Due to the lack of uniform diagnostic criteria to guide clinical practices in cardiotoxicity and cancer therapies, comprehensive cardiovascular monitoring may be critical to identify and treat heart failure risk factors and preclinical left ventricular dysfunction when needed, according to a study published May 7 in the European Heart Journal.

José López-Sendón, MD, et al., used data from the CARDIOTOX registry to determine the prevalence of common clinical, biochemical and echocardiographic parameters currently accepted as indicative of cardiotoxicity and identified after initiation of cancer therapies, as well as their relationship with heart failure criteria and treatment recommendations in current guidelines.

The researchers studied 865 patients scheduled for anticancer therapy related to moderate or high risk of cardiotoxicity. Cardiotoxicity was defined as new or worsening of myocardial damage or ventricular function from baseline during a median of 24 months follow-up.

Results showed that cardiotoxicity was identified in 37.5% patients during follow-up – 31.6% with mild, 2.8% moderate and 3.1% with severe myocardial damage or dysfunction. Results also showed the mortality rate in the severe cardiotoxicity group was 22.9 deaths per 100 patient-years vs. 2.3 deaths per 100 patient-years in the mild and moderate groups.

The researchers point out that while a significant number of patients receiving high-risk cancer therapies present objective data of myocardial injury or left ventricular dysfunction, the number of patients with severe cardiotoxicity is comparatively very low but still strongly related with all-cause mortality.

"We propose a classification of cardiotoxicity that could be used in protocols defining strategies for early identification, prevention and treatment in patients receiving potentially cardiotoxic cancer therapies," the researchers write.

In an accompanying editorial comment, Ana Pardo Sanz, MD, and José Luis Zamorano, MD, note that "the next goal is to establish the relationship of different grades of cardiotoxicity and the clinical outcomes." They add, "The elaboration of a clinical score to determine the risk of severe cardiotoxicity and, according to this, refine the follow-up and treatment of these patients, will be the key of the cardio-oncology field for the present and near future."

Clinical Topics: Cardio-Oncology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Cardiotoxicity, Prevalence, Risk Factors, Ventricular Dysfunction, Left, Echocardiography, Heart Failure, Ventricular Function, Registries, Neoplasms

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