing of endocardial borders and the assumptions of LV geometry behind the volume calculations in the EF equation. She also mentioned that strain imaging is recommended in this paper, together with troponin assessment. Finally, she discussed primary and secondary prevention treatment of myocardial dysfunction, and underlined that more data are needed before we can recommend heart failure treatment in patients with normal EF and decreased global longitudinal strain (GLS).

Dr Juan Carlos Plana, Houston, USA, was the lead author of the joint EACVI/ASE consensus paper on multimodality imaging during and after cancer therapy. He showed us very convincingly why we should use GLS in all these patients. GLS has a superior variability compared to EF and all other echo parameters for assessing LV function. Due to a moderate bias between different vendors, he urged us, however, to use the same machine and software when we compare to previous examinations in the same patient.

The last presentation was given by Dr Raluca Dulgheru, Liege, Belgium. She explained the problems of valvular heart disease in oncology patients. A common finding is valvular problems after radiation therapy, in particular after lymphoma treatment, but problems also exist after radiation therapy in breast cancer. Some cancer drugs can also lead to valvular dysfunction. The problem is caused by LV remodeling due to the toxic effect of the myocardium.

The session was very popular and interesting and gave clinically very important messages to the packed audience that attended.

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.