Introduction
Baseline individual risk assessment
Cardiovascular surveillance, echocardiography, and biomarkers
Baseline | During therapy | After completion | |||
---|---|---|---|---|---|
Comment | Comment | ||||
Trastuzumab (in early invasive disease) | Yes | Every 4 cycles | Every 2 cycles in high risk, every 3 cycles in medium risk | 6 months after final cycle | 3 and 12 months after final cycle in high risk |
Trastuzumab in metastatic disease (long-term therapy) | Yes | Every 4 cycles | Every 6 months when stable | Not indicated unless symptomatic | – |
More frequent in medium to high risk: every 2–3 cycles | |||||
Anthracyclines | Yes | After completing cumulative does of 240 mg/m2 doxorubicin | Every 2 cycles in medium to high risk | 6–12 months after final cycle (depending on risk) | Reassess after 5 years (earlier in high risk) |
VEGF and Bcr-Abl TKIs | In high-risk patients | Every 4 months during the first year | Every 6–12 months, when long-term therapy is necessary | No clear recommendations | – |
Proteasome inhibitors | Yes | Every 6 months | Look for signs of amyloidosis | No clear recommendations | – |
Immune checkpoint inhibitors | Yes (depending on baseline risk) | Immediately when cardiac symptoms occur. Every 6–12 months in long-term in high risk | CME if myocarditis suspected | No clear recommendations | Consider in high risk |
Coronary syndrome, plaque rupture |
Vasospasm |
Tako-Tsubo syndrome |
Myocardial necrosis in anthracycline therapy, trastuzumab, radiation |
Renal failure |
Pericarditis |
Myocarditis |
Anemia |
Sepsis |
Blood pressure: hypertensive crisis, hypotension |
Arrhythmias, e.g., atrial fibrillation, tachycardia |
Hypertrophic cardiomyopathy |
Amyloidosis |
Pulmonary thromboembolism |
Direct metastatic myocardial infiltration |
Volume changes, intravenous fluid load, e.g., of chemotherapy |
Renal failure |
Anemia |
Sepsis |
Age, weight, gender |
Blood pressure, hypertension |
Arrhythmias, e.g., atrial fibrillation, tachycardia |
Pulmonary thromboembolism |
Coronary ischemia |
Stiff heart, diastolic dysfunction, e.g., due to radiation |
Myocarditis |
Hypertrophic cardiomyopathy |
Amyloidosis |
Carcinoid valve disease |