Abstract

IMPORTANCE OF EARLY DETECTION OF CARDIOTOXICITY INDUCED BY CHEMOTHERAPY

Meenaz Asfin*

ABSTRACT

Cancer is a significant public health problem worldwide. Cancer therapy has undergone significant advancements over the last decades. In parallel with the increase in the number of cancer survivors is an increasing prevalence of cardiac complications from cancer treatment. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. While anthracyclines, antimetabolites, alkylating agents, and antimicrotubule agents are routinely used in chemotherapy, the recent discovery of new classes of treatments such as monoclonal antibodies and tyrosine kinase inhibitors has expanded the arsenal of cancer treatments available for use in the clinical setting. Novel diagnostic tools in combination with new therapies, more intensive treatment regimens, and better supportive care have increased overall life expectancy in cancer patients.[1] A number of factors may contribute to this growing number of adverse cardiac effects, including increased length of survival, a larger number of cancer survivors who are older (and have more traditional cardiovascular risk factors), increased incidence of more aggressive cancers requiring more aggressive therapy, and the recent introduction of a number of new classes of treatment agents with cardiotoxic effects. The anthracyclines are among the most common cardiotoxic chemotherapeutic agents and have been widely recognized since the 1960s as a contributor to heart failure.[2] The American Heart Association recommends close monitoring of cardiac function in adults during anthracycline therapy but does not specify the methods that should be used to assess for cardiotoxicity, follow-up duration, frequency of testing, or thresholds that should be used.[3] Various imaging modalities such as cardiac magnetic resonance (CMR) imaging, radionuclide angiocardiography, and echocardiography are currently available in the clinical setting for detection of cardiac dysfunction. In addition to having adequate sensitivity for the detection of subclinical cardiac damage, the imaging modality for detection of chemotherapy cardiotoxicity should also be safe for repeated use without adverse risk to the patient, and should be widely available and cost-effective. To date, echocardiography has been the most suitable imaging modality clinically available for monitoring for cardiotoxicity. It is a noninvasive technique that can be performed at the bedside and does not expose patients to ionizing radiation. Furthermore, echocardiography provides additional information on valvular and diastolic function.[4]

Keywords: Echocardiography, Chemotherapy, Cardiotoxicity, Anthracyclines, Imaging.