Chemotherapy induced cardiomyopathy

A progressive condition associated with decreased quality-of-life and poor clinical outcomes.

A well-established complication of multiple chemotherapeutic agents.

With the advent of new treatments there is an increasing number of long-term cancer survivors, and the incidence of chemotherapy-induced cardiomyopathy has been increasing.

When this form of cardiomyopathy is accompanied by an abnormal electrical activation of the ventricles manifested by left bundle branch lock, the prospects of recovery are minimal.

Cardiac resynchronization is associated with improvement in left ventricular ejection fraction after six months.

Cardiotoxicity’s most notable manifestation is left ventricular systolic dysfunction.
Cardiotoxicity from chemotherapy can range from mild asymptomatic myocardial injury manifested by troponin elevation or decreasing echocardiography derived strain to overt heart failure with a decrease in the left ventricular ejection fraction.
Chemotherapy induced cardiomyopathy is defined as a decrease in LVEF of over 10 percentage points to the value below the lower limit of normal.
LVEF or symptomatic heart failure is reported it 1-5% of chemotherapy induced myocardopathy in cancer survivors, but when the definition includes markers of myocardial dysfunction, the incidence of cardiotoxicity is 37.5% in patients receiving high-risk chemotherapy.
CIC  can compromise oncologic care by interrupting therapy or causing changes to less effective treatment.
Echocardiography is the best modality for surveillance to detect CIC.
3-D echo cardiography is the most reproducible echocardiographic method for LVEF assessment.
Cardiac MRI is the gold standard for noninvasive assessment of LV volumes and LVEF because if its high accuracy and reproducibility.
Detection of troponin levels with anthracyclines and trastusumab  treated patients helps guide possible cardiac events.
Before treatment, risk stratification to identify patients at high risk of developing CIMP.
Most guidelines provide screening recommendations for anthracyclines and trastusumab.
Up to 10% of patients  treated with anthracyclines such as doxyrubicin will develop reduction in LVEF by completion of one year of therapy.
Current guidelines suggest that left ventricular function be assessed  when patients have a cumulated dose of 200-250 mg/m2 of doxorubicin  and subsequently after every additional hundred mg/m2.

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