Practical issues in the assessment of left ventricular dysfunction in cancer patients

█ Review

DOI: 10.26430/CHUNGARICA.2023.53.2.103

Authors:
Fogarassy György
Állami Szívkórház, Balatonfüred

Levelezési cím:
Dr. Fogarassy György, e-mail: gyorgy.fogarassy@gmail.com

Summary

Based on the 2022 European cardio-oncology guideline, cardiovascular (CV) risk assessment is recommended before the use of oncotherapeutic agents with CV toxicity. In addition to the clinical evaluation, echocardiographic assessment of the left ventricle (LV) (ejection fraction (EF) and global longitudinal strain – GLS) also has importance. The 3-dimensional method is recommended for testing EF. With treatment using anthracycline, human epidermal growth factor receptor-2 inhibitors, proteasome inhibitors applied in multiple myeloma, rapidly accelerated fibrosarcoma and mitogen-activated extracellular signal-regulated kinase (RAF + MEK) inhibitors (used in melanoma) and, as well as vascular endothelial growth factor (VEGF)-inhibiting tyrosine kinase inhibitors (TKIs) and antibodies, an increased risk of cardiotoxicity with heart failure should be expected in case of an initial LV EF value of less than 55%. Echocardiography is important in assessing the risk of coronary disease, which is crucial if the planned oncological treatment increases this risk (fluoropyrimidines; VEGF inhibitors; TKI, especially the 2nd or 3rd generation BCR-ABL inhibitors). Early recognition of cardiotoxicity is especially important with anthracycline treatment, this can be achieved most effectively by the detection of LV GLS decrease. If cardioprotective treatment is started with a revealed significant relative GLS reduction (15%), the myocardial damage causing EF decrease can be prevented with a greater chance than with the follow-up based on EF. GLS-based follow-up can also lead to earlier recognition of the myocarditis rarely complicating the immune checkpoint inhibitor treatment.

ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 2

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