Update on Incorporating Biomarkers with Imaging Findings for the Detection and Management of Cardiotoxicity.

PURPOSE OF REVIEW: Modern cancer therapy comes at a cost of increased risk of cardiotoxicity. The purpose of our paper is to provide an updated review highlighting research incorporating biomarkers and imaging findings for the detection of subclinical cardiac dysfunction and management of cancer treatment-related cardiotoxicity.

RECENT FINDINGS: Biomarkers, particularly troponin, NTproBNP, and myeloperoxidase, have been shown to have a predictive role in the development of cancer treatment-related cardiotoxicity. Early reductions in global longitudinal strain and the more recently reported, circumferential strain, have been shown to be predictive of subsequent cardiotoxicity. Integrating troponin levels with longitudinal strain may have incremental value in predicting future cardiotoxicity. Initiating troponin-guided heart failure therapy following cancer treatment may impact the development of cardiotoxicity. Strain-guided heart failure therapy is currently under investigation. Early detection of subclinical cardiac dysfunction in high-risk cancer patients and subsequent medical intervention using biomarkers and imaging may help to alter the course of cancer treatment-induced cardiotoxicity. Current guidelines and expert consensus offer a general framework for monitoring high risk patients for cardiotoxicity. However, additional research is needed to provide a more sophisticated and structured approach in detecting and managing subclinical cardiac dysfunction with hopes of minimizing subsequent cardiotoxicity.