Early cardioprotective treatment in cancer patients with subclinical left ventricular dysfunction detected by biomarkers or imaging appears promising, whereas systematic preventive treatment lacks proven benefit.
Does early cardioprotective treatment (angiotensin-converting enzyme inhibitor and/or beta-blocker) prevent cardiac events in cancer patients undergoing chemotherapy?
Individualized risk profiling and early cardioprotective treatment with ACE inhibitors or beta-blockers may help prevent cardiac events in cancer patients developing subclinical left ventricular dysfunction during chemotherapy.
Subclinical left ventricular dysfunction is the most common cardiac complication after chemotherapy administration. Detection and early treatment are major issues for better cardiac outcomes in this cancer population. The most common definition of cardiotoxicity is a 10-percentage point decrease of left ventricular ejection fraction (LVEF) to a value <53%. The myocardial injury induced by chemotherapies is probably a continuum starting with cardiac biomarkers increase before the occurence of a structural myocardial deformation leading to a LVEF decline. An individualised risk profile (depending on age, cardiovascular risk factors, type of chemotherapy, baseline troponin, baseline global longitudinal strain and baseline LVEF) has to be determined before starting chemotherapy to consider cardioprotective treatment. To date, there is no proof of a systematic cardioprotective treatment (angiotensin-converting enzyme inhibitor and/or beta-blocker) in all cancer patients. However, early cardioprotective treatment in case of subclinical left ventricular dysfunction seems to be promising in the prevention of cardiac events.
Nicol et al. (Mon,) conducted a review in Subclinical left ventricular dysfunction during chemotherapy. Cardioprotective treatment (ACE inhibitors and/or beta-blockers) was evaluated. Early cardioprotective treatment in cancer patients with subclinical left ventricular dysfunction detected by biomarkers or imaging appears promising, whereas systematic preventive treatment lacks proven benefit.