Key result
Transthoracic echocardiography with LVEF and global longitudinal strain remains first-line for CTRCD surveillance, complemented by CMR and nuclear imaging, though outcome data remain limited.
Why the study?
Cancer therapy-related cardiac dysfunction may develop before symptoms or a measurable decline in LVEF, so surveillance requires assessment beyond LVEF alone.
This narrative review outlines a tiered, multimodality imaging approach beyond LVEF for cardio-oncology surveillance while emphasizing that evidence linking earlier imaging detection to improved long-term cardiovascular outcomes remains limited.
Answers are grounded in this paper and cite their sources.
Myocardial work may augment CTRCD surveillance beyond LVEF/GLS; extends current paradigms but leaves open prospective validation.
Background: Cancer therapy-related cardiac dysfunction (CTRCD) may develop before symptoms or a measurable decline in left ventricular ejection fraction (LVEF). Surveillance therefore requires assessment beyond LVEF alone. Content: This narrative review examines cardiotoxic mechanisms, imaging findings, and treatment-specific surveillance. Transthoracic echocardiography with LVEF and global longitudinal strain remains the first-line approach. Myocardial work may provide additional information, but oncology-specific action thresholds remain unvalidated. Cardiac magnetic resonance complements echocardiography when measurements are inconclusive or tissue characterization is required. Mapping abnormalities are nonspecific and do not independently establish treatment-related injury. Nuclear imaging addresses selected diagnostic questions; fibroblast activation protein inhibitor PET remains investigational. Artificial intelligence may support image analysis and data integration, although evidence from general cardiovascular populations requires oncology-specific validation. An algorithm and surveillance matrix link clinical findings, treatment, baseline risk, imaging, and biomarkers. Conclusions: A tiered approach organizes surveillance around specific clinical questions. Earlier detection should be distinguished from demonstrated clinical benefit: evidence that imaging-guided strategies improve long-term cardiovascular outcomes remains limited. Prospective studies are needed to validate emerging markers, AI applications, and the clinical and economic effects of integrated surveillance pathways.
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Veglia et al. (2026) conducted a review in Cancer therapy-related cardiac dysfunction (CTRCD). Multimodality cardiac imaging (echocardiography with LVEF and global longitudinal strain, cardiac magnetic resonance, nuclear imaging, AI) vs. LVEF assessment alone was evaluated. Transthoracic echocardiography with LVEF and global longitudinal strain remains first-line for CTRCD surveillance, complemented by CMR and nuclear imaging, though outcome data remain limited.
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