These patients might be sensitive to anthracyclines independent of the dose given. 8 Genetic polymorphism might contribute to an increased risk for cardiomyopathyĪt lower anthracycline dose, implying that genetic variations could predict cardiac Patient-related risk factors include the already known factors for coronary arteryĭisease (CAD), such as advanced age, hypertension, diabetes, smoking, female sex,Īnd postmenopausal state.
Risk factors can be classified as patient-related or therapy-related. Myocarditis-related, takotsubo’s cardiomyopathy, and secondary electricalĪbnormalities (such as conduction abnormalities and arrhythmias). Therefore, this review will arbitrarily expand the priorĬlassification to further incorporate mechanisms not previously categorized ( Table 3) such as coronaryĭisease-related (radiation exposure, endothelial damage, and/or spasm), With cancer may suffer cardiovascular injury and the need for an updatedĬlassification. With the advent of immunotherapy, there is a new set of mechanisms in which patients Trastuzumab plays aĬentral role in breast cancer treatment by binding to the human epidermal growthįactor receptor 2 (HER2) and inhibiting downstream-associated signaling cascades. Type 2 cardiotoxicity is characterized by dose-independent reversible myocardialĭamage, and the best representation of this is trastuzumab. 6 Anthracyclines are considered to have increased potential for long-term Of anthracycline metabolites which disrupt sarcomere structure and function, and Many mechanisms have been proposed for their dose-dependentĬardiac dysfunction, such as the generation of reactive oxygen species, accumulation Anthracyclines are the best representation of this Type 1 cardiotoxicity is characterized by irreversible myocardial damage due to theĬumulative administered dose. Growth factor ICPis, immune checkpoint inhibitors. Receptor 2 TKIs, tyrosine kinase inhibitors VEGF, vascular endothelial Life-threatening symptoms requiring hemodynamic support.Ībbreviations: 5-FU, 5-fluorouracil ALK, anaplastic lymphoma kinase ĬAD, coronary artery disease HER2, human epidermal growth factor (CTCAE) that define left ventricular dysfunction and HF based onĮlevations in biomarkers or abnormalities on imaging.Ģ. Grades 2 and 3 consist of symptoms with mild and Proposes the Common Terminology Criteria for Adverse Events Symptomatic patients to a final LVEF of less than 55%.ġ. LVEF decline by at least 10% from baseline to a value ofġ0% reduction from baseline LVEF assessment to defineĪsymptomatic left ventricular dysfunction. Trastuzumab-mediated cardiomyopathy was either: Longitudinal strain (GLS) compared with baseline strain.ĭoxorubicin-mediated cardiotoxicity was defined as either:ĭecrease in LVEF to less than the lower limit of normal orĬardiac review and evaluation committee in trastuzumab On subsequent imaging performed 2 to 3 weeks after the initial The American Society of Echocardiography (ASE) and the EuropeanĪssociation of cardiovascular Imaging (EACVI)ġ. ⩾10% decline in LVEF to a final value less than 53% confirmed Longitudinal strain (GLS) compared with a baseline GLS was considered subclinical 3 If these definitions were not met, then a decrease greater than 15% in global Of more than 10% to below the lower limit of normal, which is considered an LVEF ofĥ3%, despite symptoms. (EACVI), which define it as a decrease in left ventricular ejection fraction (LVEF) The most acceptedĭefinition comes from the cardiac image societies, such as the American Society ofĮchocardiography (ASE) and the European Association of Cardiovascular Imaging There are numerous proposed definitions for CTRCD ( Table 1), although an official AmericanĬollege of Cardiology (ACC) consensus statement is still needed. One of the most feared and undesirable side effects of chemotherapy, occurring in 1 Despite these advances, cancer therapy-related cardiac dysfunction (CTRCD) is Parallel increase in the number of cancer survivors due to both early detection andĪdvances in treatment. With the increased prevalence of cancer over the last decade, there has been a