Treatment of left ventricular dysfunction during cancer therapy: a comprehensive review

The growing population of cancer survivors has brought to light the critical challenge of cancer therapy-related cardiac dysfunction, particularly with the use of anthracyclines, HER2-targeted agents and other novel therapeutics. This review aims to support the personalized integration of cardiovascular risk management into oncology care to optimize long-term patient outcomes. We summarize the outline approaches to patient risk assessment and surveillance, and present evidence-based non-pharmacological and pharmacological strategies for cardioprotection during cancer treatment. These strategies highlight recent data supporting the emerging cardioprotective role of exercise training, as well as the use of SGLT2 inhibitors, ACE inhibitors, angiotensin receptor blockers, sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, statins and dexrazoxane. We present a comprehensive synthesis emphasizing the critical role of cardio-oncology in identifying patients at high risk, understanding clinical outcomes, and implementing practical, evidence-based strategies. Our findings underscore the need for proactive cardiovascular risk management to enhance long-term care in oncology patients.