. 2020 Nov 12;113(5):513–522. doi: 10.1093/jnci/djaa177

Table 2.

Recommended modifications to LVEF surveillance during the COVID-19 pandemic^a

Stage of cancer treatment	Anthracycline	Anthracycline→anti-HER2	Anti-HER2 (no anthracycline)
Baseline (before treatment)^b	All patients: check LVEF	All patients: check LVEF	All patients: check LVEF
During treatment^b	Check LVEF at doxorubicin equivalent dose >250 mg/m² Repeat LVEF at doxorubicin equivalent dose ≥400 mg/m², then every 1-2 cycles thereafter	All patients: check LVEF at 3, 6, and 12 months	High risk^d: check LVEF at 3, 6, and 12 months Non–high risk^e: check LVEF at 6 and 12 months Beyond 12 months (metastatic disease), defer^c
After completion of treatment	Defer LVEF assessment^c	—	—

Stage of cancer treatment

Anthracycline

Anthracycline→anti-HER2

Anti-HER2 (no anthracycline)

Baseline (before treatment)^b

All patients: check LVEF

During treatment^b

Check LVEF at doxorubicin equivalent dose >250 mg/m²

Repeat LVEF at doxorubicin equivalent dose ≥400 mg/m², then every 1-2 cycles thereafter

All patients: check LVEF at 3, 6, and 12 months

High risk^d: check LVEF at 3, 6, and 12 months

Non–high risk^e: check LVEF at 6 and 12 months

Beyond 12 months (metastatic disease), defer^c

After completion of treatment

Defer LVEF assessment^c

—

These recommendations only apply to patients with no prior cardiac dysfunction, those who maintain normal cardiac function during surveillance (LVEF ≥ 55%), and those without any cardiac symptoms. Any question of case-specific surveillance for a patient, especially if there is any concern of cardiac disease or symptoms, should prompt a cardio-oncology consultation. Additionally, beyond patient- and treatment-specific risks, all of these recommendations depend on the time and regional variance of COVID-19 risk. CAD = coronary artery disease; COVID-19 = coronavirus disease 2019; LVEF = left ventricular ejection fraction.

Recommend medical providers to coordinate LVEF with other appointments to minimize exposure.

Duration of deferral is based on time-dependent regional prevalence of COVID-19 pandemic and risk of exposure.

Patient-specific risk factors that are considered high risk for developing cardiac dysfunction include any of the criteria: older age (>60 years), 2 or more traditional cardiovascular risk factors (smoking, hypertension, diabetes, hyperlipidemia, obesity), prior cardiotoxic cancer therapy or mediastinal irradiation, compromised cardiac function (LVEF < 55%, more than moderate valvular heart disease, or CAD).

Patients are considered nonhigh risk if they do not meet any of the following criteria: older age (>60 years), 2 or more traditional cardiovascular risk factors (smoking, hypertension, diabetes, hyperlipidemia, obesity), prior cardiotoxic cancer therapy or mediastinal irradiation, or compromised cardiac function (LVEF < 55%, more than moderate valvular heart disease, or CAD).