Anthracycline Cardiotoxicity: Strategies for Prevention and Intervention.
However, despite efforts towards cardioprotective strategies and early detection of anthracycline cardiotoxicity, defined as decline in Left Ventricular Ejection Fraction (LVEF) of ≥10% from baseline or to <50%, there is currently no consensus on the optimal approach. Current clinical practice guidelines recommend serial LVEF monitoring to identify cardiotoxicity in high-risk patients receiving anthracyclines.
Strategies to mitigate anthracycline cardiotoxicity may be classified as pre-emptive (primary prevention) versus reactive (secondary prevention). In the recently completed PRADA study, a randomized controlled trial comparing primary prevention of cardiotoxicity with metoprolol, candesartan, versus matched placebos in 120 patients treated with anthracyclines with or without trastuzumab for early breast cancer, pre-emptive candesartan was shown to result in a statistically significantly attenuation in LVEF decline. Because a primary prevention strategy may needlessly expose many patients to potential adverse effects, secondary prevention strategies are of interest.
However, troponin elevation is not always present even in the setting of echocardiographic findings consistent with cardiotoxicity, and thus, echocardiographic strain imaging may be a more reliable indicator for secondary prevention. While preliminary in nature, this study is significant for being the first to utilize strain imaging in guiding initiation of cardioprotective therapy. In conclusion, both primary and secondary cardioprotective strategies with beta-blockers and angiotensin antagonist therapy for anthracycline cardiotoxicity hold promise at this time. In adopting a secondary prevention strategy, GLS measured by echocardiographic strain imaging may be a useful and reliable indicator for timing of intervention.
Heart Res Open J. 2015; 2(4): e9-e12.doi: 10.17140/HROJ-2-e004