Chemotherapy-related cardiotoxicity: Bridging the gap between evidence and practice

Abstract

Chemotherapy-related cardiac dysfunction (CTRCD) remains a major barrier to optimal cancer survivorship, threatening quality of life and long-term outcomes. Contemporary guidelines emphasize early detection through multimodal strategies, including echocardiographic global longitudinal strain (GLS) and cardiac biomarkers, but their real-world uptake is inconsistent. In this issue, Méndez-Toro et al present a retrospective cohort from Colombia that highlights this gap, reporting a CTRCD incidence of 8.8% in high-risk oncology patients. Although the authors observed clear declines in left ventricular ejection fraction and GLS among affected patients, less than 40% underwent end-of-treatment echocardiography and only one-quarter had biomarker surveillance. The study underscores three critical lessons: Multimodal monitoring is under-utilized, reported incidence likely underestimates the true burden, and low- and middle-income countries face unique challenges in implementing structured cardio-oncology programs. These findings demand a shift from sporadic monitoring to pragmatic, risk-adapted protocols that can translate early detection into meaningful cardioprotection.

Keywords: Cardio-oncology; Chemotherapy-related cardiac dysfunction; Global longitudinal strain; Biomarkers; Echocardiography; Cancer survivorship; Low- and middle-income countries; Multimodal monitoring

Core Tip: This study shows that chemotherapy-related cardiotoxicity is underestimated when multimodal surveillance is inconsistently applied. Cardio-oncology must now move beyond sporadic imaging and biomarkers toward structured, risk-adapted protocols, particularly in low- and middle-income countries where there is a high incidence of global cancer care.