Image
Recommendation
Cardiac dysfunction – Symptomatic
In patients with clinical signs or symptoms of cardiac dysfunction during routine clinical assessment throughout treatment, the following approaches are recommended:
i. Echocardiogram for diagnostic workup
ii. Cardiac MRI can be performed if echocardiogram is not available or is not technically feasible (e.g. poor image quality). Alternatively, gated heart pool scan can be considered
iii. Serum cardiac biomarkers (troponins, natriuretic peptides) as an adjunct to imaging and clinical assessment
iv. Refer to a cardiologist based on clinical context and findings.
Consider deferral or cessation of cardiotoxic treatment where clinically indicated, in collaboration with a cardiologist.
In individuals with clinical signs or symptoms concerning for cardiac dysfunction, the following strategy is recommended:
Echocardiogram for diagnostic workup (Evidence-based – benefits outweight harms; evidence quality – intermediate; Strength of recommendation – strong)
Cardiac magnetic resonance imaging (MRI) or multigated acquisition (MUGA) scan if echocardiogram is not available or technically feasible (eg, poor image quality), with preference given to cardiac MRI (Evidence-based – benefits outweigh harms; evidence quality – intermediate; Strength of recommendation – moderate)
Serum cardiac biomarkers (troponins, natriuretic peptides) or echocardiography-derived strain imaging in conjunction with routine diagnostic imaging imaging (Evidence-based – benefits outweigh harms; evidence quality – intermediate; Strength of recommendation – moderate)
Referral to a cardiologist based on findings (Informal consensus – benefits outweigh harms; evidence quality – insufficient; Strength of recommendation – strong)
<p>No recommendations can be made regarding continuation or discontinuation of cancer therapy in individuals with evidence of cardiac dysfunction. This decision, made by the oncologist, should be informed by close collaboration with a cardiologist, fully evaluating the clinical circumstances and considering the risks and benefits of continuation of therapy responsible for the cardiac dysfunction</p>
There is moderate confidence that the recommendation reflects best practice. This is based on (1) good evidence for a true net effect (eg, benefits exceed harms); (2) consistent results, with minor and/or few exceptions; (3) minor and/or few concerns about study quality; and/or (4) the extent of panelists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a moderate recommendation
There is high confidence that the recommendation reflects best practice. This is based on (1) strong evidence for a true net effect (eg,benefits exceed harms); (2) consistent results, with no or minor exceptions; (3) minor or no concerns about study quality; and/or (4) the extent of panelists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a strong recommendation
How this guidance was developed
This recommendation was adapted from the ASCO 2017 clinical practice guideline on oncological cardiac dysfunction (US). The source recommendation is based on a systematic review of the evidence conducted to February 2016 and the various elements were graded ‘moderate’ or ‘strong’ (using ASCO methods). There is a strong preference for use of echocardiogram and it was noted that a cardiac MRI should only be considered in consultation with a cardiologist, as it is used in the evaluation of cardiac function, not as a screening tool.
Support for these approaches and more detailed indications for the monitoring of cardiac safety during treatment in patients receiving anthracyclines and anti-HER2 treatments, are provided in the ESMO 2020 guidelines for the management of cardiac disease throughout oncological treatment.
Related guidance by topic
Cardiac dysfunction – Symptomatic
Recommendation
In patients with clinical signs or symptoms of cardiac dysfunction during routine clinical assessment throughout treatment, the following approaches are recommended:
i. Echocardiogram for diagnostic workup
ii. Cardiac MRI can be performed if echocardiogram is not available or is not technically feasible (e.g. poor image quality). Alternatively, gated heart pool scan can be considered
iii. Serum cardiac biomarkers (troponins, natriuretic peptides) as an adjunct to imaging and clinical assessment
iv. Refer to a cardiologist based on clinical context and findings.
Consider deferral or cessation of cardiotoxic treatment where clinically indicated, in collaboration with a cardiologist.
Principles in action
Safe and quality care
Image
Multidisciplinary care
Image
Care coordination
This recommendation was adapted from the ASCO 2017 clinical practice guideline on oncological cardiac dysfunction (US). The source recommendation is based on a systematic review of the evidence conducted to February 2016 and the various elements were graded ‘moderate’ or ‘strong’ (using ASCO methods). There is a strong preference for use of echocardiogram and it was noted that a cardiac MRI should only be considered in consultation with a cardiologist, as it is used in the evaluation of cardiac function, not as a screening tool.
Support for these approaches and more detailed indications for the monitoring of cardiac safety during treatment in patients receiving anthracyclines and anti-HER2 treatments, are provided in the ESMO 2020 guidelines for the management of cardiac disease throughout oncological treatment.
Related guidance by topic
Image
