Cardiovascular Toxicity Risk Assessment in Cancer Therapy

CV Toxicity Risk Stratification

• CV toxicity risk stratification is recommended for all patients with cancer before starting potentially cardiotoxic anticancer therapy.
• Communicating the results of the CV toxicity risk assessment to the patient and other healthcare professionals is recommended.
• Patients with low CV toxicity risk can proceed with anticancer therapy without delay.

Cardiology Referral

• Cardiology referral is recommended for high-risk and very high-risk patients before anticancer therapy.
• Referral is also recommended for patients with cancer and pre-existing CVD or abnormal findings at baseline CV toxicity risk assessment.

ECG Baseline Assessment

• An ECG is recommended in all patients starting cancer therapy as part of their baseline CV risk assessment.
• Referral to a cardiologist is recommended for patients with an abnormal baseline ECG.

Cardiac Biomarker Assessment

• Baseline measurement of NP and/or cTn is recommended in all patients with cancer at risk of CTRCD if these biomarkers are going to be measured during treatment.

Cardiac Imaging Modalities

• Echocardiography is recommended as the first-line modality for the assessment of cardiac function in patients with cancer.
• 3D echocardiography is recommended to measure LVEF.
• GLS is recommended in all patients with cancer having echocardiography, if available.
• Baseline cardiac imaging prior to potentially cardiotoxic therapies is recommended in high-risk and very high-risk patients.

Primary Prevention of CTRCD

• Management of CVRF according to the 2021 ESC Guidelines on CVD prevention in clinical practice is recommended before, during, and after cancer therapy.

Secondary Prevention of CTRCD

• Management of CVD according to applicable ESC Guidelines is recommended before, during, and after cancer therapy.

Baseline Risk Assessment and Monitoring during Anthracycline Chemotherapy

• Baseline echocardiography is recommended in all patients with cancer before anthracycline chemotherapy.
• Echocardiography is recommended within 12 months after completing treatment in all adults receiving anthracycline chemotherapy.
• In high- and very high-risk patients, echocardiography is recommended every two cycles and within 3 months after completing treatment.
• Baseline measurement of NP and cTn is recommended in high- and very high-risk patients prior to anthracycline chemotherapy.
• Monitoring of cTn and NP is recommended before every cycle during anthracycline chemotherapy and 3 and 12 months after therapy completion in high- and very high-risk patients.

Baseline Risk Assessment and Monitoring during HER2-Targeted Therapies

• Baseline echocardiography is recommended before HER2-targeted therapies in all patients.
• Echocardiography is recommended every 3 months and within 1 year after completing therapy in patients receiving neoadjuvant or adjuvant HER2-targeted therapies.