ESC 2022 2022 ESC Guidelines on cardio-oncology
European Society of Cardiology｜循環器 / 腫瘍循環器｜133 ページ｜チャンク 1108｜推奨 335 件｜current
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.21 | IIb | C | risk, cardiology referrald may be considered.e | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | B | CV toxicity risk stratificationc before starting potentially cardiotoxic anticancer therapy is recommended in all patients with cancer.12,14,19,21,25,28,31 | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | C | Communicating the results of the CV toxicity risk assessment to the patient and other appropriate healthcare professionals is recommended. | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | IIa | C | The use of HFA-ICOS risk assessment should be considered to stratify CV toxicity risk in patients with cancer scheduled to receive cardiotoxic anticancer therapy.12 | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | C | It is recommended that patients categorized to be at low CV toxicity risk should proceed to anticancer therapy without delay. In patients categorized at moderate CV toxicity | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | C | Cardiology referrald is recommended in high-risk and very high-risk patients before anticancer therapy.f | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | C | Discussion of the risk/benefit balance of cardiotoxic anticancer treatment in high- and very high-risk patients in a multidisciplinary approach prior to starting treatment is recommended. | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.21 | I | C | Cardiology referrald is recommended for patients with cancer and pre-existing CVD or abnormal findings at baseline CV toxicity risk assessmentg who require potentially cardiotoxic anticancer therapy. | Recommendation Table 1 — Recommendations for a general approach to cardiovascular toxicity risk categorization |
| p.23 | I | C | An ECG is recommended in all patients starting cancer therapy as part of their baseline CV risk assessment. | Recommendation Table 2 — Recommendations for electrocardiogram baseline assessment |
| p.23 | I | C | In patients with an abnormal baseline ECG,c referral to a cardiologistd is recommended. | Recommendation Table 2 — Recommendations for electrocardiogram baseline assessment |
| p.24 | I | C | Baseline measurement of NPc and/or cTnd is recommended in all patients with cancer at risk of CTRCD if these biomarkers are going to be measured during treatment to detect CTRCD.e,53,55 | Recommendation Table 3 — Recommendation for cardiac biomarker assessment prior to potentially cardiotoxic therapies |
| p.25 | IIb | C | diagnostic and CMR is not available.106–108 | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.25 | I | C | Echocardiography is recommended as the first-line modality for the assessment of cardiac function in patients with cancer.4,12,54,94 | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.25 | I | B | 3D echocardiography is recommended as the preferred echocardiographic modality to measure LVEF.77–79,89 | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.25 | I | C | GLS is recommended in all patients with cancer having echocardiography, if available.75,80,81,89,90,92,93,102,103 | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.25 | IIa | C | CMR should be considered for the assessment of cardiac function when echocardiography is unavailable or non-diagnostic.83,104,105 MUGA may be considered when TTE is not | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.25 | I | C | Baseline comprehensive TTE is recommended in all patients with cancer at high risk and very high risk of CV toxicity before starting anticancer therapy.d,54 | Recommendation Table 4 — Recommendations for cardiac imaging modalities in patients with cancer |
| p.28 | I | C | Management of CVRF according to the 2021 ESC Guidelines on CVD prevention in clinical practice is recommended before,c during, and after cancer therapy.19 | Recommendation Table 5 — Recommendations for primary prevention of cancer therapy-related cardiovascular toxicity |
| p.28 | IIa | B | Dexrazoxane should be considered in adult patients with cancer at high and very high CV toxicity risk when anthracycline chemotherapy is indicated.d,158 | Recommendation Table 5 — Recommendations for primary prevention of cancer therapy-related cardiovascular toxicity |
| p.28 | IIa | B | Liposomal anthracyclines should be considered in adult patients with cancer at high and very high CV toxicity risk when anthracycline chemotherapy is indicated.e,164,165,168 | Recommendation Table 5 — Recommendations for primary prevention of cancer therapy-related cardiovascular toxicity |
| p.29 | IIa | B | ACE-I or ARB and beta-blockers recommended for HFf should be considered for primary prevention in high- and very high-risk patients receiving anthracyclines and/or anti-HER2 therapies.145,150,155–157,159,160,175 | |
| p.29 | IIa | C | ACE-I or ARB and beta-blockers recommended for HFf should be considered for primary prevention in high- and very high-risk patients receiving targeted cancer therapies that may cause HF.g | |
| p.29 | IIa | B | Statins should be considered for primary prevention in adult patients with cancer at high and very high CV toxicity risk.h,149,176–185 | |
| p.29 | I | C | Management of CVD according to applicable ESC Guidelines is recommended before,c during, and after cancer therapy. | Recommendation Table 6 — Recommendation for secondary prevention of cancer therapy-related cardiovascular toxicity |
| p.31 | I | B | TTE Baseline echocardiographyc is recommended in all patients with cancer before anthracycline chemotherapy.12,24,208–210 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | I | B | In all adults receiving anthracycline chemotherapy, an echocardiogram is recommended within 12 months after completing treatment.208 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | I | C | In high- and very high-risk patients, echocardiography is recommended every two cycles and within 3 months after completing treatment.24,208–210 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | IIa | C | In moderate-risk patients, additional echocardiography should be considered after a cumulative dose of ≥250 mg/m2 of doxorubicin or equivalent.7 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | IIb | C | In low-risk patients, additional echocardiography may be considered after a cumulative dose of ≥250 mg/m2 of doxorubicin or equivalent.7 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | I | B | Cardiac serum biomarkers Baseline measurement of NP and cTn is recommended in high- and very high-risk patients prior to anthracycline chemotherapy.55,65,211 | Recommendation Table 7 — Recommendations for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months after therapy |
| p.31 | IIa | C | Baseline measurement of NP and cTn should be considered in low- and moderate-risk patients prior to anthracycline chemotherapy.211 | |
| p.31 | I | B | cTn and NP monitoring before every cycle during anthracycline chemotherapy and 3 and 12 months after therapy completion is recommended in high- and very high-risk patients.55,175,211 | |
| p.31 | IIa | C | cTn and NP monitoring every two cycles during anthracycline chemotherapy and within 3 months after therapy completion should be considered in moderate-risk patients and in low-risk patients receiving a cumulative dose of ≥250 mg/m2 of doxorubicin or equivalent.55,59,212,213 | |
| p.31 | IIb | C | cTn and NP monitoring every two cycles during anthracycline chemotherapy and within 3 months after therapy completion may be considered in low-risk patients.55,59,212,213 | |
| p.32 | I | B | Baseline echocardiographyc is recommended before HER2-targeted therapies in all patients.225 | Recommendation Table 8 — Recommendations for baseline risk assessment and monitoring during human epidermal receptor 2-targeted therapies and in the first 12 months after therapy |
| p.33 | I | B | In patients receiving neoadjuvant or adjuvant HER2-targeted therapies, echocardiography is recommended every 3 months and within 12 months after completing treatment.225,226 | |
| p.33 | IIb | C | In low-risk HER2+ EBC patientsd who are asymptomatic and with a normal assessment after 3 months, reducing monitoring to every 4 months may be considered. | |
| p.33 | IIa | C | In high- and very high-risk HER2+ EBC patients,d more frequent echocardiography monitoringe should be considered during treatment. | |
| p.33 | I | C | In metastatic HER2+ disease, echocardiography is recommended every 3 months during the first year; if the patient remains asymptomatic without CV toxicity, then surveillance can be reduced to | |
| p.33 | I | C | Cardiac biomarkers Baseline NP and cTn measurement are recommended in high- and very high-risk patients prior to anti-HER2-targeted therapies.227,228 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | IIa | C | NP and cTn monitoring every 2–3 cycles during therapy and 3 and 12 months after the end of therapy should be considered in high- and very high-risk HER2+ EBC patients.d,55 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | IIa | A | Baseline cTn measurement should be considered in low- and moderate-risk patients post-anthracycline chemotherapy but prior to starting anti-HER2-targeted therapies.55,62 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | IIb | C | NP and cTn monitoring at baseline, every 3 months, and 12 months after therapy may be considered in low- and moderate-risk HER2+ EBC patients.d,55 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | I | C | Baseline CV risk assessment and evaluation including BP measurement, ECG, lipid profile, HbA1c measurement, and SCORE2/ SCORE2-OPc or equivalent is recommended19 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | I | C | before starting fluoropyrimidines. A baseline echocardiogram is recommended in patients with a history of symptomatic CVD before starting fluoropyrimidines. | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.33 | IIb | C | Screening for CADd may be considered in patients at high and very high risk of CADc before fluoropyrimidines. © ESC 2022 | Recommendation Table 9 — Recommendations for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.36 | I | C | BP monitoring BP measurement is recommended for patients treated with VEGFi, bevacizumab, or ramucirumab at every clinical visit. | Recommendation Table 10 — Recommendations for baseline risk assessment and monitoring during vascular endothelial growth factor inhibitors |
