Cancer Therapy-Related Cardiac Dysfunction: Pooled Incidence of Subclinical and Clinical Presentations Using Multimodal Multi-Parametric Imaging—A Systematic Review and Meta Analysis

Objective: To estimate the pooled incidence of cancer therapy-related cardiac dysfunction (CTRCD), assess longitudinal changes in global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF), and summarise the available evidence comparing echocardiography and cardiac magnetic resonance (CMR) for serial functional assessment. Methods: We performed a systematic review and meta-analysis of observational studies reporting CTRCD in adults receiving cancer therapy. Pooled CTRCD incidence was estimated, study-level meta-regression explored associations between baseline mean GLS and LVEF and CTRCD event rates, and longitudinal changes in GLS and LVEF were compared between CTRCD and non-CTRCD cohorts across follow-up visits. Exploratory subgroup analyses compared findings derived from echocardiography and CMR. Results: Thirty-three studies were included (total enrolled n = 2083; analysed at follow-up n = 1973), including 27 echocardiography-only studies, 4 CMR-only studies, and 2 studies reporting both modalities at baseline. The pooled incidence of CTRCD was 27% (95% CI 0.20–0.35), with substantial heterogeneity across studies. In study-level meta-regression, baseline mean GLS (p = 0.195) and baseline mean LVEF (p = 0.668) were not significantly associated with CTRCD event rates. Compared with non-CTRCD cohorts, CTRCD cohorts showed greater worsening in GLS across all analysed follow-up intervals. Within CTRCD cohorts, both GLS and LVEF deteriorated over time, whereas non-CTRCD cohorts showed smaller changes overall. Exploratory subgroup analyses did not detect statistically significant differences between echocardiography and CMR in the available datasets. Conclusions: CTRCD is reported in approximately one-quarter of patients across published studies, although estimates vary substantially by population, therapy, follow-up schedule, and CTRCD definition. Longitudinal deterioration in GLS appears earlier and more consistently than decline in LVEF, supporting the role of serial deformation imaging in surveillance. Baseline study-level mean GLS and LVEF were not significantly associated with CTRCD event rates, and direct comparative evidence between echocardiography and CMR remains limited.