Table 4.

Summary of recommendations for baseline and long-term monitoring of cardiotoxicities in patients with cancer

Who to screen	When and how
ASCO guidelines80
Patients with clinical signs or symptoms suggestive of cardiac dysfunction	Echocardiogram CMR or MUGA if echocardiogram is not available or not feasible Serum cardiac biomarkers (troponins, natriuretic peptides) or echocardiography-derived strain imaging plus routine diagnostic imaging
Asymptomatic patients at increased risk for cardiac dysfunction	Routine surveillance imaging Echocardiogram, 6 and 12 months after completion of cancer therapy CMR or MUGA if echocardiogram is not available or not technically feasible No recommendations on frequency and duration of surveillance in patients who have no evidence of cardiac dysfunction on a 6–12-month post-treatment echocardiogram
ESMO guidelines24
Any patient on potentially cardiotoxic therapy High-risk patients (pre-existing CVD) or those receiving high-dose cardiotoxic therapy (e.g. anthracycline)	ECG, including QTc at baseline Cardiac biomarkers: hs-cardiac troponins (TnI or TnT), BNP or NT-proBNP at baseline and periodically thereafter (3–6 weeks or before each cycle) Reassessment of LV function based on cumulative anthracycline dose
Patients scheduled to receive cancer therapy associated with HF or LV dysfunction	Imaging evaluation of LVEF and diastolic function at baseline Baseline and serial blood pressure monitoring Periodic cardiac physical examination, cardiac biomarkers and/or cardiac imaging
ESC guidance3
All patients receiving cancer therapy	Assessment of CAD based on history, age, and gender 12-lead electrocardiogram and QTc interval at baseline and during treatment Blood pressure at baseline and periodically during treatment Frequency of surveillance depends on patient and treatment characteristics
Patients with a history of QT prolongation, cardiac disease, bradycardia, thyroid dysfunction, electrolyte abnormalities	Monitor with repeated 12-lead electrocardiogram
Patients with severe hypertension	Close monitoring and evaluation of adherence to antihypertensive drugs
Patients treated with pyrimidine analogues or at risk for myocardial ischaemia	Echocardiography (3D preferred) to monitor for myocardial ischaemia and to estimate LVEF and LV volumes before, during and after treatment Exact interval is not established, but should be repeated during follow-up to confirm recovery, or detect irreversible LV dysfunction
Patients receiving radiotherapy	Adults and survivors of childhood cancers exposed to chest radiotherapy should be offered lifelong surveillance

3D, three-dimensional; ASCO, American Society of Clinical Oncology; BNP, B-type natriuretic peptide; CAD, coronary artery disease; CMR, cardiac magnetic resonance; CVD, cardiovascular disease; ECG, electrocardiography; ESC, European Society of Cardiology; ESMO, European Society for Medical Oncology; HF, heart failure; hs-TnI or TnT, high-sensitivitycardiac troponins (I or T); LV, left ventricular; LVEF, left ventricular ejection fraction; MUGA, multi-gated acquisition; NT-proBNP, N-terminal pro-B-type natriuretic peptide.