| p.36 | I | C | Daily home monitoring of BP for patients treated with VEGFi during the first cycle, after each increase of VEGFi dose, and every 2–3 weeks thereafter is recommended. | Recommendation Table 10 — Recommendations for baseline risk assessment and monitoring during vascular endothelial growth factor inhibitors |
| p.36 | I | C | ECG monitoring In patients treated with VEGFi at moderate or high risk of QTc prolongation, QTcc monitoring is recommended monthly during the first 3 months and every 3–6 months thereafter.d | Recommendation Table 10 — Recommendations for baseline risk assessment and monitoring during vascular endothelial growth factor inhibitors |
| p.36 | I | C | Echocardiography Baseline echocardiography is recommended in high- and very high-risk patients treated with VEGFi or bevacizumab. | Recommendation Table 10 — Recommendations for baseline risk assessment and monitoring during vascular endothelial growth factor inhibitors |
| p.36 | IIa | C | Baseline echocardiography should be considered in low- and moderate-risk patients treated with a VEGFi or bevacizumab. | Recommendation Table 10 — Recommendations for baseline risk assessment and monitoring during vascular endothelial growth factor inhibitors |
| p.36 | IIb | C | Echocardiography may be considered every 4 months during the first year in moderate-risk patients receiving VEGFi or bevacizumab. | |
| p.36 | IIa | C | Echocardiography should be considered every 3 months during the first year in high- and very high-risk patients receiving a VEGFi or bevacizumab.e | |
| p.36 | IIa | C | Echocardiography every 6–12 months should be considered in moderate- and high-risk patients with cancer who require long-term treatment with a VEGFi. | |
| p.36 | IIb | C | Cardiac biomarker NP may be considered at baseline and then every 4 months during the first year in moderate-risk patients receiving a VEGFi. | |
| p.36 | IIa | C | NP should be considered at baseline, 4 weeks after starting treatment, and them every 3 months during the first year in high- and very high-risk patients receiving a VEGFi. | |
| p.39 | I | C | Baseline CV risk assessmentc is recommended in patients who require second- or third-generation BCR-ABL TKI.256,261 | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | I | C | In patients treated with nilotinib or ponatinib, CV risk assessmentc is recommended every 3 months during the first year and every 6–12 months thereafter.256,261 | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | IIa | C | QTcd measurement should be considered at baseline, at 2 and 4 weeks after starting nilotinib, and 2 weeks after any dose increase.259 | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | IIa | C | Baseline echocardiography should be considered in all patients before starting second- and third-generation BCR-ABL TKI. | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | I | C | Baseline echocardiography is recommended in patients scheduled to receive dasatinib. | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | IIa | C | Echocardiography should be considered every 3 months during the first year in high- and very high-risk patients receiving dasatinib or ponatinib. | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | IIb | C | Echocardiography may be considered every 6–12 months in patients who require long-term (.12 months) ponatinib or dasatinib. | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | IIb | C | Serial assessment of ankle brachial index may be considered to detect subclinical peripheral vascular disease. | Recommendation Table 11 — Recommendations for baseline risk assessment and monitoring during second- and third-generation breakpoint cluster region–Abelson oncogene locus tyrosine kinase inhibitors |
| p.39 | I | B | © ESC 2022 BP monitoring and management BP measurement is recommended for patients treated with BTK inhibitors at every clinical visit.264 | Recommendation Table 12 — Recommendations for baseline risk assessment and monitoring during Bruton tyrosine kinase inhibitor therapy |
| p.39 | IIa | C | Weekly home monitoring of BP during the first 3 months and every month thereafter should be considered for patients treated with BTK inhibitors. | Recommendation Table 12 — Recommendations for baseline risk assessment and monitoring during Bruton tyrosine kinase inhibitor therapy |
| p.39 | I | C | Echocardiography Baseline echocardiography is recommended in high-risk patientsc scheduled to receive BTK inhibitors.267,268 | Recommendation Table 12 — Recommendations for baseline risk assessment and monitoring during Bruton tyrosine kinase inhibitor therapy |
| p.39 | I | C | TTE is recommended in all patients who develop AF during BTK inhibitor therapy. | Recommendation Table 12 — Recommendations for baseline risk assessment and monitoring during Bruton tyrosine kinase inhibitor therapy |
| p.40 | I | C | AF Opportunistic screening for AF by pulse-taking or ECG rhythm strip is recommended at every clinical visit during BTK inhibitor therapy.273 | |
| p.43 | I | C | in high- and very high-risk patients.66,303 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | C | to PI in low- and moderate-risk patients.66 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | I | C | BP monitoring BP measurement is recommended for patients treated with PI at every clinical visit. | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | C | Home monitoring of BP weekly during the first 3 months and monthly thereafter should be considered for patients treated with PI. Cardiac serum biomarkers Measurement of NP is recommended prior to PI | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | B | Measurement of NP should be considered prior In patients receiving carfilzomib or bortezomib, measurement of NP should be considered at baseline and every cycle during the first 6 cycles.c,66 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | I | B | NP and cTn measurements are recommended at baseline and every 3–6 months in patients with AL-CA.d,290 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | I | C | TTE Baseline echocardiography, including assessment for AL-CA, is recommended in all patients with MM scheduled to receive PI. | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | B | Echocardiography surveillance every 3 cycles should be considered in high- and very high-risk patients receiving carfilzomib.280 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIb | C | Echocardiography surveillance every 3 cycles may be considered in low- and moderate-risk patients receiving carfilzomib. | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | C | Echocardiography surveillance should be considered every 3–6 months in patients with AL-CA treated with PI.d,290 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | I | B | VTE prophylaxis Therapeutic doses of LMWH are recommended in patients with MM with previous VTE.296,298,302,304,305 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | I | A | Prophylactic doses of LMWH are recommended in patients with MM with VTE-related risk factorse (excluding previous VTE) at least during the first 6 months of therapy.296,304,305 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIa | B | Aspirin should be considered as an alternative to LMWH in patients with MM with no risk factors or one VTE-related risk factore (excluding previous VTE) at least during the first 6 months of therapy.296,304–307 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.43 | IIb | C | in patients with MM with VTE-related risk factorse (excluding previous VTE) at least during the first 6 months of therapy.300–302 | Recommendation Table 13 — Recommendations for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.44 | I | C | In patients treated with cobimetinib/vemurafenib, an ECG is recommended at 2 and 4 weeks after initiation of treatment and every 3 months thereafter.c | Recommendation Table 14 — Recommendations for baseline risk assessment and monitoring during combined rapidly accelerated fibrosarcoma and mitogen-activated extracellular signal-regulated kinase inhibitor therapy |
| p.46 | I | B | high-risk patientsc before starting ICI therapy.333 | Recommendation Table 15 — Recommendations for baseline risk assessment and monitoring during immunotherapy |
| p.46 | I | B | ECG, NP, and cTn measurements are recommended in all patients before starting ICI therapy.333 Baseline echocardiography is recommended in | Recommendation Table 15 — Recommendations for baseline risk assessment and monitoring during immunotherapy |
| p.46 | IIb | C | Baseline echocardiography may be considered in all patients before starting ICI therapy. | Recommendation Table 15 — Recommendations for baseline risk assessment and monitoring during immunotherapy |
| p.46 | IIa | B | Serial ECG and cTn measurements should be considered before ICI doses 2, 3, and 4, and if normal, reduce to every three doses until completion of therapy to detect subclinical ICI-related CV toxicity.333 | |
