In addition to myocardial injury, mechanisms of CV toxicity include arterial damage, valve dysfunction, and involvement of the pericardium and conduction tissue. Apart from dealing with the event outcome of HF, cardiologists have primarily been involved in detection of LV dysfunction. HF may develop acutely due to anthracycline cardiotoxicity, myocarditis and takotsubo mechanisms. However, the usual course is chronic, and attributable to multiple injuries with worsening LV impairment. CV imaging plays a vital role in risk stratification and detection of cardiotoxicity (3). However, guidelines range from using modern imaging as a cornerstone (4), to others with a more conservative approach (5). Guidelines are largely opinion based, which is understandable because much evidence is observational and there are few RCTs (6).
Detection of subclinical LV dysfunction has proven difficult and complicated, as standard tools (eg. EF) are not up to the task of sensitive discrimination over sequential assessment. Strain imaging has been a particularly useful tool in cardio oncology but its use is constrained by unfamiliarity in Oncology circles. The fact that this dysfunction is subclinical has led to concerns that we are not detecting a disease entity, with real risks of over-zealous screening - anxiety and unnecessary interference with cancer therapy. Important work has been done over the last decade in standardization of measurements (7), serial follow up (8) and population-based studies (9).
The use of CV imaging in cardio-oncology is part of a larger effort in cardiology to detect early disease and intervene to prevent it from progressing – especially in HF (10,11).