Cardiotoxicity Associated with Antineoplastic Therapy: A Multidisciplinary Approach to Personalized Monitoring Using...

Area of Science:

• Cardiology
• Oncology
• Medical Imaging
• Biomarkers

Background:

• Cardiotoxicity from cancer therapies can negatively impact patient outcomes and treatment adherence.
• Early detection of subclinical cardiac dysfunction is crucial for managing cancer patients undergoing cardiotoxic treatments.

Purpose of the Study:

• To evaluate a multimodal strategy for early detection of subclinical cardiac dysfunction in cancer patients.
• To assess the utility of radionuclide imaging and molecular biomarkers for personalized monitoring in oncologic care.

Main Methods:

• Prospective observational study of 90 adult cancer patients (breast, lymphoma, lung) receiving cardiotoxic regimens.
• Monitoring included clinical assessment, ECG, MUGA/gated SPECT, echocardiography (LVEF, GLS), and biomarkers (hs-Tn, NT-proBNP, sST2).
• Patients were evaluated at baseline, mid-treatment, end-treatment, and 6-month follow-up.

Main Results:

• Progressive increases in hs-Tn, NT-proBNP, and sST2 were observed during treatment.
• Left ventricular ejection fraction (LVEF) declined, and global longitudinal strain (GLS) decreased, indicating cardiac dysfunction.
• 30% of patients showed imaging-defined cardiac dysfunction, with 10% experiencing overt cardiotoxicity. hs-Tn changes strongly correlated with GLS.
• An integrated multimodal model demonstrated high predictive performance (AUC 0.91).

Conclusions:

• The multimodal strategy effectively identifies cancer patients at risk for cardiotoxicity.
• This approach supports multidisciplinary decision-making for intensified surveillance and tailored cardioprotective interventions.
• Findings are clinically promising but require multicenter validation for routine implementation.