| p.46 | I | C | CV assessmentd is recommended every 6–12 months in high-risk patientsc who require long-term (.12 months) ICI treatment.321– 323,335,336 | |
| p.46 | IIb | C | CV assessmentd may be considered every 6–12 months in all patients who require long-term (.12 months) ICI treatment. | |
| p.48 | I | B | Annual CV risk assessmentc is recommended during ADT.19,339,341,342 | Recommendation Table 16 — Recommendations for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.48 | I | B | Baseline CV risk assessmentc and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-OPd is recommended in patients treated with ADT without pre-existing CVD.19,341,342 | Recommendation Table 16 — Recommendations for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.48 | I | B | Baseline and serial ECGs are recommended in patients at risk of QTc prolongation during ADT therapy.e,339–342 | Recommendation Table 16 — Recommendations for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.48 | IIa | B | A GnRH antagonist should be considered in patients with pre-existing symptomatic CADf who require ADT.341,342 | Recommendation Table 16 — Recommendations for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.48 | I | C | Baseline CV risk assessmentc and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-OPd,e is recommended in BC patients receiving endocrine therapies without pre-existing CVD.19 | Recommendation Table 17 — Recommendations for baseline risk assessment and monitoring during endocrine therapy for breast cancer |
| p.48 | I | C | Annual CV risk assessmentc is recommended during endocrine therapy in BC patients with high 10-year risk of (fatal and non-fatal) CV events according to SCORE2/SCORE2-OP.d,e | Recommendation Table 17 — Recommendations for baseline risk assessment and monitoring during endocrine therapy for breast cancer |
| p.48 | IIa | C | CV risk assessmentc should be considered every 5 years in BC patients with low or moderate 10-year risk of (fatal and non-fatal) CV events according to SCORE2/SCORE2-OP.d,e | Recommendation Table 17 — Recommendations for baseline risk assessment and monitoring during endocrine therapy for breast cancer |
| p.49 | I | B | Baseline echocardiography is recommended in all patients with cancer before starting osimertinib.376 | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.49 | IIa | B | Echocardiography should be considered every 3 months in patients during osimertinib therapy.376 | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.49 | I | A | QTcc,d monitoring is recommended at baseline and 14 and 28 days in all patients with cancer receiving ribociclib.361,365,367,368 | Recommendation Table 18 — Recommendations for baseline risk assessment and monitoring during cyclindependent kinase 4/6 inhibitor therapy |
| p.49 | I | B | QTcc,d monitoring is recommended in patients treated with ribociclib with any dose increase.361,365,367,368 | Recommendation Table 18 — Recommendations for baseline risk assessment and monitoring during cyclindependent kinase 4/6 inhibitor therapy |
| p.49 | IIa | C | QTcc monitoring should be considered in patients treated with palbociclib or abemaciclib who have a baseline QTc above the normal rangec or other conditions that may prolong the QTc interval.e | Recommendation Table 18 — Recommendations for baseline risk assessment and monitoring during cyclindependent kinase 4/6 inhibitor therapy |
| p.49 | I | C | © ESC 2022 Baseline CV risk assessmentc is recommended in patients before ALK inhibitors and EGFR inhibitors. | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.49 | IIa | C | Home BP monitoring should be considered for patients treated with brigatinib, crizotinib, or lorlatinib. | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.49 | IIa | C | Cholesterol profile assessment every 3–6 months should be considered for patients on crizotinib and lorlatinib. | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.49 | IIa | C | ECG should be considered 4 weeks after starting therapy and every 3–6 months in patients during ALK inhibitor therapy. | Recommendation Table 19 — Recommendations for baseline risk assessment and monitoring during anaplastic lymphoma kinase and epidermal growth factor receptor inhibitors |
| p.51 | I | C | Baseline ECG, NP, and cTn are recommended in all patients with cancer before starting CAR-T and TIL therapies.388 | Recommendation Table 20 — Recommendations for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumourinfiltrating lymphocytes therapies |
| p.51 | I | C | A baseline echocardiography is recommended in patients with pre-existing CVD before starting CAR-T and TIL therapies.388 | Recommendation Table 20 — Recommendations for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumourinfiltrating lymphocytes therapies |
| p.51 | IIa | C | A baseline echocardiography should be considered before starting CAR-T and TIL therapies.388 | Recommendation Table 20 — Recommendations for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumourinfiltrating lymphocytes therapies |
| p.51 | I | C | Measurement of NP, cTn, and echocardiography are recommended in patients who develop CRS of ASTCT ≥2.c,378,388 | Recommendation Table 20 — Recommendations for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumourinfiltrating lymphocytes therapies |
| p.51 | I | B | Baseline CV risk assessmentc and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-OPd is recommended.19,389 | Recommendation Table 21 — Recommendations for baseline risk assessment of patients before radiotherapy to a volume including the heart |
| p.51 | IIa | C | Baseline echocardiography should be considered in patients with previous CVD before RT to a volume including the heart. | Recommendation Table 21 — Recommendations for baseline risk assessment of patients before radiotherapy to a volume including the heart |
| p.53 | IIa | C | Baseline NP measurement should be considered before HSCT.417,418 | Recommendation Table 22 — Recommendations for baseline risk assessment in haematopoietic stem cell transplantation patients |
| p.53 | I | C | Baseline and serial CV risk assessment (3 and 12 months, then yearly) including BP measurement, ECG, lipid measurement, and HbA1c is recommended in HSCT patients. | Recommendation Table 22 — Recommendations for baseline risk assessment in haematopoietic stem cell transplantation patients |
| p.53 | I | C | Echocardiography is recommended in all patients before HSCT. | Recommendation Table 22 — Recommendations for baseline risk assessment in haematopoietic stem cell transplantation patients |
| p.54 | I | C | A specialist CV assessmentc is recommended for optimal diagnostic workup and management of patients with cancer who present with new CV toxicity during and after cancer treatment.5 | Recommendation Table 23 — Recommendation for the management of cardiovascular disease and cancer therapy-related cardiovascular toxicity in patients receiving anticancer treatment |
| p.56 | I | B | HF therapy is recommended for patients who develop symptomatic CTRCD during anthracycline chemotherapy.c,208,425 | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | Discontinuation of anthracycline chemotherapy is recommended in patients who develop symptomatic severe CTRCD.c | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | Temporary interruption of anthracycline chemotherapy is recommended in patients who develop symptomatic moderate CTRCDc and a multidisciplinary approach regarding the decision to restart is recommended. | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | A multidisciplinary approach regarding interruption vs. continuation of anthracycline chemotherapy is recommended in patients who develop mild symptomatic CTRCD.c | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | CTRCD Temporary interruption of anthracycline chemotherapy and initiation of HF therapy is recommended in patients who develop asymptomatic moderate or severe CTRCD.c,22 | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | A multidisciplinary approach regarding the decision when to restart is recommended in all patients with moderate or severe asymptomatic CTRCD.c,22 | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | I | C | Continuation of anthracycline chemotherapy is recommended in asymptomatic patients who have LVEF ≥50% and who have developed a significant fall in GLSc or a troponin or a NP elevation . ULN. | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | IIa | B | Asymptomatic patients who have LVEF ≥50% and who have developed a significant fall in GLSc should be considered for ACE-I/ARB and/or beta-blockers.d,75,93,102 | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | IIb | C | Asymptomatic patients who have LVEF ≥50% and who have developed NP .ULN may be considered for ACE-I/ARB and/or beta-blockers.d,211 | |
| p.56 | IIb | C | further CV toxicity. | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.56 | IIb | C | Dexrazoxanef may be considered in patients with moderate or severe symptomatic or asymptomatic CTRCDc who require further anthracycline chemotherapy to reduce the risk of further CV toxicity. | Recommendation Table 24 — Recommendations for the management of cancer treatment-related cardiac dysfunction during anthracycline chemotherapy |
