Table 1.
Risk assessment and monitoring associated with left ventricular dysfunction
| Patient‐Related Risk Factors | Medication‐Related Risk Factorsa |
|---|---|
| One point for each risk factor present | High (risk score 4): anthracyclines, trastuzumab, ifosfamide, cyclophosphamide, clofarabine |
| Age (bimodal distribution): <15 or >65 years | Intermediate (risk score 2): docetaxel, pertuzumab, sunitinib, sorafenib |
| Female | Low (risk score 1): bevacizumab, imatinib, lapatinib, dasatinib |
| Hypertension | Rare (risk score 0): etoposide, rituximab, thalidomide |
| Diabetes mellitus | |
| Atherosclerosis (coronary artery disease, cerebrovascular disease, peripheral artery disease) | |
| Preexisting heart disease or heart failure | |
| Prior anthracycline | |
| Prior radiation therapy to the chest | |
| Cardiotoxicity risk score | |
| Medication‐related risk score + number of patient‐related risk factors = CRS >6: very high; CRS 5–6: high; CRS 3–4: intermediate; CRS 1–2: low; CRS 0: very low | |
| Mayo Clinic monitoring recommendations | |
| Very high risk: echocardiogram with GLS before every (other) cycle, end, 3–6 months, and 1 year; optional ECG, cTn with echocardiogram during chemotherapy | |
| High risk: echocardiogram with GLS every 3 cycles, end, 3–6 months, and 1 year after treatment; optional ECG, cTn with echocardiogram during chemotherapy | |
| Intermediate risk: echocardiogram with GLS, midterm, end, and 3–6 months after treatment; optional ECG, cTn midterm of chemotherapy | |
| Low risk: Optional echocardiogram with GLS and/or ECG; cTn at the end of treatment | |
| Very low risk: None |
Abbreviations: cTn, serum cardiac troponin. ECG, electrocardiogram; GLS, global longitudinal strain.
Risk assessment, cardiotoxicity risk score at the time of baseline assessment and monitoring for patients undergoing anticancer therapy. From: Herrmann et al.,38 with permission.
a
Medication‐related risk factor (1–4) was based on the risk for a decline or dysfunction in the ventricular function.