Left Ventricular Dysfunction and Chemotherapeutic Agents

• Published in: Current cardiology reports Vol. 20; no. 4; p. 20
• Main Authors: Clasen, Suparna C., Wald, Joyce W.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2018
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Antineoplastic Agents - adverse effects; Biomarkers; Cardiology; Cardiotoxicity - diagnosis; Cardiotoxicity - drug therapy; Cardiotoxicity - prevention & control; Echocardiography; Heart Failure (H Eisen; Heart Failure - drug therapy; Heart Failure - etiology; Humans; Medicine; Medicine & Public Health; Neoplasms - drug therapy; Practice Guidelines as Topic; Renin-Angiotensin System - drug effects; Section Editor; Topical Collection on Heart Failure; Ventricular Dysfunction, Left - chemically induced; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - drug therapy; Heart failure; Cardio-oncology; Chemotherapy; LV dysfunction; Cancer therapy-related cardiotoxicity
• ISSN: 1523-3782; 1534-3170
• DOI: 10.1007/s11886-018-0967-x

Purpose of Review We aim to summarize the effect of cancer therapy-related cardiotoxicity on the development of left ventricular (LV) dysfunction. Recent Findings We discuss commonly used cancer therapeutics that have the potential for both acute and delayed cardiotoxicity. LV dysfunction from cancer therapies may be found by routine cardiac imaging prior to clinical manifestations of heart failure (HF) and we discuss the current multi-modality approaches for early detection of toxicity with the use of advanced echocardiographic parameters including strain techniques. Further, we discuss the role of biomarkers for detection of LV dysfunction from cancer therapies. Current approaches monitoring and treating LV dysfunction related to cancer therapy-related cardiotoxicity include addressing modifiable cardiovascular risk factors especially hypertension and early initiation of neurohormonal blockade (NHB) with disease-modifying beta-blockers and renin–angiotensin–aldosterone system (RAAS) inhibitors. Once LV dysfunction is identified, traditional ACC/AHA guideline-directed therapy is employed. Further, we highlight the use of advanced heart failure therapies including mechanical resynchronization devices, the use of durable ventricular assist devices, and cardiac transplantation as increasingly employed modalities for treatment of severe LV dysfunction and advanced heart failure in the cardio-oncology population. Summary This review seeks to highlight the importance of early detection, treatment, and prevention of LV dysfunction from cancer therapy-related cardiotoxicity.