Table 2.

Monitoring and referral to cardiology

Cardiotoxicity risk	Monitoring
High risk drugs + established heart disease and LVEF <40%	Carefully assess indication for cardiotoxic agents. Individualize, support from cardiology
High/moderate risk drugs + CVRF or LVEF >40%	Baseline: ECG; blood test (HbA1c, lipids and troponin?); LVEF measurement (2D/3D US ± GLS) During treatment: control CVRF, troponin in each cycle?; assess BB, ACEIs, and statins End of treatment: troponin?; ECG, LVEF measurement (2D/3D US ± GLS) Follow-up: measure LVEF at 6 months from end of treatment (2D/3D US ± GLS), and every 3–4 years
High/moderate risk drugs + asymptomatic without CVRF	Baseline: ECG; blood test (HbA1c, lipids, and troponin?) End of treatment: troponin?; ECG, LVEF measurement (2D/3D US ± GLS) Follow-up: according to symptoms
Criteria for referral to cardiology  Patients with high or intermediate risk of cardiotoxicity, to optimize medical treatment: BB, ACEIs, statins   Previous treatment with adriamycin ≥300 mg/m2   Mediastinal irradiation ≥30 Gy   Previous heart disease (cardiomyopathy, heart failure, arrhythmias or ischemic heart disease), if not followed up in cardiology   Poorly controlled CVRF with treatment: HT, diabetes, dyslipidemia, smoking  Alterations at baseline: ECG, troponin or LVEF measurement  Alterations during follow-up:   LVEF decrease >10% or LVEF <53%   Abnormal GLS (>−19%) or decrease >15%   Positive troponin I   Chest pain, dyspnea on exertion, syncope, arrhythmias   HT refractory to conventional treatment

ACEIs angiotensin converting enzyme inhibitors, BB beta-blockers, CVRF cardiovascular risk factors, ECG electrocardiogram, GLS global longitudinal strain, Hb hemoglobin, HT hypertension, LVEF left ventricular ejection fraction