Multimodal Monitoring Strategy Detects Antineoplastic Cardiotoxicity in 30% of Cancer Patients, Guiding Personalized Care
Background
Cardiotoxicity associated with antineoplastic therapy is a significant concern, potentially compromising both long-term cardiovascular outcomes and the continuity of crucial cancer treatment. Current monitoring approaches may not always provide sufficiently early or personalized detection of subclinical cardiac dysfunction, leading to delayed interventions. This study aimed to evaluate a comprehensive, multimodal strategy integrating advanced radionuclide imaging and molecular biomarkers to facilitate early detection and personalized monitoring within multidisciplinary oncologic care, addressing this critical gap.
Study Design
In a prospective, observational, single-center study, 90 adults diagnosed with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic regimens were evaluated. Patients were monitored at baseline (T0), after 3-4 cycles (T1), at treatment completion (T2), and at 6-month follow-up (T3). Antineoplastic exposure was categorized by dominant cardiotoxic profile (e.g., anthracycline-containing, anti-HER2). Monitoring included clinical assessment, ECG, MUGA/gated SPECT, echocardiography (measuring LVEF and GLS), and serial measurements of hs-Tn, NT-proBNP, and sST2 biomarkers.
Results
The median patient age was 56 years, with 62% being women. Baseline mean LVEF was 60±5% and mean GLS was -19.5±2.1%. During antineoplastic treatment, hs-Tn, NT-proBNP, and sST2 progressively increased. Concurrently, LVEF declined to 57±6% and GLS to -16.6±2.5% by treatment completion. Imaging-defined cardiac dysfunction was observed in 30% of patients, with 10% experiencing overt cardiotoxicity. Changes in hs-Tn showed the strongest correlation with GLS (r=-0.42, p=0.002).
Key Findings
- Imaging-defined cardiac dysfunction occurred in 30% of patients receiving cardiotoxic antineoplastic therapy.
- Overt cardiotoxicity developed in 10% of the monitored patient cohort.
- Mean LVEF declined from 60±5% at baseline to 57±6% at treatment completion.
- Mean GLS declined from -19.5±2.1% at baseline to -16.6±2.5% at treatment completion.
- Changes in
hs-Tncorrelated strongly with GLS (r=-0.42, p=0.002).
Why It Matters
This multimodal monitoring model offers a significant advancement for personalized management of cardiotoxicity in cancer patients. By identifying patients at high risk for cardiac dysfunction earlier, clinicians can implement intensified surveillance, initiate early cardioprotective strategies, optimize patients preoperatively, or adjust treatment sequencing. This shifts the paradigm from reactive management of overt cardiotoxicity to proactive, individualized risk mitigation, potentially improving both cardiovascular and oncological outcomes. The findings suggest a more precise approach to integrating cardiac health into cancer care protocols.
cardiotoxicity
cancer
antineoplastic-therapy
biomarkers
imaging
monitoring