Jul 2026· Journal of pediatric hematology/oncology· 0 citations· 35 references
Medicine
TL;DR
It is suggested that survivors treated with anthracyclines require systematic surveillance and targeted interventions to address modifiable cardiovascular risk factors and increasing awareness of prior cardiotoxic cancer treatment among survivors and health care providers may facilitate cardiovascular risk reduction.
Abstract
Anthracycline chemotherapy is associated with cardiotoxicity, underscoring the importance of minimizing modifiable cardiac risk factors in affected individuals. This study evaluated cardiac function, prevalence of metabolic syndrome and smoking, and awareness of prior cardiotoxic treatment among adult survivors of childhood cancer treated with anthracyclines at the pediatric oncology service in Iceland between 1981 and 2011 (n=89). Data were collected from medical records, self-reported questionnaires, and clinical assessments conducted between 2016 and 2019. Of 76 eligible survivors, 60 participated (29 females, 31 males; aged 20 to 48 y). Two individuals were excluded before enrollment due to previously diagnosed heart failure. Left ventricular dilation was observed in 15 participants (25%), predominantly mild to moderate, with 1 severe case. The prevalence was lower after BSA indexing. Metabolic syndrome was present in 20% of participants, and 20% reported current smoking. Approximately half of the participants reported undergoing echocardiography within the past 10 years, while only 10% were aware that their cancer treatment could cause cardiotoxicity. These findings suggest that survivors treated with anthracyclines require systematic surveillance and targeted interventions to address modifiable cardiovascular risk factors. Increasing awareness of prior cardiotoxic cancer treatment among survivors and health care providers may facilitate cardiovascular risk reduction.
Anthracyclines remain a cornerstone of breast cancer therapy but carry a significant risk of cancer therapy-related cardiac dysfunction (CTRCD). This study evaluates the incidence of CTRCD in an Indonesian setting using the latest 2022 ESC Cardio-Oncology guidelines, focusing on subclinical markers such as high-sensitivity Troponin I (hs-cTnI), Global Longitudinal Strain (GLS) and Mechanical Dispersion (MD).
This retrospective analytical cohort study involved 98 breast cancer patients treated with anthracyclines at a national referral hospital in Indonesia from July 2018 to February 2020. Clinical assessments, hs-cTnI, and echocardiography (LVEF, GLS, and MD) were performed at baseline, 1, 3, and 6 months. CTRCD was defined per the 2022 ESC criteria.
CTRCD occurred in 74.5% of patients, predominantly as asymptomatic mild cases (63.26%). While symptomatic CTRCD was relatively low (7.14%), asymptomatic dysfunction was detected as early as one-month post-chemotherapy. A significant progressive decline was observed in LVEF (68.2 ± 6.2% to 61.3 ± 8.8%,
p
< 0.001) and GLS (-19.7 ± 2.9% to -17.1 ± 3.5%,
p
< 0.001). Notably, mechanical dispersion significantly increased over time (
p
= 0.029), and median hs-cTnI surged from 1.6 ng/L to 82.2 ng/L (
p
< 0.001) by month 6.
The high incidence of asymptomatic CTRCD underscores the inadequacy of relying on clinical symptoms alone. Integration of hs-cTnI, GLS, and mechanical dispersion monitoring is may be essential for early detection and enables timely cardioprotective intervention.
A simplified risk score based on readily available clinical and echocardiographic variables for predicting anthracycline-related cardiotoxicity and the RE-ACT score provides additional post-treatment prognostic value is developed and validated and supports a practical 2-step strategy for personalized surveillance in cardio-oncology.
