. 2023 Feb 15;25(3):133–146. doi: 10.1007/s11886-022-01834-x

Table 2.

HFA-ICOS and ESC risk assessment in patients receiving potentially cardiotoxic cancer therapy

Baseline HFA-ICOS risk assessment tool [62•] (Tool specific to cancer therapy, examples listed for anthracyclines)	Risk following treatment
Very high risk: Baseline HF or cardiomyopathy* High risk: Severe valvular disease, prior MI, PCI or CABG, age > = 80, prior anthracyclines or radiation, stable angina, LVEF < 50%, or ≥ 5 points of medium risk factors Moderate risk: Medium risk factors with a total of 2–4 points Low risk: No risk factor or 1 medium risk factor Medium risk factors: borderline LVEF 50–54% (2 points), age 65–79 (2 points), HTN (1 point), DM (1 point), smoker (1 point), obese (1 point), elevated cTn (1 point), elevated NP (1 point)	Very high: very high baseline risk, doxorubicin ≥ 400 mg/m², RT > 25 Gy MHD, RT > 15–25 Gy MHD + doxorubicin ≥ 100 mg/m² Early high (< 5 years after therapy): high baseline risk, moderate to severe CTRC, doxorubicin 250–399 mg/m², high-risk HSCT Late high: RT > 15–25 Gy MHD, RT 5–15 Gy MHD + doxorubicin ≥ 100 mg/m², poorly controlled CV risk factors Moderate: moderate baseline risk, doxorubicin 100–249 mg/m², RT 5–15 Gy MHD, RT < 5 Gy MHD + doxorubicin ≥ 100 mg/m² Low: low baseline risk and normal end of therapy cardiac assessment, mild CTRC with recovery, RT < 5 Gy MHD, doxorubicin < 100 mg/m²

Baseline HFA-ICOS risk assessment tool [62•]
(Tool specific to cancer therapy, examples listed for anthracyclines)

Risk following treatment

Very high risk: Baseline HF or cardiomyopathy*

High risk: Severe valvular disease, prior MI, PCI or CABG, age > = 80, prior anthracyclines or radiation, stable angina, LVEF < 50%, or ≥ 5 points of medium risk factors

Moderate risk: Medium risk factors with a total of 2–4 points

Low risk: No risk factor or 1 medium risk factor

Medium risk factors: borderline LVEF 50–54% (2 points), age 65–79 (2 points), HTN (1 point), DM (1 point), smoker (1 point), obese (1 point), elevated cTn (1 point), elevated NP (1 point)

Very high: very high baseline risk, doxorubicin ≥ 400 mg/m², RT > 25 Gy MHD, RT > 15–25 Gy MHD + doxorubicin ≥ 100 mg/m²

Early high (< 5 years after therapy): high baseline risk, moderate to severe CTRC, doxorubicin 250–399 mg/m², high-risk HSCT

Late high: RT > 15–25 Gy MHD, RT 5–15 Gy MHD + doxorubicin ≥ 100 mg/m², poorly controlled CV risk factors

Moderate: moderate baseline risk, doxorubicin 100–249 mg/m², RT 5–15 Gy MHD, RT < 5 Gy MHD + doxorubicin ≥ 100 mg/m²

Low: low baseline risk and normal end of therapy cardiac assessment, mild CTRC with recovery, RT < 5 Gy MHD, doxorubicin < 100 mg/m²

The HFA developed a risk scoring system specific to each cardiotoxic cancer therapy utilized during baseline cardiovascular risk assessment [62•]. Patients receive both qualitative (medium, high, very high) and quantitative scores that may guide biomarker surveillance. Examples in table provided for treatment with anthracyclines. The ESC 2022 guidelines adopted this risk tool for baseline risk assessment, while specifying additional risk factors during and after cancer therapy [6••]

CABG coronary artery bypass grafting, cTn troponin, ESC European Society of Cardiology, Gy gray, HF heart failure, HFA Heart Failure Association of the ESC, ICOS International Cardio-Oncology Society, MHD mean heart dose, MI myocardial infarction, NP natriuretic peptide, PCI percutaneous coronary intervention, RT radiation therapy, TKI tyrosine kinase inhibitor

^*Other very-high risk factors for other cancer therapies include anti-HER2 therapy (baseline HF or cardiomyopathy, prior trastuzumab cardiotoxicity), vascular endothelial growth factor (baseline HF or cardiomyopathy, arterial vascular disease), proteasome inhibitors (baseline HF or cardiomyopathy, prior proteasome inhibitor cardiotoxicity, venous thrombosis, cardiac amyloidosis, arterial vascular disease), and multi-targeted kinase inhibitors (arterial vascular disease, arterial thrombosis with TKI)