title: Echocardiographic Assessment of Cardiotoxic Effects of Cancer Therapy.
abstract: Patients with cancer can present with difficult management issues, as the medicine can sometimes cause sequelae destructive to healthy tissue. As this population lives longer, cardiotoxic effects are beginning to emerge, but the early recognition of this signal can prove difficult, with too late a recognition leading to lifelong cardiac impairment and dysfunction. Cardio-oncology can bridge this difficulty, and echocardiography and its newer imaging abilities are proving efficacious in this population. This article will address common sequelae of cardiotoxic treatment regimens and offer recommendations for echocardiographic surveillance. We recommend echocardiography, preferably three-dimensional and strain imaging, to monitor for cardiotoxic myocardial effects before, during, and after chemotherapy with cardiotoxic drug regimens, particularly anthracycline derivatives. A reduction in left ventricular (LV) global longitudinal strain in all patients, or reduction in LV global circumferential strain or global radial strain in patients at intermediate to high risk for cardiotoxicity, despite normal LV ejection fraction warrants a clinical assessment on the benefits of continuing cardiotoxic chemotherapeutic agents. Lifelong surveillance using echocardiography for cardiotoxicity and radiation-related valvular, pericardial, and coronary artery disease is prudent.
authors: Division of Cardiovascular Medicine. Health Sciences Campus, University of Louisville, 550 South Jackson Street, 3rd Floor, Louisville, KY, 40202, USA. wjbott01@louisville.edu.
authors: Wendy J
authors: WJ
authors: Bottinor
authors: Division of General Internal Medicine, Palliative Medicine, and Medical Education, University of Louisville, 550 South Jackson Street, 3rd Floor, Ste A3K00, Louisville, KY, 40202, USA.
authors: Christopher K
authors: CK
authors: Migliore
authors: Division of Cardiovascular Medicine. Health Sciences Campus, University of Louisville, 550 South Jackson Street, 3rd Floor, Louisville, KY, 40202, USA.
authors: Carrie A
authors: CA
authors: Lenneman
authors: Division of Cardiovascular Medicine. Health Sciences Campus, University of Louisville, 550 South Jackson Street, 3rd Floor, Louisville, KY, 40202, USA.
authors: Marcus F
authors: MF
authors: Stoddard
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D066126:Cardiotoxicity / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013318:Stroke Volume / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
keywords: Chemotherapy cardiotoxicity; Echocardiography strain; Pericardial disease; Valvular heart disease