D. Cardinale, Nicola Cosentino, Chiara Morocutti et al.· JACC CardioOncology· 1 citation
Cardiotoxicity associated with antineoplastic therapies remains an important clinical challenge in modern oncology. Early identification of subclinical cardiac injury may improve cardiovascular surveillance and long-term outcomes in cancer patients. This prospective observational cohort study included 90 adult patients with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic therapy. Patients with clinically manifest heart failure, severe arrhythmias, advanced renal disease, recent acute myocardial infarction, untreated severe valvular disease, or other major cardiovascular comorbidities were excluded. High-sensitivity cardiac troponin T (hs-cTnT), NT-proBNP, and soluble ST2 (sST2) were measured at baseline, during treatment, at therapy completion, and at late follow-up. Non-parametric tests were used for repeated-measures and subgroup comparisons. Significant temporal variations were observed for all biomarkers. hs-cTnT increased from 5 [3–8] ng/L at baseline to 15 [10–25] ng/L at T2, while NT-proBNP increased from 120 [80–190] pg/mL to 210 [150–320] pg/mL. sST2 demonstrated a delayed elevation and remained increased at follow-up. Distinct biomarker patterns were observed across malignancy subgroups, with higher hs-cTnT increases in breast cancer, more prominent NT-proBNP elevation in lymphoma, and higher sST2 values in lung cancer. Serial biomarker assessment may provide complementary information on myocardial injury, ventricular stress, and fibrotic remodeling during cancer therapy. The observed biomarker trajectories are suggestive of different biological processes involved in therapy-related cardiotoxicity, but they should be interpreted in conjunction with imaging findings and clinical outcomes.
L. Kajanto, D. Stănculeanu, Anca Chisoi et al.· Cardio-Oncology· 0 citations
GLS and LVEF were the most sensitive echocardiographic parameters for differentiating between groups with and without cardiotoxicity, showing consistent changes throughout the study.
R. D. De Sousa, V. Fonseca, M. Henriques et al.· European Heart Journal, Supp...· 0 citations
Introduction: Breast cancer is one of the most common malignancies worldwide, and anthracyclines remain a cornerstone of its treatment. However, their use is associated with the risk of cardiotoxicity, which may lead to subclinical myocardial injury, progressive ventricular dysfunction, and heart failure. Although left ventricular ejection fraction is still widely used in routine surveillance, it often decreases relatively late. Therefore, increasing attention has been directed toward diastolic dysfunction as a possible earlier marker of anthracycline-induced cardiac injury.
Methods: A systematic review was conducted using the PubMed database. The search strategy included the terms “breast cancer” OR “breast neoplasms,” “anthracycline” OR “doxorubicin” OR “epirubicin,” and “diastolic dysfunction” OR “diastolic function.” The search was limited to studies published between 2010 and 2026, written in English, and conducted in humans. A total of 43 records were identified. After title and abstract screening, 15 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria and were included in the final qualitative synthesis.
Results: The reviewed studies showed that anthracycline therapy was associated with worsening of conventional and tissue Doppler indices of diastolic function, including E/A ratio, deceleration time, e′ velocity, and E/e′ ratio, often despite preserved left ventricular ejection fraction. Several studies also demonstrated abnormalities in more advanced echocardiographic markers, such as diastolic strain rate, diastolic strain time, left atrial strain, and intrinsic wave velocity propagation. In longitudinal analyses, early diastolic dysfunction was associated with later worsening of global longitudinal strain, decline in left ventricular ejection fraction, or subsequent cancer therapy-related cardiac dysfunction.
Conclusions: Diastolic dysfunction appears to be a clinically relevant and potentially early marker of anthracycline-induced cardiotoxicity in breast cancer patients. Its earlier recognition may support closer cardio-oncology surveillance, improve risk stratification, and help identify patients who may benefit from earlier specialist evaluation and consideration of cardioprotective strategies before overt systolic dysfunction develops. Further prospective studies are needed to determine which diastolic parameters are the most sensitive and clinically useful in routine practice.
T. Mainka, Emil Sergejuk, W. Kotlarski et al.· International Journal of Inn...· 0 citations
A significant decline in right ventricular function is demonstrated during anthracycline-based cardiotoxic therapy and persisting up to one year after treatment completion, even in patients with low cardiotoxic risk, despite changes being subclinical and largely within normal ranges.
I. Gigovska Dimova, G. Petkovska, I. Ismaili et al.· European Heart Journal, Supp...· 0 citations