title: Update on cardiotoxicity of anti-cancer treatments.
abstract: OBJECTIVE
  Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques.
  
  
  METHODS
  This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography.
  
  
  RESULTS
  Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal.
  
  
  CONCLUSIONS
  Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Rosa
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gigli
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Maria Isabella
authors.initials: MI
authors.lastname: Tagliasacchi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Di Iorio
authors.affiliation: Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland.
authors.forename: Federico
authors.identifier: http://orcid.org/0000-0003-2957-4078
authors.initials: F
authors.lastname: Carbone
authors.affiliation: Department of Internal Medicine, University of Genoa, Genoa, Italy.|IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca Sul Cancro, Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Nencioni
authors.affiliation: Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland.|First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunelli
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D000068258:Bevacizumab / Q000009:adverse effects; D066126:Cardiotoxicity / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D004452:Echocardiography; D006801:Humans; D007211:Indoles / Q000009:adverse effects; D000077341:Lapatinib; D008279:Magnetic Resonance Imaging; D009369:Neoplasms / Q000628:therapy*; D049268:Positron-Emission Tomography; D011758:Pyrroles / Q000009:adverse effects; D011799:Quinazolines / Q000009:adverse effects; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D000077210:Sunitinib; D043823:Taxoids / Q000009:adverse effects; D000068878:Trastuzumab / Q000009:adverse effects; D014336:Troponin / Q000097:blood; D014748:Vinca Alkaloids / Q000009:adverse effects
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D007211:Indoles; D011758:Pyrroles; D011799:Quinazolines; D043823:Taxoids; D014336:Troponin; D014748:Vinca Alkaloids; D000077341:Lapatinib; D000068258:Bevacizumab; D000068878:Trastuzumab; D000077210:Sunitinib
keywords: Cancer; cardiac imaging; cardiotoxicity; treatment