Anthracycline Cardiotoxicity: Strategies for Prevention and Intervention

Abstract

The cardiotoxic effects of anthracycline compounds, used extensively to treat malignancies
such as breast cancer and lymphoma, are well known.1,2 However, despite efforts
towards cardioprotective strategies and early detection of anthracycline cardiotoxicity, defined
as decline in Left Ventricular Ejection Fraction (LVEF) of ≥10% from baseline or to <50%,3,4
there is currently no consensus on the optimal approach. Current clinical practice guidelines
recommend serial LVEF monitoring to identify cardiotoxicity in high-risk patients receiving
anthracyclines;3,4 however, it has come to light that LVEF reduction may be a late manifestation
of cardiotoxicity,5,6 with potentially limited prospects for reversibility.7-9 Recently, echocardiographic
strain imaging has emerged as a promising way to detect subclinical cardiotoxicity prior
to LVEF reduction,10-13 where small reduction in Global Longitudinal Strain (GLS) has been
identified as a robust predictor of future LVEF reduction and cardiac events.14-16 The reliability
of this approach in patients treated with anthracyclines has been specifically evaluated,17-19 with
reported cardiotoxicity rates ranging from <1% to 32%.20 Recent studies have established a
GLS reduction of ≥11% as a strong predictor of cardiotoxicity.19,21-24