The possibilities of echocardiography for detecting cardiotoxic effects of antineoplastic medications

Abstract

Background. In recent decades, advancements in cancer treatment have resulted in enhanced patient survival rates, yet concurrently, escalated morbidity and mortality due to therapy-induced side effects, with cardiovascular complications (CVC) at the forefront. The risk of cardiovascular disease (CVD) during chemotherapy lies in the potentiality of interrupting or discontinuing the treatment of the underlying ailment, thereby diminishing the patient’s prospects of survival. Regrettably, delayed manifestations of cardiotoxic effects subsequent to the completion of anticancer therapy further diminish the patients’ quality of life and escalate mortality rates. Consequently, early diagnosis and timely identification of cardiotoxic effects induced by anticancer drugs have emerged as paramount objectives, shaping a novel domain in medicine termed cardio-oncology. Purpose. Assess the condition and modern ideas of the development of echocardiography in the assessment of cardiac dysfunction in the context of chemotherapy. Materials and Methods. References were analyzed using English-language biomedical databases (MEDLINE (Pubmed), Web of Science (Web of Knowledge) using the following keywords: «cardiotoxicity», «echocardiography», «chemotherapy», «ventricular dysfunction», «anticancer therapy», «risk stratification» for 2019–2024. Results. Cardiotoxicity arising as a consequence of anticancer therapy can manifest in various forms, including left ventricular (LV) myocardial dysfunction, heart failure (HF), pulmonary hypertension, thromboembolic complications, arterial hypertension, coronary heart disease, pericardial disease, valvular heart disease, and others. Detecting the subclinical variant of cardiotoxicity, which precedes the onset of HF, is of paramount importance. Presently, echocardiography remains the preferred method for evaluating the structural and functional status of the LV myocardium. However, studies have demonstrated that measuring LV ejection fraction (EF) via transthoracic echocardiography may not effectively detect LV dysfunction in its early stages. In recent years, novel myocardial imaging techniques have emerged for this purpose, with speckle-tracking echocardiography (STE) in both two-dimensional and three-dimensional modes showing promise. Соnclusion. The early detection of cardiotoxic effects induced by anticancer drugs emerges as a critical concern in cardiology practice. Evaluation of global myocardial strain derived from two-dimensional LV images provides valuable insights into diagnosing early LV dysfunction, especially in patients undergoing chemotherapy.