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Review
. 2016 Feb;9(2):e002843.
doi: 10.1161/CIRCHEARTFAILURE.115.002843.

Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions

Carine E Hamo  1 , Michelle W Bloom  1 , Daniela Cardinale  1 , Bonnie Ky  1 , Anju Nohria  1 , Lea Baer  1 , Hal Skopicki  1 , Daniel J Lenihan  1 , Mihai Gheorghiade  1 , Alexander R Lyon  1 , Javed Butler  2
Affiliations
Review

Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions

Carine E Hamo et al. Circ Heart Fail. 2016 Feb.

Abstract

Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.

Keywords: cardiomyopathies; cardiotoxicity; heart; heart failure; trastuzumab.

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Figures

Figure 1
Figure 1
Proposed Algorithm for the Surveillance and Treatment of Cardiotoxicity in Patients Receiving Potentially Cardiotoxic Chemotherapy Prior to (A), During (B), and Following (C) Therapy. *Continuous variables of risk 1 MUGA may be considered if echocardiography or CMR not available 2 For high-risk patients or when available, strain-imaging. Use of Echo contrast when indicated 3 65–74 may represent an intermediate risk group 4 Troponin, BNP 5 Consider earlier imaging if higher baseline risk
Figure 1
Figure 1
Proposed Algorithm for the Surveillance and Treatment of Cardiotoxicity in Patients Receiving Potentially Cardiotoxic Chemotherapy Prior to (A), During (B), and Following (C) Therapy. *Continuous variables of risk 1 MUGA may be considered if echocardiography or CMR not available 2 For high-risk patients or when available, strain-imaging. Use of Echo contrast when indicated 3 65–74 may represent an intermediate risk group 4 Troponin, BNP 5 Consider earlier imaging if higher baseline risk
Figure 1
Figure 1
Proposed Algorithm for the Surveillance and Treatment of Cardiotoxicity in Patients Receiving Potentially Cardiotoxic Chemotherapy Prior to (A), During (B), and Following (C) Therapy. *Continuous variables of risk 1 MUGA may be considered if echocardiography or CMR not available 2 For high-risk patients or when available, strain-imaging. Use of Echo contrast when indicated 3 65–74 may represent an intermediate risk group 4 Troponin, BNP 5 Consider earlier imaging if higher baseline risk
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