BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab

Abstract

The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.

Keywords: 2D, 2-dimensional; 3D, 3-dimensional; A2C, apical 2-chamber; A3C, apical 3-chamber; A4C, apical 4-chamber; BSE, British Society of Echocardiography; CMR, cardiac magnetic resonance; CTRCD, cancer therapy–related cardiac dysfunction; ECG, electrocardiogram; GLS, global longitudinal strain; HER2 therapy; HER2, human epidermal growth factor receptor 2; LV, left ventricular; LVEF, left ventricular ejection fraction; MV, mitral valve; RH, right heart; ROI, region of interest; RV, right ventricular; TDI, tissue Doppler imaging; TRV, tricuspid regurgitant velocity; anthracycline; echocardiography; guidelines; imaging.

Graphical abstract

Central Illustration

Echocardiography Protocol in Patients Undergoing Treatment With Anthracyclines/HER2-Positive–Targeted Therapy Assessment at baseline, during therapy (including patients on indefinite HER2-positive–targeted therapy in case of metastatic disease) and long-term follow-up after the completion of cancer therapy. BSE = British Society of Echocardiography; GLS = global longitudinal strain; LV = left ventricular; LVEF = left ventricular ejection fraction.