| p.58 | I | B | HF therapy is recommended for patients who develop symptomatic moderate-to-severe CTRCD with LVEF , 50%c during HER2-targeted treatment.14,61,430,431 Temporary interruption of HER2-targeted | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | treatment is recommended in patients who develop moderate or severe symptomatic CTRCDc and the decision to restart should be based on a multidisciplinary approach after improvement of LV function and symptoms resolved.d | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | In patients who develop mild symptomatic CTRCD,c HF therapy and a multidisciplinary approach regarding the decision to continue vs. interrupt HER2-targeted therapy are recommended.d,431,432 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | Temporary interruption of HER2-targeted therapy and initiation of HF therapy is recommended in patients who develop asymptomatic severe CTRCD.c | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | A multidisciplinary approach regarding the decision to restart HER2-targeted treatment is recommended in patients with severe asymptomatic CTRCD.c | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | IIa | B | Continuation of HER2-targeted therapy should be considered in patients who develop asymptomatic moderate (LVEF 40–49%) CTRCDc with more frequent cardiac monitoring.33,189,428,433 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | Continuation of HER2-targeted therapy is recommended in patients who develop asymptomatic mild (LVEF ≥50%) CTRCDc with more frequent cardiac monitoring.428 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | I | C | ACE-I/ARB and beta-blockers are recommended in patients who develop asymptomatic moderate (LVEF 40–49%) CTRCDc during HER2-targeted treatment.e,189 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | IIa | B | ACE-I/ARB and/or beta-blockers should be considered in asymptomatic patients receiving HER2-targeted therapies who have LVEF ≥50% but develop a significant fall in GLSc while continuing HER2-targeted therapy.e,22,428 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.58 | IIa | B | continuing HER2-targeted therapy.e,22,211,428 | Recommendation Table 25 — Recommendations for the management of cancer treatment-related cardiac dysfunction during human epidermal receptor 2-targeted therapies |
| p.61 | I | B | cTn, ECG, and CV imaging (echocardiography and CMR) are recommended to diagnose ICI-associated myocarditis.320,434,435,453 | Recommendation Table 26 — Recommendations for the diagnosis and management of immune checkpoint inhibitor-associated myocarditis |
| p.61 | I | C | In patients with suspected ICI-associated myocarditis, temporary interruption of ICI treatment is recommended until the diagnosis is confirmed or refuted. | Recommendation Table 26 — Recommendations for the diagnosis and management of immune checkpoint inhibitor-associated myocarditis |
| p.61 | IIa | C | EMB should be considered to confirm the diagnosis of ICI-associated myocarditis if the diagnosis is suspected but not confirmed after cardiac imaging and biomarkers.c | |
| p.61 | I | C | Interruption of ICI treatment is recommended in patients with confirmed ICI-associated myocarditis. | |
| p.61 | I | C | Continuous ECG monitoring to assess for new AV block and tachyarrhythmias during the acute phase is recommended for all patients with symptomatic ICI-associated myocarditis. | |
| p.61 | I | C | Early high-dose corticosteroidsd are recommended in patients with cancer and confirmed ICI-associated myocarditis.22,436,454 | |
| p.61 | I | C | Continuation of high-dose corticosteroids is recommended for the treatment of ICI-associated myocarditis until resolution of symptoms, LV systolic dysfunction, conduction abnormalities, and significant cTn reduction.e | |
| p.61 | IIa | C | Switching from i.v. to oral prednisolone should be considered after clinical improvement (resolution of: symptoms, LV systolic dysfunction, conduction abnormalities, and significant cTn reductione).f | |
| p.61 | IIa | C | Second-line immunosuppression treatment should be considered in patients with steroid-refractory ICI-associated myocarditis.g | |
| p.61 | I | C | Admission to ICU (level 3), treatment with i.v. methylprednisolone, and optimal CV treatment including mechanical support (when indicated) is recommended for patients with ICI-associated fulminant myocarditis.14 | |
| p.61 | IIa | C | A single dose of i.v. methylprednisoloned should be considered in unstableh patients with cancer where ICI-induced myocarditis is suspected. | |
| p.61 | I | C | A multidisciplinary discussion is recommended before restarting ICI treatment in selected patients with previous uncomplicated ICI-associated myocarditis. | |
| p.63 | III | C | during the acute TTS phase.c | Recommendation Table 27 — Recommendations for the diagnosis and management of Takotsubo syndrome in patients with cancer |
| p.63 | I | C | Coronary angiography (invasive or CCTA) is recommended to exclude ACS. CMR is recommended to exclude myocarditis and QT-prolonging drugs are not recommended | Recommendation Table 27 — Recommendations for the diagnosis and management of Takotsubo syndrome in patients with cancer |
| p.64 | I | B | An invasive strategy is recommended in patients with cancer presenting with STEMI or high-risk NSTE-ACS with life expectancy ≥6 months.475,479,483 | Recommendation Table 28 — Recommendations for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.64 | IIa | C | A conservative non-invasive strategy should be considered in patients with poor cancer prognosisc (with life expectancy ,6 months) and/ or very high bleeding risk presenting with STEMI or NSTE-ACS.479 | Recommendation Table 28 — Recommendations for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.64 | I | C | A temporary interruption of cancer therapy is recommended in patients where the cancer therapy is suspected as a contributing cause.d,10,490 | Recommendation Table 28 — Recommendations for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.64 | IIa | C | A short DAPT strategy should be considered in patients with cancer with very high bleeding risk treated with PCI for an ACS.e | Recommendation Table 28 — Recommendations for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.65 | III | C | ,10 000/μL. | Recommendation Table 29 — Recommendation for the management of chronic coronary syndromes in patients receiving anticancer treatment |
| p.65 | III | C | In patients with cancer, thrombocytopaenia, and ACS, clopidogrel is not recommended if platelets ,30 000/μL and prasugrel or ticagrelor are not recommended if platelets ,50 000/μL. | Recommendation Table 29 — Recommendation for the management of chronic coronary syndromes in patients receiving anticancer treatment |
| p.65 | IIb | C | Ticagrelor or prasugrel may be considered in patients with cancer with low bleeding risk and excessive thrombotic risk who are treated with PCI for ACS. | Recommendation Table 29 — Recommendation for the management of chronic coronary syndromes in patients receiving anticancer treatment |
| p.65 | I | C | Individualized duration of DAPT is recommended in patients with cancer with CCS, following revascularization, based upon thrombotic/ ischaemic and bleeding risk, type and stage of cancer, and current cancer treatment.100,498 © ESC 2022 | Recommendation Table 29 — Recommendation for the management of chronic coronary syndromes in patients receiving anticancer treatment |
| p.65 | I | C | In patients with cancer and pre-existing severe VHD, management according to the 2021 ESC/ EACTS Guidelines for the management of VHD is recommended, taking into consideration cancer prognosis and patient preferences.507 | Recommendation Table 30 — Recommendations for the management of valvular heart disease in patients receiving anticancer treatment |
| p.66 | I | C | In patients with cancer developing new VHD during cancer therapy, management according to the 2021 ESC/EACTS Guidelines for the management of VHD507 is recommended, taking into consideration cancer prognosis and patient comorbidities. | |
| p.69 | IIa | C | CHA2DS2-VASc score should be considered for risk stratification for stroke/systemic thromboembolism taking into account that it may underestimate the actual thromboembolic risk.519,526 | Recommendation Table 31 — Recommendations for the management of atrial fibrillation in patients receiving anticancer treatment |
| p.69 | I | C | Long-term anticoagulation is recommended for stroke/systemic thromboembolism prevention in patients with cancer with AF and a CHA2DS2-VASc score ≥2 (men) or ≥3 (women) as per the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation.273 | Recommendation Table 31 — Recommendations for the management of atrial fibrillation in patients receiving anticancer treatment |
| p.69 | IIa | C | Long-term anticoagulation should be considered for stroke/systemic thromboembolism prevention in patients with cancer with AF and a CHA2DS2-VASc score = 1 (men) or = 2 (women) as per the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation.273 | |
| p.69 | IIb | C | Patients with cancer,c AF, and CHA2DS2-VASc score 0 (men) or 1 (women) may have a higher thrombotic risk than patients without cancer and may be considered for therapeutic anticoagulation after consideration of the bleeding risk.526 | |
| p.69 | I | C | Thromboembolic and bleeding risk reassessment is recommended during follow-up in patients with cancer with AF.d,273 | |
| p.69 | IIa | B | NOAC should be considered for stroke prevention in preference to LMWH and VKA (excluding patients with mechanical heart valves or moderate-to-severe mitral stenosis) in patients without a high bleeding risk, significant drug–drug interactions, or severe renal dysfunction.531–537 | |
| p.69 | IIa | C | LMWH should be considered in patients with active cancere and AF who are not suitable for NOACf.525 | |
| p.69 | IIb | C | LAA occlusion may be considered for stroke prevention in patients with cancer with AF and contraindications for long-term anticoagulation with a life expectancy .12 months.273,539 | |
| p.69 | III | C | Antiplatelet therapy or prophylactic LMWH are not recommended for stroke or systemic thromboembolism prevention in AF with cancer.273 | |
