Role of echocardiography in monitoring of cardiac toxicity of cancer pharmacotherapy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

Abstract

Recent oncology development results in significant reduction of morbidity and mortality of several kinds of cancer. Such great achievements are at the cost of frequent cardiotoxicity, which predominantly is manifested as cardiomyopathy, cardiac dysfunction and heart failure (HF). Cardiotoxicity may manifest early - during treatment or late - after treatment completion. There are type 1 - anthracycline-related and type 2 - trastuzumab-related cardiotoxicity. Early detection of cardiotoxicity is crucial for preventing late heart dysfunction and HF. Baseline echocardiographic assessment should be performed in every patient before initiation of cancer treatment and serial monitoring of cardiac safety by means of echocardiography is recommended. The most widely used for this purpose is left ventricular ejection fraction (LVEF) calculated by Simpson's method with 2 dimensional transthoracic echocardiography. LVEF has numerous limitations, among which significant inter- and intraobserver variability, late decrease of LVEF with its often irreversibility are the most important. Noncontrast 3 dimesional echocardiography is the most reproducible technique for LVEF measurement. Newer echocardiographic technique - myocardial strain imaging has the potential to detect early subclinical cardiac dysfunction due to cardiotoxicity and may be used for the prediction of LV dysfunction. The role of other echocardiographic parameters, particularly of LV diastolic function has not been exactly defined in literature. The decision on discontinuation or modification of cancer therapy should be based on 2 improper, separate measurements of particular echocardiographic parameter or better more than 1 improper parameter should be taken into account. After completion of cancer treatment, echocardiography follow-up is recommended to detect late cardiotoxicity.