Ryan D. Gentzler, MD, MS
Professor of Cardiology
In this edition of Grand Rounds in Hematology and Oncology from January 2023, Hillary Maitland, Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, introduces Antonio Abbate, MD, PhD, Ruth C. Heede Professor of Cardiology, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia. In this 54-minute presentation, Dr. Abbate gives a thorough overview of cancer therapy-related cardiac dysfunction (CTRCD), emphasizing early detection and standardized management. The talk ends with a Q&A discussion.
Dr. Abbate defines CTRCD as a decrease in left ventricular ejection fraction (LVEF) of over 10 percentage points to below 50%, regardless of symptoms. This definition encompasses both symptomatic and asymptomatic cases, as well as diastolic dysfunction. With increasing cancer survivorship, CTRCD has become a critical concern, particularly given the potential for delayed cardiac toxicity.
Dr. Abbate highlights the limitations of traditional LVEF monitoring and underscores the importance of integrating biomarkers and imaging for early detection. Troponin is emphasized for its role in identifying early myocardial injury, particularly in patients receiving anthracyclines. Elevations in troponin correlate with worse outcomes and may guide prophylactic strategies such as ACE inhibitors. Natriuretic peptides (BNP, NT-proBNP) are also discussed as tools for detecting subclinical dysfunction and monitoring heart failure symptoms.
Global longitudinal strain (GLS) is a sensitive echocardiographic marker of subclinical myocardial dysfunction. A relative drop of over 15% from baseline is associated with future LVEF decline. Dr. Abbate supports incorporating GLS into routine surveillance, especially for patients on HER2-targeted therapies. Cardiac MRI is acknowledged as the gold standard for cardiac structure and function assessment and is recommended when echocardiographic data are suboptimal or when myocarditis is suspected.
Dr. Abbate proposes surveillance strategies stratified by patient risk level and therapeutic regimen. For high-risk patients, such as those receiving anthracyclines or immune checkpoint inhibitors, baseline and serial monitoring with troponin, BNP, and imaging is advised. He strongly encourages integrating cardiology expertise into oncology care to optimize outcomes and reduce long-term cardiac morbidity.