Perspectives on monitoring and diagnosis of chemotherapy-induced cardiotoxicity

Abstract

The study included all patients at risk for chemotherapy-related cardiotoxicity, without exclusions based on the type of cancer, reflecting the institution’s epidemiology with a predominance of breast cancer. Myocarditis was not an exclusion; its absence may reflect underdiagnosis. Age, although a known risk factor, showed no significant differences, and no upper chemotherapy dose limits were imposed to better capture real-world scenarios. A typographical error in the patient count was amended to 195. Limitations include its retrospective design, selection bias, and incomplete dose data. A prospective multicenter registry is underway to enhance diagnostic accuracy, include diverse types of cancer, and improve generalizability.

Keywords: Cardiotoxicity; Chemotherapy; Echocardiography; Global longitudinal strain; Myocarditis; Risk assessment

Core Tip: The accurate identification and monitoring of chemotherapy-related cardiotoxicity demand inclusive patient selection and robust diagnostic strategies. Our study demonstrates that real-world cohorts often reflect local epidemiological patterns rather than exclusionary criteria, underscoring the need for comprehensive inclusion of both solid and hematologic malignancies. Retrospective designs, while valuable, may overlook subclinical conditions such as myocarditis and lack precise chemotherapy dose tracking. Integrating advanced imaging, standardized biomarker surveillance, and multicenter collaboration in prospective registries can close these gaps, enhance diagnostic certainty, and improve risk stratification. Such approaches will strengthen cardio-oncology practice and optimize long-term cardiovascular outcomes in cancer patients.