Subclinical anthracycline therapy-related cardiac Dysfunction: an ignored stage B heart failure in an African...

Anthracyclines are potent antineoplastic agents with a proven efficacy in the treatment of many paediatric and adult haematological and solid-organ cancers. Anthracycline therapy-related cardiac dysfunction (ATRCD) is the commonest and most well-studied chemotherapy-induced cardiovascular toxicity. Therefore patients who received anthracycline therapy are considered in stage A heart failure. Recent study findings suggest that anthracycline cardiotoxicity represents a continuum that begins with subclinical myocardial cell injury, followed by an early asymptomatic decline in left ventricular ejection fraction that can progress to symptomatic heart failure if left untreated. In Western countries, ATRCD has been reported in 57% of anthracyclines-treated patients. However, data on incidence and spectrum of ATRCD in Africa are not available. This literature review aimed to highlight the concept of subclinical ATRCD as a stage B heart failure in the spectrum of ATRCD, and the importance of early detection. We emphasise the potential burden and risk of subclinical ATRCD in the African population, with the ultimate aim of drawing the attention of health workers in Africa to improve care of the relevant population.