| p.69 | IIa | C | Heart rate control strategy, preferably with beta-blockers, should be considered in patients who develop well-tolerated AF while they are receiving active cancer treatmentg. | |
| p.72 | I | C | Discontinuation of QTc-prolonging cancer therapy is recommended in patients who develop TdP or sustained ventricular tachyarrhythmias during treatment.549 | Recommendation Table 32 — Recommendations for the management of long corrected QT interval and ventricular arrhythmias in patients receiving anticancer treatment |
| p.72 | I | C | Temporary interruption of QTc-prolonging cancer therapy is recommended in patients who develop asymptomatic QTcF ≥500 ms and an ECG should be repeated every 24 h until resolution of the QTcF prolongation.549 | Recommendation Table 32 — Recommendations for the management of long corrected QT interval and ventricular arrhythmias in patients receiving anticancer treatment |
| p.72 | I | C | Immediate withdrawal of any offending drug and correction of electrolyte abnormalities and other risk factorsc is recommended in patients with cancer who develop QTcF ≥500 ms.349,442,546 | Recommendation Table 32 — Recommendations for the management of long corrected QT interval and ventricular arrhythmias in patients receiving anticancer treatment |
| p.72 | I | C | Weekly ECG monitoring is recommended in asymptomatic patients with cancer with QTcF 480–500 ms who are treated with a QTc-prolonging cancer therapy.349,442,546 | Recommendation Table 32 — Recommendations for the management of long corrected QT interval and ventricular arrhythmias in patients receiving anticancer treatment |
| p.72 | I | C | A 12-lead ECG is recommended after any dose increase of QTc-prolonging cancer therapy.270,442,544 | Recommendation Table 32 — Recommendations for the management of long corrected QT interval and ventricular arrhythmias in patients receiving anticancer treatment |
| p.72 | I | C | Restarting QTc-prolonging cancer therapy A multidisciplinary discussion is recommended before restarting QTc-prolonging drugs in patients who have developed significant QTcF prolongation, to discuss alternative cancer treatments.4,22,259,349,442,546 | |
| p.72 | IIb | C | In patients who experienced significant QTcF prolongation, restarting the culprit QTc-prolonging cancer treatment may be considered, ideally at a reduced dose according to each drug recommendation.45,259,349,442,546,549 | |
| p.72 | I | C | Weekly ECG monitoring during the first 4–6 weeks and then monthly thereafter is recommended in patients with cancer after restarting QTc-prolonging cancer therapy.549 | |
| p.74 | I | C | General Effective treatment of cancer therapy-induced arterial hypertension to prevent cancer treatment interruption and CV complications is | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | I | C | recommended. A BP target ,140 mmHg systolic and ,90 mmHg diastolic is recommended during cancer therapy. | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | IIb | C | A BP target ,130 mmHg systolic and ,80 mmHg diastolic may be considered during cancer therapy provided that the treatment is well tolerated. | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | IIb | C | In selected asymptomatic patients with metastatic cancer, a systolic BP 140–160 mmHg and diastolic BP 90–100 mmHg treatment threshold may be considered provided there is ongoing BP monitoring. The competing cancer and CV risk evaluation is | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | I | C | recommended if the systolic BP is ≥180 mmHg or diastolic BP ≥110 mmHg, and any cancer therapy associated with hypertension should be deferred or temporarily withheld until the BP is controlled to values ,160 mmHg (systolic) and ,100 mmHg (diastolic). | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | I | B | ACE-I or ARB are the first-line antihypertensive drugsc recommended for BP management in patients with cancer.555–557 | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | I | C | Dihydropyridine CCB are recommended as second-line antihypertensive drugs for patients with cancer with uncontrolled BP. | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | I | C | Combination therapy with ACE-I or ARB and dihydropyridine CCB is recommended in patients with cancer with systolic BP ≥160 mmHg and diastolic BP ≥100 mmHg. | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.74 | III | C | Diltiazem and verapamil are not recommended to treat arterial hypertension in patients with cancer due to their drug–drug interactions.d | Recommendation Table 33 — Recommendations for the management of arterial hypertension in patients receiving anticancer treatment |
| p.77 | I | A | Apixaban, edoxaban, or rivaroxabanc are recommended for the treatment of symptomatic or incidental VTE in patients with cancer without contraindications.d,578–581,584,585 | Recommendation Table 34 — Recommendations for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.77 | I | A | LMWH are recommended for the treatment of symptomatic or incidental VTE in patients with cancer with platelet count .50 000/μL.298,299,578– 581,584,585 | Recommendation Table 34 — Recommendations for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.77 | IIb | C | In patients with cancer with platelet counts of 25 000–50 000/μL, anticoagulation with half-dose LMWH may be considered after a multidisciplinary discussion.591 | Recommendation Table 34 — Recommendations for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.77 | IIa | A | Prolongation of anticoagulation therapy beyond 6 months should be considered in selected patients with active cancere including metastatic disease.589,590 | Recommendation Table 34 — Recommendations for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.77 | I | C | Catheter-associated VTE Duration of anticoagulation in patients with cancer with a catheter-associated VTE is recommended for a minimum of 3 months and continuing longer if the catheter remains in situ. | Recommendation Table 34 — Recommendations for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.78 | I | B | Extended prophylaxis with LMWH for 4 weeks post-operatively is recommended for patients with cancer undergoing major open or laparoscopic abdominal or pelvic surgery with low bleeding risk and high VTE risk.c,298,299,595 | Recommendation Table 35 — Recommendations for venous thromboembolism prophylaxis during anticancer treatment |
| p.78 | I | B | Prophylactic LMWH for the primary prevention of VTE is indicated in hospitalized patients with cancer or those with prolonged bedrest or reduced mobility in the absence of bleeding or other contraindications.298,299,592,594 | Recommendation Table 35 — Recommendations for venous thromboembolism prophylaxis during anticancer treatment |
| p.78 | IIb | B | For ambulatory patients with cancer at high risk of thrombosis receiving systemic therapy,d primary thromboprophylaxis with a NOAC (apixaban or rivaroxaban) or LMWH may be considered, provided there are no significant contraindications.e,298,593,594,601,602 | Recommendation Table 35 — Recommendations for venous thromboembolism prophylaxis during anticancer treatment |
| p.78 | I | C | A discussion with the patient about the relative benefits and harms, cancer prognosis, drug cost, and duration of treatment is recommended prior to prophylactic anticoagulation for the primary prevention of VTE. | Recommendation Table 35 — Recommendations for venous thromboembolism prophylaxis during anticancer treatment |
| p.79 | I | C | In patients who develop new symptomatic PAD, a multidisciplinary approach regarding the decision to continue vs. interrupt culprit cancer therapyc is recommended. | Recommendation Table 36 — Recommendation for management of peripheral artery disease during anticancer treatment |
| p.80 | I | C | Right-heart catheterization and discontinuation of dasatinib is recommended in patients who develop symptomatic or asymptomatic increase in peak TRV .3.4 m/s. | Recommendation Table 37 — Recommendations for the management of pulmonary hypertension during anticancer treatment |
| p.80 | IIa | C | Dasatinib dose reduction and close monitoring of peak TRV with echocardiography should be considered in patients who develop new asymptomatic peak TRV ranging from 2.9 to 3.4 m/s. | Recommendation Table 37 — Recommendations for the management of pulmonary hypertension during anticancer treatment |
| p.80 | I | C | In patients with confirmed dasatinib-induced PAHc or new asymptomatic peak TRV .3.4 m/s, an alternative BCR-ABL inhibitor is recommended after peak TRV recovery to ,2.8 m/s. | Recommendation Table 37 — Recommendations for the management of pulmonary hypertension during anticancer treatment |
| p.81 | I | C | General Diagnosis and management of acute pericarditis in patients with cancer based on the 2015 ESC Guidelines for the diagnosis and management of pericardial diseases is recommended and a multidisciplinary discussion is needed before | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | IIa | C | interrupting cancer therapy.444 A surgical pericardial window should be considered if the percutaneous approach is not feasible or in cases of recurrent malignant pericardial effusions. | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | IIb | C | Intrapericardial instillation of cytostatic or sclerosing agents may be considered for prevention of recurrence. | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | I | C | Multimodality CV imaging (echocardiography, CMR + CT), ECG and measurement of cardiac biomarkers are recommended to confirm the diagnosis, assess the haemodynamic consequences of pericardial disease, and rule out | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | I | C | associated myocarditis. Prednisolone and colchicine are recommended for patients with ICI-associated pericarditis.326,624,625,630 | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | I | C | Interruption of ICI treatment in patients with confirmed ICI-associated pericarditis with moderate-to-severe pericardial effusion is | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.81 | I | C | recommended. A multidisciplinary discussion is recommended before restarting ICI treatment. | Recommendation Table 38 — Recommendations for the management of pericardial diseases in patients receiving anticancer treatment |
