Anthracycline Cardiotoxicity

Anthracyclines remain an integral part of chemotherapy regimens in many adult and pediatric cancers but cause myocardial damage that may manifest as either subclinical decrements of left ventricular ejection function or overt cardiomyopathy. Anthracycline-related cardiotoxicity is doselimiting, and the risks of congestive heart failure increase with higher cumulative doses, particularly above 500 mg/m in adults and 300 mg/m in pediatric patients. The cardiotoxic effects of anthracyclines may be enhanced by other treatments, including radiation or trastuzumab. Anthracyclines may also lower the threshold for developing cardiac damage associated with aging or comorbid conditions, such as hypertension and diabetes mellitus. As the number of cancer survivors continues to grow, the burden of anthracycline-related cardiac damage is higher than previously thought. Thus, there is a critical need to better define and quantify treatment-related cardiovascular toxicity. Currently, predictors of anthracycline cardiotoxicity used in standard practice are limited to clinical cardiac risk factors and estimates of left ventricular function by echocardiography or gated radionuclide scans. This is a limited approach, and there is a need to expand anthracycline risk assessment in an evidence-based manner, given significant advances in cardiac imaging.