Left Ventricular Dysfunction and Chemotherapeutic Agents
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Purpose of Review
We aim to summarize the effect of cancer therapy-related cardiotoxicity on the development of left ventricular (LV) dysfunction.
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.
This review seeks to highlight the importance of early detection, treatment, and prevention of LV dysfunction from cancer therapy-related cardiotoxicity.
KeywordsLV dysfunction Cardio-oncology Chemotherapy Cancer therapy-related cardiotoxicity Heart failure
American College of Cardiology
angiotensin-converting enzyme inhibitors
American Heart Association
angiotensin receptor blockers
cardiac magnetic resonance imaging
cardiovascular risk factors
global longitudinal strain
Interagency Registry for Mechanically Assisted Circulatory Support
left ventricular ejection fraction
tyrosine kinase inhibitors
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United Network for Organ Sharing
Suparna C. Clasen reports grants from NIH T32 funding.
Compliance with Ethical Standards
Conflict of Interest
Suparna C. Clasen and Joyce W. Wald declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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