EXPRESS: Silent Damage, Early Signals: A Narrative Review of the Evolving Role of Cardiac Biomarkers in Oncology-Driven Cardiotoxicity

Advancements in cancer therapy have led to improved patient survival but have also introduced an increasing risk of cardiotoxicity, particularly with agents such as anthracyclines, trastuzumab, and various targeted treatments. Cardiotoxic effects may present as myocardial injury, systolic or diastolic dysfunction, or heart failure, often developing insidiously before clinical symptoms become evident. Early detection is therefore crucial to preserve cardiovascular health in oncology patients. This narrative review examines the expanding role of cardiac biomarkers; including high-sensitivity troponins, natriuretic peptides, Galectin-3, soluble ST2, and novel molecular markers like microRNAs, in identifying and monitoring chemotherapy-induced cardiac injury. It also highlights how these biomarkers complement advanced imaging techniques such as global longitudinal strain, cardiac magnetic resonance, and myocardial deformation imaging to detect subclinical changes before ejection fraction declines. Furthermore, we explore the clinical relevance of biomarker-guided monitoring, the role of cardioprotective agents such as dexrazoxane, and the emerging utility of stress-based functional testing in evaluating cardiac reserve. Overall, the review emphasizes a tailored, multimodal approach that integrates biomarkers, imaging, and clinical risk profiling to enhance early intervention and sustain cancer treatment without compromising cardiac function.