Even when [three-dimensional] echo is not possible, [two-dimensional] echo still provides excellent information to the clinician and allows for early detection of any cardiac issues.
—Juan Carlos Plana, MD, FASE
Patients with cancer and survivors of cancer are living longer than ever before as a result of significant advances made over the past decade. Importantly, however, cardiovascular complications of their cancer treatment may present a life-threatening issue after their cancer treatment has ended. Significant numbers of patients who have been treated with chemotherapy drugs are at risk to have weakened hearts. Adult survivors of childhood cancer are 15 times as likely to have congestive heart failure and 10 times as likely to have coronary artery disease as their healthy siblings. To help clinicians monitor and minimize the cardiotoxic effects of various cancer therapies, the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) have released a comprehensive Expert Consensus on multimodality imaging evaluation of adult patients during and after cancer therapy. The paper was published recently in Journal of the American
Society of Echocardiography.
Detecting and Monitoring Damage to the Heart
This consensus paper is the result of several years’ work to outline the specific effects of the many different cancer therapies that exist, and details the strengths and challenges of various forms of imaging in detecting and monitoring damage to the heart as early as possible. The paper confirms that echocardiography is the modern method of choice for the evaluation of patients before, during, and after cancer therapy. Perhaps most importantly, the consensus statement also strongly recommends an early baseline echocardiogram for all patients undergoing cancer therapy, and provides recommended time intervals for follow-up specific to each form of therapy used.
Juan Carlos Plana, MD, FASE, was Chair of the writing group for the Consensus Statement.. Dr. Plana is former Co-Director of the Cardio-Oncology Clinic at the Cleveland Clinic and now a Professor of Medicine at Baylor College of Medicine. Dr. Plana said “This proactive imaging protocol is extremely helpful as it provides an accurate starting point for the patient’s normal cardiovascular health and offers the clinician early detection and warning should there be any adverse changes during the cancer treatment.”
The size of the cardiotoxicity problem is significant, as there are currently over 12 million people in the United States living with active cancer or with a history of the disease, and this number is expected to grow as screening tests become more widely available, cancer treatment improves, and the United States population ages. The field of cardio-oncology has emerged as a result of better understanding and tools for early diagnosis of these adverse effects and aims to provide an integrated and holistic approach to patient care. Dr. Plana said that “once patients have survived cancer, they don’t die from cancer, they die from heart disease. Cardio-oncology is about making sure that doesn’t happen.”
The Consensus Statement also outlines the various innovative tools that echocardiography offers, such as three-dimensional echocardiography, myocardial deformation or “strain” imaging, contrast echocardiography, and stress echo. Notes Dr. Plana, “While [three-dimensional] echo is the preferred echo technique for monitoring cardio-toxicity, it may not always be available. But even when [three-dimensional] echo is not possible, [two-dimensional] echo still provides excellent information to the clinician and allows for early detection of any cardiac issues, which is the most important consideration.” If cardiac dysfunction is detected early, cardioprotective medications can be prescribed to mitigate damage, or treatment can be modified when necessary. ■
Disclosure: Dr. Plana reported no potential conflicts of interest. For full disclosures of all study authors, visit www.onlinejase.com.
1. Plana JC, Galderisi M, Barac A, et al: Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiography 27:911-939, 2014.