Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity

Abstract

The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the last several years. The use of drugs for the treatment of cancers increased, and new molecules and protocols were developed to improve outcomes in these patients. Although, these novel approaches also produced a progressive increase in side effects, particularly myocardial dysfunction. Imaging of the heart was highly accurate in the early diagnosis of cancer therapeutics related-cardiac dysfunction. Echocardiography is the first-line method to assess ventricular function alterations, and it is required to satisfy the need for an early, easy and accurate diagnosis to stratify the risk of heart failure and manage treatments. A careful monitoring of cardiac function during the course of therapy should prevent the onset of severe heart impairment. This review provides an overview of the most important findings of the role of echocardiography in the management of chemotherapy-treated patients to create a clear and complete description of the efficacy of conventional measurements, the importance of comprehensive heart evaluations, the additional role of new echocardiographic techniques, the utility of integrated studies using other imaging tools and the positions of the most important international societies on this topic.

Cardiovascular Toxicity in Cancer Patients Treated with Tyrosine Kinase Inhibitors: A Real-World Single-Center Experience

“…In this study, it did not show significant differences between the two groups. Myocardial deformation indices of left ventricle (GLS) are known to be a very sensitive tool for the early detection of left ventricular dysfunction, and they have many advantages [19]. Several studies demonstrated that GLS is a predictor of cardiotoxicity.…”

Prevention, monitoring and treatment of cardiovascular adverse events in myeloma patients receiving carfilzomib A consensus paper by the European Myeloma Network and the Italian Society of Arterial Hypertension

“…The most frequently used parameter for routine cardiotoxicity monitoring is LVEF. A LVEF of >52% for men and >54% for women is considered normal . A LVEF drop of >10% or >5% with heart failure symptoms is considered diagnostic of cardiotoxicity.…”

Evaluation and Long-Term Outcomes of Cardiac Toxicity in Paediatric Cancer Patients

“…Right ventricular dysfunction is rare, but some drugs such as anthracyclines, cyclophosphamide and 5-luouracil can cause right ventricular systolic and diastolic function [7]. It is important to be aware of the ofending agents in order to minimize exposure, if clinically possible, in a failing heart.…”

“…If all structures are seen adequately during the irst echocardiogram, subsequent echocardiograms can be targeted function exams. The cardiac valves should be visualized on all exams as these patients have an increased risk of endocarditis, nonbacterial thrombotic endocarditis as well as radiation-induced heart disease afecting valves [7]. Transthoracic echocardiography is acceptable for looking for endocarditis if there are clear windows to the heart valves; otherwise depending on the index of suspicion, transoesophageal echocardiography is indicated as the gold standard.…”

“…While EF is an adequate gross marker of cardiac function, it may not be sensitive enough to detect early cardiac dysfunction [13][14][15]. Zito et al demonstrated that there is enough variability in EF measurements that it is not sensitive to detect a decrease in EF less than 10% [7]. If one is using EF as their main determinant of cardiac function, they may miss patients who have a signiicant decrease in cardiac function that may alter the course of therapy.…”