| p.84 | IIa | B | considered in CS with high CV risk.638–640 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | Educating and supporting patients with cancer to make appropriate healthy lifestyle choices is recommended.c | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | Education is recommended for patients with cancer regarding recognition for early signs and symptoms of CVD. | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | B | CVRF assessment is recommended during the first year after cancer therapyc,12,22,31,632,643 and thereafter according to the 2021 ESC Guidelines on CVD prevention in clinical practice.19 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | B | In asymptomatic high-risk patients,d echocardiography and cardiac serum biomarkers are recommended at 3 and 12 months after completion of cancer therapy.53,54,59,61,68,148,208,425 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | IIa | B | In asymptomatic moderate-risk patients,e echocardiography and cardiac serum biomarkers should be considered within 12 months after completion of cancer therapy.53,54,59,61,68,148,208 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | IIb | C | In asymptomatic low-risk patients,e echocardiography and cardiac serum biomarkers may be considered within 12 months after completion of cancer therapy.634 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | Cardiology referralf is recommended in patients with cancer with new cardiac symptoms or new asymptomatic abnormalities in echocardiography and/or cardiac serum biomarkers at the end of therapy assessment.11 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | IIb | C | In selected patients with exercise intolerance persisting at 12 months after cancer treatment and with normal resting echocardiogram and cardiac biomarkers, exercise stress echocardiography and/or CPET may be considered. | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | Targeted cardiac rehabilitation should be Long-term continuation of cardiac medication is recommended in patients who develop severe CTRCD during cancer therapy. | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | CV follow-up and treatment optimization is recommended in patients who developed TKI-mediated hypertension during cancer therapy.644,645 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.84 | I | C | therapy.646 | Recommendation Table 39 — Recommendations for end-of-cancer therapy cardiovascular risk assessment |
| p.85 | I | B | Education of adults who are childhood and adolescent CS treated with anthracyclines, mitoxantrone, and/or RT to a volume including the heart and their healthcare providers regarding their increased CV risk is recommended.655–657 | Recommendation Table 40 — Recommendations for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.85 | I | C | Annual screening for modifiable CVRFc is recommended in adults who are childhood and adolescent CS treated with anthracyclines, mitoxantrone, and/or RT to a volume including the heart. | Recommendation Table 40 — Recommendations for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.85 | I | C | CV assessmentd is recommended in female childhood and adolescent CS prior to pregnancy or in the first trimester. | Recommendation Table 40 — Recommendations for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.85 | IIa | B | Echocardiography surveillance should be considered every 2 years in adults who are high-risk childhood and adolescente CS.7 | Recommendation Table 40 — Recommendations for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.85 | IIa | B | Echocardiography surveillance should be considered every 5 years in adults who are moderate-risk childhood and adolescente CS.7,654 | Recommendation Table 40 — Recommendations for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.86 | IIb | C | years in asymptomatic moderate-risk adult CS.f | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | I | B | © ESC 2022 Annual CV risk assessment,c including ECG and NP, and CVRF management is recommended in CS who were treated with a potentially cardiotoxic cancer drug or RT.d,631–633,671,672 | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | I | C | CV toxicity risk restratificatione is recommended 5 years after therapy to organize long-term follow-up. | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | IIa | C | Echocardiography at years 1, 3, and 5 after completion of cardiotoxic cancer therapy and every 5 years thereafter should be considered in asymptomatic very high- and early high-risk adult CS.f | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | IIa | C | Echocardiography should be considered in asymptomatic late high-risk adult CSf starting at 5 years after radiation to a volume including the heart and then every 5 years. Echocardiography may be considered every 5 | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | IIa | C | Non-invasive screening for CADg should be considered every 5–10 years in asymptomatic patients who received .15 Gy MHD,d starting at 5 years after radiation. | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.86 | IIa | C | Carotid ultrasound imaging should be considered every 5 years in asymptomatic patients with a history of head/neck RT, starting at 5 years after radiation and every 5–10 years thereafter. | Recommendation Table 41 — Recommendations for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.87 | IIa | C | Renal artery ultrasound should be considered in patients with a history of abdominal and pelvic radiation who present with worsening renal function and/or systemic hypertension. | |
| p.88 | I | C | ACE-I/ARB and/or beta-blockers are recommended in adult CS with moderate asymptomatic CTRCD.c,208,425,675–678 | Recommendation Table 42 — Recommendations for adult cancer survivors who develop cancer therapy-related cardiac dysfunction late after cardiotoxic cancer therapy |
| p.88 | IIb | C | ACE-I/ARB and/or beta-blockers may be considered in adult CS with mild asymptomatic CTRCD.d | Recommendation Table 42 — Recommendations for adult cancer survivors who develop cancer therapy-related cardiac dysfunction late after cardiotoxic cancer therapy |
| p.88 | I | C | Non-invasive stress testingc is recommended in asymptomatic CS with new moderate or severe radiation-induced CAD detected on CCTA to guide ischaemia-directed management.635,688 | Recommendation Table 43 — Recommendations for adult cancer survivors with coronary artery disease |
| p.88 | I | C | A MDT discussion is recommended for clinical decision-making in patients with radiation-induced CAD and inducible ischaemia or severe left main CAD. | Recommendation Table 43 — Recommendations for adult cancer survivors with coronary artery disease |
| p.88 | I | C | Symptomatic CAD Pre-operative assessment of LIMA and RIMA viability, venous access, and sternal wound healing is recommended in CS with radiation-induced CAD where CABG is considered. | Recommendation Table 43 — Recommendations for adult cancer survivors with coronary artery disease |
| p.89 | IIb | B | PCI may be considered in CS with radiation-induced CAD with severe left main or three-vessel disease with a high SYNTAX score (.22) in whom the procedure is technically feasible.682,689,690 | |
| p.89 | I | C | A MDT approach is recommended to discuss and define the surgical riskc in CS with severe VHD. | Recommendation Table 44 — Recommendations for adult cancer survivors with valvular heart disease |
| p.89 | IIa | B | TAVI should be considered for patients with symptomatic severe aortic stenosis caused by © ESC 2022 radiation at intermediate surgical risk.504,506,693,694,696,697 | |
| p.90 | IIb | C | Patients with acute pericarditis during RT to a volume including the heart are at higher risk of developing chronic constrictive pericarditis, hence echocardiography surveillance every 5 years may be considered. RT, radiotherapy. aClass of recommendation. bLevel of evidence. | Recommendation Table 45 — Recommendation for adult cancer survivors with pericardial complications |
| p.91 | I | C | In high-risk female CS, pre-pregnancy counselling and management during pregnancy and around delivery by a multidisciplinary pregnancy heart team is recommended. | Recommendation Table 46 — Recommendations for cardiovascular monitoring in cancer survivors during pregnancy |
| p.91 | I | C | A baseline CV evaluation including history, physical examination, ECG, NP, and echocardiography is recommended in female CS with a history of CTRCD who are considering pregnancy. | Recommendation Table 46 — Recommendations for cardiovascular monitoring in cancer survivors during pregnancy |
| p.91 | IIa | C | A baseline CV evaluation including history, physical examination, ECG, and echocardiography should be considered in all female CS who received potentially cardiotoxic cancer therapy and are considering pregnancy. | Recommendation Table 46 — Recommendations for cardiovascular monitoring in cancer survivors during pregnancy |
| p.91 | I | C | A CV evaluation including echocardiography is recommended at 12 weeks of pregnancy in female CS who are either high-risk or who received potentially cardiotoxic cancer therapy and did not have a baseline CV assessment. | Recommendation Table 46 — Recommendations for cardiovascular monitoring in cancer survivors during pregnancy |
