Table 2.

Cancer Therapy–Related Cardiac Dysfunction Definitions According to Scientific Societies

ASE/EACVI 201458	ESC Position Paper 201646	ESMO 202059
Decrease in LVEF of >10% from baseline to LVEF <53% Relative drop in GLS >15% from baseline	Decrease in LVEF of >10% from baseline to LVEF <50% Relative decrease in GLS of >15% from baseline	LVEF drop by ≥10%-15% or LVEF <50% HF symptoms regardless of LVEF
IC-OS 202160
•Mild: LVEF ≥50% and new relative decrease in GLS by >15% from baseline and/or new rise in cardiac biomarkers (cardiac troponin I/T >99th percentile, BNP >35 pg/mL, NT-proBNP ≥125 pg/mL)
•Moderate: new reduction in LVEF by ≥10% or <10% to absolute 40% < LVEF <50% and new relative decrease in GLS by >15% from baseline, and/or new rise in cardiac biomarkers
•Severe: new LVEF reduction to <40%; for symptomatic patients: mild heart failure symptoms or more
ESC Guidelines 20226
Asymptomatic
•Mild: LVEF ≥50% and decline in GLS >15% and/or new rise in cardiac biomarkers
•Moderate: new decrease in LVEF by 10% to a LVEF of 40% to 49% or new decrease by <10% to a LVEF of 40% to 49% and decline in GLS by 15% or new rise in cardiac markers
•Severe: new decrease in LVEF to <40%
Symptomatic
•Mild: mild HF symptoms, no intensification of therapy required
•Moderate: required intensification of diuretic agents and HF therapy
•Severe: hospitalization for HF
•Very severe: HF requiring inotropic or mechanical support and consideration of transplantation

ASE = American Society of Echocardiography; BNP = brain natriuretic peptide; EACVI = European Association of Cardiovascular Imaging; ESC = European Society of Cardiology; ESMO = European Society of Medical Ooncology; GLS = global longitudinal strain; HF = heart failure; IC-OS = International Cardio-Oncology Society; LVEF = left ventricular ejection fraction; NT-proBNP = N-terminal pro–B-type natriuretic peptide.