Challenges in Implementing Optimal Echocardiographic Screening in Cardio-Oncology.

Abstract

Echocardiography is the foundation of noninvasive screening in patients exposed to potentially cardiotoxic chemotherapeutic agents. Guidelines are becoming more consistent in regard to screening and recommend an integrative approach between cardiology and oncology providers as well as optimal non-invasive imaging modalities. Optimal screening with the latest technology will place a significant cost and administrative burden on echocardiographic laboratories and cardiology clinics. This review seeks to explore the latest studies regarding quality, cost, patient burden, and value related to implementing wide-spread screening for patients exposed to cardiotoxic chemotherapy. 3D and speckle tracking echocardiography are more reliable and can detect more subtle changes than traditional 2D volumes. Limited studies have revealed an uptake of optimal screening between 30 and 40%. Even fewer studies have evaluated the system-wide cost and value impact of screening in cardio-oncology or have evaluated patient-centered outcomes, such as cost and time burden. Finally, novel approaches, such as the use of point of care ultrasound with artificial intelligence guidance, may help alleviate these challenges. Screening patients at risk for cancer therapeutics-related cardiac dysfunction poses real-world challenges to our healthcare system. While modern echocardiographic techniques improve our ability to detect cardiac dysfunction, further research is needed to understand the challenges of wide-spread implementation.