Cardiomyopathy associated with cancer therapy

Abstract

Chemotherapy-associated cardiomyopathy is a well known cardiotoxicity of contemporary cancer treatment and a cause of increasing concern for both cardiologists and oncologists. As cancer outcomes improve, cardiovascular disease has become a leading cause of morbidity and mortality among cancer survivors. Asymptomatic or symptomatic left ventricular systolic dysfunction in the setting of cardiotoxic chemotherapy is an important entity to recognize. Early diagnosis of cardiac injury through the use of novel blood-based biomarkers or noninvasive imaging modalities may allow for the initiation of cardioprotective medications or modification of chemotherapy regimen to minimize or prevent further damage. Several clinical trials are currently underway to determine the efficacy of cardioprotective medications for the prevention of chemotherapy-associated cardiomyopathy. Implementing a strategy that includes both early detection and prevention of cardiotoxicity will likely have a significant impact on the overall prognosis of cancer survivors. Continued coordination of care between cardiologists and oncologists remains critical to maximizing the oncologic benefit of cancer therapy while minimizing any early or late cardiovascular effects.

Keywords: Cardiotoxicity; chemotherapy; congestive heart failure.

Figure 1

Two-dimensional myocardial strain measurement Example of assessment of longitudinal myocardial strain in the apical 4-chamber view: (A) normal longitudinal strain in a healthy patient; (B) abnormal longitudinal strain in a Hodgkin lymphoma survivor previously treated with anthracycline chemotherapy and mediastinal radiotherapy. The colored lines represent measurements of regional myocardial deformation. The white dotted line represents the global average of all segments in each view.

Figure 2

Proposed diagnostic, preventive, and treatment strategies for patients at risk for chemotherapy associated cardiomyopathy