Role of Cardiovascular Imaging in Cancer Patients Receiving Cardiotoxic Therapies: A Position Statement on Behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC)
Jelena Čelutkienė, Radek Pudil, Teresa López‐Fernández, Julia Grapsa, Petros Nihoyannopoulos, Jutta Bergler‐Klein, Alain Cohen‐Solal, Dimitrios Farmakis, Carlo G. Tocchetti, Stephan von Haehling, Vassilis I. Barberis, Frank A. Flachskampf, Indrė Čeponienė, Eva Haegler‐Laube, Thomas Suter, Tomas Lapinskas, Sanjay Prasad, Rudolf A. de Boer, Kshama Wechalekar, Markus S. Anker, Zaza Iakobishvili, Chiara Bucciarelli‐Ducci, Jeanette Schulz‐Menger, Bernard Cosyns, Oliver Gaemperli, Yu. N. Belenkov, Jean‐Sébastien Hulot, Maurizio Galderisi, Patrizio Lancellotti, Jeroen J. Bax, Thomas H. Marwick, Ovidiu Chioncel, Tiny Jaarsma, Wilfried Müllens, Massimo Piepoli, Thomas Thum, Stéphane Heymans, Christian Mueller, Brenda Moura, Frank Ruschitzka, José Luis Zamorano, Giuseppe Rosano, Andrew J.S. Coats, Riccardo Asteggiano, Petar Seferović, Thor Edvardsen, Alexander R Lyon
Abstract
Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed.