Monitoring: How should we monitor our patients for cardiovascular toxicity? Serum biomarkers, imaging or both?
1University College London, University College London Hospital & Barts Heart Centre, London, UK
Survival rates from childhood cancers are now greater than 80%, and there is increasing recognition of the high incidence of late cardiotoxic effects even with modern cancer treatment regimens. Oncologists and cardiologists therefore have a responsibility to collaborate to improve the prevention, early detection and treatment of cardiotoxic effects during and following cancer treatment.
Although it is acknowledged that baseline cardiac investigations should be performed prior to starting potentially cardiotoxic treatment and that early detection and treatment is essential to prevent long term cardiac dysfunction, there is currently no evidence-based consensus for screening during cancer treatment, and the long-term cardiac follow-up of childhood cancer survivors is highly variable.
The current mainstay of cardiac monitoring involves echocardiography and measurement of serum cardiac biomarkers, most notably NT-proBNP and troponin. Conventional echocardiography however has significant limitations in that it has poor reproducibility and is unable to detect early subtle cardiac deterioration. This presentation will focus on current recommendations for monitoring during treatment and will present the recently-published international harmonised guidelines for screening for late cardiotoxic effects in childhood cancer survivors. It will also introduce novel imaging biomarkers for improving the early detection of subclinical cardiotoxicity, including LV strain measurements and cardiac MRI.