Should the 'echo guidelines' be followed in cancer patients?

Abstract

10.2217/FON.15.109 © 2015 Future Medicine Ltd Which cardiac monitoring guidelines apply to cancer patients? Never before has this question generated more interest; in fact, this topic and the cardiovascular care of cancer patients in general has led to a whole new discipline, which has become known as ‘cardio-oncology’. In keeping with traditions, most attention in this field has been devoted to the deteriorating effects of cancer therapies on cardiac structure and function, even though cancer in itself might have an impact on the heart and its treatment can lead to vascular complications, QTc prolongation and other consequences as well. Accordingly, much of the contributions to this emerging field have been made by investigators with an interest in cardiac imaging, especially in echocardiography. Not surprising then, the key multimodality cardiac surveillance recommendations for cancer patients were published by the European and American Societies of Echocardiography: one for patients after radiation therapy and one for patients undergoing chemotherapy [1,2]. In both consensus statements, echocardiography takes a central role but recommendations are more refined for patients undergoing active chemotherapy. Accordingly, in case of exposure to agents with known cardiotoxicity risk, the first recommendation is to pursue a baseline echocardiogram – with (2D speckle) strain imaging if available – and to obtain cardiac troponin (cTn) levels (assay and sensitivity level not specified). If the LVEF is less than 53%, global longitudinal strain (GLS) is below the lower limit of normal, and/or cTn levels are elevated, the recommendation is for a Cardiology consultation and discussion of the pros and cons of continuing with planned cancer therapy and the initiation of ‘cardioprotective’ agents. Otherwise, the recommendation is for repetition of the outlined tests before each additional cycle if abnormalities were noted or a cumulative dose of 240 mg/m has been reached, and then again at the completion of therapy and 6 months after for patients receiving anthracyclines. For those patients receiving trastuzumab, the same parameters are to be obtained every 3 months during treatment (same with VEGF signaling inhibitors or tyrosine kinase inhibitors but one additional assessment after the first month), OPINION Special Focus Issue: Cardio-oncology