Table 2. Definitions of cardiotoxicity.
| Organisation | Definition of cardiotoxicity | Comments |
|---|---|---|
| ASE/EACVI | LVEF fall by >10% to absolute EF <53% | Change in LV function may be global or regional |
| Symptomatic or asymptomatic for heart failure | ||
| ESC | LVEF fall by >10% from baseline to EF <50% | Symptomatic or asymptomatic for heart failure |
| NCI | CTCAE Heart Failure Grade 1–5 | Grade 1 (asymptomatic) |
| Grade 2 (mild to moderate symptoms) | ||
| Grade 3 (symptomatic on minimal exertion/at rest) | ||
| Grade 4 (life-threatening) | ||
| Grade 5 (death) | ||
| CCS | LVEF fall by >10% from baseline or LVEF <53% | Guidelines also recommend (I) 3D echocardiography or same imaging modality during cancer therapy, (II) myocardial strain imaging and (III) cardiac biomarkers (N-terminal pro brain natriuretic peptide, troponin) for early detection |
| ESMO | Symptomatic decline in LVEF of at least 5% to <55% or asymptomatic decline in LVEF of at least 10% to <55% | Symptoms for congestive heart failure with signs including but not limited to S3 gallop, tachycardia, or both |
| Decline in LVEF either global or more severe in the septum |
ASE, American Society of Echocardiography; CCS, Canadian Cardiovascular Society; CTCAE, Common Terminology Criteria for Adverse Events; EACVI, European Association of Cardiovascular Imaging; EF, ejection fraction; ESC, European Society of Cardiology; ESMO, European Society of Medical Oncology; LV, left ventricular; NCI, National Cancer Institute; reproduced from Chung et al. (13).