| p.91 | IIa | C | A second CV evaluation including echocardiography should be considered at 20 weeks of pregnancy in high-risk female CSc who received potentially cardiotoxic cancer therapy. | Recommendation Table 46 — Recommendations for cardiovascular monitoring in cancer survivors during pregnancy |
| p.95 | I | C | Management by an expert MDT (the pregnancy heart team) in an expert centre is recommended for pregnant women with cancer who require cardiotoxic cancer therapy.741 | Recommendation Table 47 — Recommendations for cardiovascular assessment and monitoring of pregnant women with cancer |
| p.95 | I | C | Cardiac assessment prior to cardiotoxic cancer therapy in pregnant women is recommended and consists of clinical history, physical examination, ECG, and echocardiography.741 | Recommendation Table 47 — Recommendations for cardiovascular assessment and monitoring of pregnant women with cancer |
| p.95 | IIa | C | Monthly or bimonthly CV evaluation, including TTE, should be considered during cardiotoxic cancer therapyc in pregnant women with cancer. | Recommendation Table 47 — Recommendations for cardiovascular assessment and monitoring of pregnant women with cancer |
| p.95 | IIb | C | cTn may be considered at baseline and during anthracycline chemotherapy in pregnant women with cancer. | Recommendation Table 47 — Recommendations for cardiovascular assessment and monitoring of pregnant women with cancer |
| p.95 | I | B | Echocardiographyc is recommended for the detection of carcinoid cardiac involvement in all patients with carcinoid syndrome and elevated NP levels and/or clinical signs of carcinoid heart disease, and for surveillance every 3 or 6 months depending on the severity of cardiac involvement | Recommendation Table 48 — Recommendations for carcinoid valvular heart diseases |
| p.95 | IIa | B | and clinical status.772,790,791 NP should be considered for screening and surveillance of carcinoid heart disease every 6 months.777–780 | Recommendation Table 48 — Recommendations for carcinoid valvular heart diseases |
| p.95 | I | C | A MDT discussion for optimal medial management to prevent carcinoid crisis is recommended before any invasive or surgical cardiac procedure. | Recommendation Table 48 — Recommendations for carcinoid valvular heart diseases |
| p.95 | I | C | Valve replacement surgery is recommended in symptomatic patients with severe carcinoid tricuspid or pulmonary VHD and an expected survival ≥12 months.d,783,785 | Recommendation Table 48 — Recommendations for carcinoid valvular heart diseases |
| p.95 | IIa | C | Valve replacement surgery should be considered in patients with asymptomatic severe carcinoid tricuspid or pulmonary VHD, progressive RV dysfunction/dilatation, and an expected survival ≥12 months.d,772 | Recommendation Table 48 — Recommendations for carcinoid valvular heart diseases |
| p.96 | I | C | Valve replacement or repair surgery is recommended in symptomatic patients with severe carcinoid mitral or aortic VHD and an expected survival ≥12 months.783,785 | |
| p.98 | I | A | AL-CA.290,803,804 | Recommendation Table 49 — Recommendations for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |
| p.98 | I | B | Echocardiography, NP, and cTn are recommended for the diagnosis of AL-CA in patients with plasma cell dyscrasia.290,820–822 CMR is recommended in patients with suspected | Recommendation Table 49 — Recommendations for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |
| p.98 | IIa | C | EMB should be considered in patients with suspected AL-CA involvement if CMR is not diagnostic.290 | Recommendation Table 49 — Recommendations for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |
| p.98 | IIa | C | Admission with inpatient ECG monitoring should be considered for high-risk patients with AL-CA requiring PI during their first cycle of therapy.c,808,811 | Recommendation Table 49 — Recommendations for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |
| p.102 | I | C | Risk stratification including planned radiation type and energy, dose to CIED, the patient’s device type, and pacing dependence is recommended prior to starting treatment.824,825,827,828 | Recommendation Table 50 — Recommendations for riskstratificationandmonitoringforpatientswithcardiac implantable electronic devices undergoing radiotherapy |
| p.102 | I | C | In patients undergoing RT, a CIED check is recommended in all patients before and after completing RT, and during RT according to individual risk.824,826 | Recommendation Table 50 — Recommendations for riskstratificationandmonitoringforpatientswithcardiac implantable electronic devices undergoing radiotherapy |
| p.102 | I | C | In patients with a CIED undergoing RT at high risk of arrhythmia and/or device dysfunction, ECG monitoring and/or pulse oximetry are recommended during every RT session.827,829,831 | Recommendation Table 50 — Recommendations for riskstratificationandmonitoringforpatientswithcardiac implantable electronic devices undergoing radiotherapy |
| p.105 | I | C | Cardiology referral is recommended in high-risk and very high-risk patients before anticancer therapy. | Recommendation Table 1 for a general approach to cardiovascular toxicity risk categorization |
| p.106 | I | C | An ECG is recommended in all patients starting cancer therapy as part of their baseline CV risk assessment. | Recommendation Table 2 for electrocardiogram baseline assessment |
| p.106 | I | C | In patients with an abnormal baseline ECG, referral to a cardiologist is recommended. | Recommendation Table 2 for electrocardiogram baseline assessment |
| p.106 | I | C | Echocardiography is recommended as the first-line modality for the assessment of cardiac function in patients with cancer. | Recommendation Table 4 for cardiac imaging modalities in patients with cancer |
| p.106 | I | B | 3D echocardiography is recommended as the preferred echocardiographic modality to measure LVEF. | Recommendation Table 4 for cardiac imaging modalities in patients with cancer |
| p.106 | I | C | GLS is recommended in all patients with cancer having echocardiography, if available. | Recommendation Table 4 for cardiac imaging modalities in patients with cancer |
| p.106 | I | C | Management of CVD according to applicable ESC Guidelines is recommended before, during, and after cancer therapy. | Recommendation Table 6 for secondary prevention of cancer therapy-related cardiovascular toxicity |
| p.106 | I | B | Baseline echocardiography is recommended in all patients with cancer before anthracycline chemotherapy. | Recommendation Table 7 for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months |
| p.106 | I | B | In all adults receiving anthracycline chemotherapy, an echocardiogram is recommended within 12 months after completing treatment. | Recommendation Table 7 for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months |
| p.106 | I | B | Baseline measurement of NP and cTn is recommended in high- and very high-risk patients prior to anthracycline chemotherapy. | Recommendation Table 7 for baseline risk assessment and monitoring during anthracycline chemotherapy and in the first 12 months |
| p.106 | I | B | Baseline echocardiography is recommended before HER2-targeted therapies in all patients. | Recommendation Table 8 for baseline risk assessment and monitoring during HER2-targeted therapies and in the first 12 months |
| p.106 | I | B | In patients receiving neoadjuvant or adjuvant HER2-targeted therapies, echocardiography is recommended every 3 months and within 12 months after completing treatment. | Recommendation Table 8 for baseline risk assessment and monitoring during HER2-targeted therapies and in the first 12 months |
| p.106 | I | C | Baseline NP and cTn measurement are recommended in high- and very high-risk patients prior to anti-HER2-targeted therapies. | Recommendation Table 8 for baseline risk assessment and monitoring during HER2-targeted therapies and in the first 12 months |
| p.107 | I | C | A baseline echocardiogram is recommended in patients with a history of symptomatic CVD before starting fluoropyrimidines. | Recommendation Table 9 for baseline risk assessment and monitoring during fluoropyrimidine therapy |
| p.107 | I | C | BP measurement is recommended for patients treated with VEGFi, bevacizumab, or ramucirumab at every clinical visit. | Recommendation Table 10 for baseline risk assessment and monitoring during VEGFi |
| p.107 | I | C | 3 months and every 3–6 months thereafter. | Recommendation Table 10 for baseline risk assessment and monitoring during VEGFi |
| p.107 | I | C | Baseline echocardiography is recommended in high- and very high-risk patients treated with VEGFi or bevacizumab. | Recommendation Table 10 for baseline risk assessment and monitoring during VEGFi |
| p.107 | I | C | Baseline CV risk assessment is recommended in patients who require second- or third-generation BCR-ABL TKI. | Recommendation Table 11 for baseline risk assessment and monitoring during second- and third-generation BCR-ABL tyrosine kinase inhibitors |
| p.107 | I | C | Baseline echocardiography is recommended in patients scheduled to receive dasatinib. | Recommendation Table 11 for baseline risk assessment and monitoring during second- and third-generation BCR-ABL tyrosine kinase inhibitors |
| p.107 | I | B | BP measurement is recommended for patients treated with BTK inhibitors at every clinical visit. | Recommendation Table 12 for baseline risk assessment and monitoring Bruton tyrosine kinase inhibitor therapy |
| p.107 | I | C | Baseline echocardiography is recommended in high-risk patients scheduled to receive BTK inhibitors. | Recommendation Table 12 for baseline risk assessment and monitoring Bruton tyrosine kinase inhibitor therapy |
