Focused echocardiography in cardio‐oncology

Abstract

Transthoracic echocardiography (TTE) is the cornerstone of imaging in patients with a malignancy in all stages of their treatment—before, during, and after the completion of it—to identify most of the cardiotoxic complications. However, the restricted time and resources of cardio‐oncology services and the high volume of oncological patients and survivors on the other hand limit the access of this population to this modality. Focused Echo in Cardio‐Oncology (FECO) in proportion to other focused cardiac protocols is proposed as a valuable tool after the initial standard complete TTE to: (a) identify the potential toxicity expected by the specific cancer therapy applied; (b) assess sequentially the pre‐existing abnormality, if any, in relation to therapy; (c) assess the effect of any cardio‐protective intervention; (d) identify any cardiac origin of patient complaints during or after therapy; (e) assess cardiac function in asymptomatic patients who develop significant changes in cardiac biomarkers during cancer therapy. Four different protocols of FECO are proposed according to the type of cardiotoxicity anticipated: FECOm (in patients on chemotherapeutics that cause myocardial dysfunction), FECOv (in patients at risk of valvular heart disease), FECOpd (in patients at risk of pericardial disease), and FECOph (in patients at risk of pulmonary hypertension). The application of FECO protocols is aimed to ensure accuracy, reliability, and effectiveness in the early identification of cardiovascular complications, improving quality of life, and being at the same time cost‐effective.

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

“…3D-TTE, 2D-TTE, CMR) is recommended throughout the entire treatment to decrease inter-technique variability. 94,199,200 Cardiac imaging should be performed at any time if patients receiving cardiotoxic therapies present with new cardiac symptoms.…”

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…The role of CV imaging in cancer patients receiving cardiotoxic therapies has been highlighted in a position statement by the HFA 12 and in the European Society for Medical Oncology guidelines. 80 The role of focus echocardiography 81 and CMR 82 has also been recently discussed. In daily practice, caution should, however, be given if using late gadolinium enhancement or qualitative T2-weighted STIR imaging-only approach for the exclusion of checkpoint inhibitor-associated myocarditis.…”

Investigation of biomarker-based follow-up of anthracycline-induced cardiotoxicity in patients with breast cancer based on the latest protocol from the European Society of Cardiology guideline on cardio-oncology

“…For instance, docetaxel has been reported to affect 2.3-13% of the population, whereas the incidence of paclitaxel is less than 1%. 30 For cyclophosphamide, the incidence varies from 7-28% depending on its dose. 30,31 However, few studies have addressed the difference in protocols with the same chemotherapeutic agents.…”

“…30 For cyclophosphamide, the incidence varies from 7-28% depending on its dose. 30,31 However, few studies have addressed the difference in protocols with the same chemotherapeutic agents. In addition, no comparative studies have evaluated the cardiotoxicity of different agents in the same class.…”