Table 1.

A proposal for the cardiotoxicity surveillance during COVID-19 pandemic

Treatment	Recommendations before pandemic	Recommendations during pandemic
Anthracyclines: basal evaluation	Cardiological visit only in intermediate and high-risk patients (age ≥60 years, cardiopathy, high-dose RT, high cumulative anthracycline dose, ≥2 CVR factors) Echocardiography to all patients	Cardiological visit only in high-risk patients (cardiopathy, high dosage of RT, high cumulative anthracycline dose) Echocardiography only in high-risk patients
Anthracyclines: during treatment	Echocardiography at mid-cycle if high CVR Echocardiography at the end of treatment to all patients	No screening in asymptomatic patients Echocardiography in patients with symptoms and signs of HF; high-dose RT, high cumulative anthracycline dose (>400 mg/m2) or with doses of 250 mg/m2 in presence of CVR factors or cardiopathy
Anthracyclines: follow-up	If no cardiotoxicity echocardiography at 6–12 months and after 2–3–5 years In presence of cardiotoxicity echocardiography at 3–6–12 months and each year until 5 years	In asymptomatic patients defer the echo-imaging
Trastuzumab: basal evaluation	Echocardiography to all patients	Echocardiography only in high-risk patients.
Trastuzumab: during treatment	If LVEF is normal, echocardiography every 3 months. If LVEF 40–49%, optimize HF therapy with ACEI and beta-blockers. Continue treatment if LVEF stable after 4 weeks and repeat echocardiography after 4 weeks. If LVEF <40% stop trastuzumab treatment, optimize HF therapy with ACEI and beta-blockers, and evaluate the patient after 4 weeks	In low-risk patients with no previous anthracycline treatment, echocardiography at 6–12 months; if metastatic disease echocardiography every 6 months In high-risk patients, echocardiography as usual every 3 months If left ventricular dysfunction during treatment or signs and symptoms of HF follow pre-pandemic recommendations
Trastuzumab: follow-up	The same as anthracyclines	In asymptomatic patients defer the echo-imaging.

Adapted from Calvillo-Argüelles et al.¹¹¹

ACEI, angiotensin-converting enzyme inhibitor; CVR, cardiovascular risk; HF, heart failure; LVEF, left ventricular ejection fraction; RT, radiotherapy.