Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio‐Oncology Guidelines

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  Figure 1. Pragmatic approach for monitoring patients treated with anthracyclines (A) and human epidermal growth factor‐2 (HER2) inhibitors (B). *The cardio‐oncological evaluation will systematically include at least 1 visit with: Clinical consultation (including BP measurement).ECG.Blood glucose, lipid profile, and glomerular filtration rate calculation should be evaluated before initiation of anthracyclines and HER2 inhibitors. Recheck at least at 1 year, 2 years, and periodically thereafter for patients who received anthracyclines.TTE including measurements of LVEF measurements (ideally 3‐dimensional but at least 2‐dimensional Simpson biplane method) and GLS. In the absence of GLS quantification of LV longitudinal function, use mitral annular displacement by M‐mode echocardiography and/or peak systolic velocity of the mitral annulus by pulsed‐wave DTI.LV contrast agents could be potentially useful in 2‐dimensional echocardiography.CMR is recommended if the quality of TTE is suboptimal.Use the same imaging modality for monitoring.Actively manage modifiable cardiovascular risk factors and diseases.Encourage exercise on a regular basis and healthy dietary habits. †For monitoring, assays…

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  Figure 2. Pragmatic approach for monitoring patients treated with VEGFi and mTORis (A), Bcr‐Ablis (B), proteasome inhibitors (C), and ibrutinib (D). *The cardio‐oncological evaluation will systematically include at least 1 visit with Clinical consultation (including BP measurement).ECG.Blood glucose, lipid profile, and glomerular filtration rate calculation should be evaluated before initiation of these drugs. Recheck at least every 3 months for 1 year, then every 6 months for patients who received VEGFi, mTORi, and Bcr‐Abli.TTE including measurements of LVEF measurements (ideally 3‐dimensional but at least 2‐dimensional Simpson biplane method) and GLS. In the absence of GLS quantification of LV longitudinal function, use mitral annular displacement by M‐mode echocardiography and/or peak systolic velocity of the mitral annulus by pulsed‐wave DTI.LV contrast agents could be potentially useful in 2‐dimensional echocardiography.CMR imaging is recommended if the quality of TTE is suboptimal.Use the same imaging modality for monitoring.Actively manage modifiable cardiovascular risk factors and diseases.Encourage to exercise on a regular basis and healthy dietary habits. †Transthoracic…

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  Figure 3. Pragmatic approach for monitoring patients treated with immune checkpoint inhibitors. *For monitoring, assays should be performed by the same laboratory (same type of troponin, same method of measurement) and before each administration. Troponin+ if >99th percentile of the upper reference limit or significantly increased compared with baseline. CV indicates cardiovascular; irAEs, immune‐related adverse events.

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  Figure 4. Definitions and management of overt cancer therapy–related left ventricular systolic dysfunction (A) and early cancer therapy–related myocardial toxicity (B). *The cardio‐oncological evaluation will systematically include at least 1 visit with Clinical consultation (including BP measurement).ECG.Blood glucose, lipid profile, glomerular filtration rate calculation.TTE including measurements of LVEF measurements (ideally 3‐dimensional but at least 2‐dimensional Simpson biplane method) and GLS. In the absence of GLS quantification of LV longitudinal function, use mitral annular displacement by M‐mode echocardiography and/or peak systolic velocity of the mitral annulus by pulsed‐wave DTI.LV contrast agents could be potentially useful in 2‐dimensional echocardiography.CMR is recommended if the quality of TTE is suboptimal.Use the same imaging modality for monitoring.Actively manage modifiable cardiovascular risk factors and diseases.Encourage to exercise on a regular basis and healthy dietary habits. †Heart failure (HF) therapy should be continued indefinitely unless normal systolic left ventricular (LV) function remains stable after cessation of HF therapy and no further cancer…

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  Figure 5. Definitions and management of cancer therapy–related hypertension (A), QTc interval prolongation (B), atrial fibrillation (C), and immune checkpoint inhibitors–related myocarditis (D). *The cardio‐oncological evaluation will systematically include at least one visit with Clinical consultation (including BP measurement).ECG.Blood glucose, lipid profile, glomerular filtration rate calculation.TTE including measurements of LVEF measurements (ideally 3‐dimensional but at least 2‐dimensional Simpson biplane method) and GLS. In the absence of GLS quantification of LV longitudinal function, use mitral annular displacement by M‐mode echocardiography and/or peak systolic velocity of the mitral annulus by pulsed‐wave DTI.LV contrast agents could be potentially useful in 2‐dimensional echocardiography.CMR is recommended if the quality of TTE is suboptimal.Use the same imaging modality for monitoring.Actively manage modifiable cardiovascular risk factors and diseases.Encourage to exercise on a regular basis and healthy dietary habits. †Hypertension emergencies are situations in which grade 3 hypertension (systolic arterial pressure ≥180 mm Hg and/or diastolic arterial pressure ≥110 mm Hg) is…