Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the European Society of Cardiology (ESC)

Abstract

Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed.

COVID-19 myocarditis and prospective heart failure burden

“…Pediatric patients who underwent chemotherapy with anthracycline and/or radiotherapy have 15 times higher HF incidence [49]. The proportion of chemotherapy-related cardiac dysfunction [50] is variable and depends upon initial CV risk factors, preexisting CV disease, as well as chemotherapy (may rise up to 27% upon treatment with HER2 -inhibitors) [51]. However, the prevalence of cancer-treatment-related myocarditis is thought to be largely underestimated, especially in those who undergo immuno-oncological treatment [52].…”

Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

“…Previous studies have also explored early detection of chemotherapy-induced changes in cardiac function using the echocardiographic measures of ejection fraction and/or global longitudinal strain. [25][26][27][28] In the subset of patients in our study who developed cardiotoxicity and had pre-and posttreatment left ventricular ejection fraction (LVEF) and GLS data available, a GLS decline was observed in the absence of a meaningful decrease in LVEF. This small dataset is congruent with the ndings from Awadalla et al, who demonstrated GLS decreases were lower in patients with ICI induced myocarditis compared to control patients and was associated with the development of major adverse cardiovascular events.…”

Role of Cardiac Imaging in the Diagnosis of Immune Checkpoints Inhibitors Related Myocarditis

“…Most recent ESMO and ASCO guidelines dealing with the management of ICI-related myocarditis do not describe any diagnostic workup (26,27). However, recent position statements from the European heart failure association suggest, despite clear evidences, to obtain references values before ICI initiation based on an echocardiogram, an electrocardiogram, and biomarkers measurement (troponin and a natriuretic peptide) (28,29).…”