| p.107 | I | C | TTE is recommended in all patients who develop AF during BTK inhibitor therapy. | Recommendation Table 12 for baseline risk assessment and monitoring Bruton tyrosine kinase inhibitor therapy |
| p.107 | I | C | Opportunistic screening for AF by pulse-taking or ECG rhythm strip is recommended at every clinical visit during BTK inhibitor therapy. | Recommendation Table 12 for baseline risk assessment and monitoring Bruton tyrosine kinase inhibitor therapy |
| p.107 | I | C | BP measurement is recommended for patients treated with PI at every clinical visit. | Recommendation Table 13 for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.107 | I | C | Measurement of NP is recommended prior to PI in high- and very high-risk patients. | Recommendation Table 13 for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.107 | I | B | NP and cTn measurements are recommended at baseline and every 3–6 months in patients with AL-CA. | Recommendation Table 13 for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.107 | I | C | Baseline echocardiography, including assessment for AL-CA, is recommended in all patients with MM scheduled to receive PI. | Recommendation Table 13 for baseline risk assessment and monitoring during multiple myeloma therapies |
| p.108 | I | B | Therapeutic doses of LMWH are recommended in patients with MM with previous VTE. | |
| p.108 | I | B | ECG, NP, and cTn measurements are recommended in all patients before starting ICI therapy. | Recommendation Table 15 for baseline risk assessment and monitoring during immunotherapy |
| p.108 | I | B | Baseline echocardiography is recommended in high-risk patients before starting ICI therapy. | Recommendation Table 15 for baseline risk assessment and monitoring during immunotherapy |
| p.108 | I | C | CV assessment is recommended every 6–12 months in high-risk patients who require long-term (.12 months) ICI treatment. | Recommendation Table 15 for baseline risk assessment and monitoring during immunotherapy |
| p.108 | I | B | Baseline and serial ECGs are recommended in patients at risk of QTc prolongation during ADT therapy. | Recommendation Table 16 for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.108 | I | B | Annual CV risk assessment is recommended during ADT. | Recommendation Table 16 for baseline risk assessment and monitoring during androgen deprivation therapy for prostate cancer |
| p.108 | I | A | QTc monitoring is recommended at baseline and 14 and 28 days in all patients with cancer receiving ribociclib. | Recommendation Table 18 for baseline risk assessment and monitoring during cyclin-dependent kinase 4/6 inhibitor therapy |
| p.108 | I | B | QTc monitoring is recommended in patients treated with ribociclib with any dose increase. | Recommendation Table 18 for baseline risk assessment and monitoring during cyclin-dependent kinase 4/6 inhibitor therapy |
| p.108 | I | C | Baseline CV risk assessment is recommended in patients before ALK inhibitors and EGFR inhibitors. | Recommendation Table 19 for baseline risk assessment and monitoring during ALK and EGFR inhibitors |
| p.108 | I | B | Baseline echocardiography is recommended in all patients with cancer before starting osimertinib. | Recommendation Table 19 for baseline risk assessment and monitoring during ALK and EGFR inhibitors |
| p.108 | I | C | Baseline ECG, NP, and cTn are recommended in all patients with cancer before starting CAR-T and TIL therapies. | Recommendation Table 20 for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumour-infiltrating lymphocytes therapies |
| p.108 | I | C | A baseline echocardiography is recommended in patients with pre-existing CVD before starting CAR-T and TIL therapies. | Recommendation Table 20 for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumour-infiltrating lymphocytes therapies |
| p.108 | I | C | Measurement of NP, cTn, and echocardiography are recommended in patients who develop CRS of ASTCT ≥2. | Recommendation Table 20 for baseline risk assessment and monitoring in patients receiving chimeric antigen receptor T cell and tumour-infiltrating lymphocytes therapies |
| p.109 | I | B | Baseline CV risk assessment and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-OP is recommended. | Recommendation Table 21 for baseline risk assessment of patients before radiotherapy to a volume including the heart |
| p.109 | I | C | Echocardiography is recommended in all patients before HSCT. | Recommendation Table 22 for baseline risk assessment in haematopoietic stem cell transplantation patients |
| p.109 | I | B | HF therapy is recommended for patients who develop symptomatic CTRCD during anthracycline chemotherapy. | Recommendation Table 24 for the management of cancer treatment-related cardiac dysfunction during anthracycline |
| p.109 | I | C | Discontinuation of anthracycline chemotherapy is recommended in patients who develop symptomatic severe CTRCD. | Recommendation Table 24 for the management of cancer treatment-related cardiac dysfunction during anthracycline |
| p.109 | I | B | cTn, ECG, and CV imaging (echocardiography and CMR) are recommended to diagnose ICI-associated myocarditis. | Recommendation Table 26 for the diagnosis and management of immune checkpoint inhibitor-associated myocarditis |
| p.110 | I | C | Interruption of ICI treatment is recommended in patients with confirmed ICI-associated myocarditis. | |
| p.110 | I | C | Early high-dose corticosteroids are recommended in patients with cancer and confirmed ICI-associated myocarditis. | |
| p.110 | I | C | Coronary angiography (invasive or CCTA) is recommended to exclude ACS. | Recommendation Table 27 for the diagnosis and management of Takotsubo syndrome in patients with cancer |
| p.110 | I | B | CMR is recommended to exclude myocarditis and MI. | Recommendation Table 27 for the diagnosis and management of Takotsubo syndrome in patients with cancer |
| p.110 | III | C | QT-prolonging drugs are not recommended during the acute TTS phase. | Recommendation Table 27 for the diagnosis and management of Takotsubo syndrome in patients with cancer |
| p.110 | I | C | A temporary interruption of cancer therapy is recommended in patients where the cancer therapy is suspected as a contributing cause. | Recommendation Table 28 for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.110 | III | C | In patients with cancer, thrombocytopaenia and ACS, aspirin is not recommended if platelets ,10 000/μL. | Recommendation Table 28 for the management of acute coronary syndromes in patients receiving anticancer treatment |
| p.110 | I | C | Thromboembolic and bleeding risk reassessment is recommended during follow-up in patients with cancer with AF. | Recommendation Table 31 for the management of atrial fibrillation in patients receiving anticancer treatment |
| p.111 | I | C | A 12-lead ECG is recommended after any dose increase of QTc-prolonging cancer therapy. | |
| p.111 | I | C | A BP target ,140 mmHg systolic and ,90 mmHg diastolic is recommended during cancer therapy. | Recommendation Table 33 for the management of arterial hypertension in patients receiving anticancer treatment |
| p.111 | I | B | ACE-I or ARB are the first-line antihypertensive drugs recommended for BP management in patients with cancer. | Recommendation Table 33 for the management of arterial hypertension in patients receiving anticancer treatment |
| p.111 | I | C | Dihydropyridine CCB are recommended as second-line antihypertensive drugs for patients with cancer with uncontrolled BP. | Recommendation Table 33 for the management of arterial hypertension in patients receiving anticancer treatment |
| p.111 | I | A | LMWH are recommended for the treatment of symptomatic or incidental VTE in patients with cancer with platelet count .50 000/μL. | Recommendation Table 34 for the management of venous thromboembolism in patients receiving anticancer treatment |
| p.112 | I | C | Prednisolone and colchicine are recommended for patients with ICI-associated pericarditis. | |
| p.112 | I | C | A multidisciplinary discussion is recommended before restarting ICI treatment. | |
| p.112 | I | C | Educating and supporting patients with cancer to make appropriate healthy lifestyle choices is recommended. | Recommendation Table 39 for end-of-cancer therapy cardiovascular risk assessment |
| p.112 | I | C | Education is recommended for patients with cancer regarding recognition for early signs and symptoms of CVD. | Recommendation Table 39 for end-of-cancer therapy cardiovascular risk assessment |
| p.112 | I | C | Long-term continuation of cardiac medication is recommended in patients who develop severe CTRCD during cancer therapy. | Recommendation Table 39 for end-of-cancer therapy cardiovascular risk assessment |
| p.112 | I | C | CV follow-up and treatment optimization is recommended in patients who developed vascular toxicities during cancer therapy. | Recommendation Table 39 for end-of-cancer therapy cardiovascular risk assessment |
| p.112 | I | C | ECG follow-up is recommended in patients who developed QT lengthening or LQTS during cancer therapy. | Recommendation Table 39 for end-of-cancer therapy cardiovascular risk assessment |
| p.112 | I | C | CV assessment is recommended in female childhood and adolescent CS prior to pregnancy or in the first trimester. | Recommendation Table 40 for cardiovascular surveillance in asymptomatic adults who are childhood and adolescent cancer survivors |
| p.112 | I | C | CV toxicity risk restratification is recommended 5 years after therapy to organize long-term follow-up. | Recommendation Table 41 for cardiovascular surveillance in asymptomatic adult cancer survivors |
| p.112 | I | C | ACE-I/ARB and/or beta-blockers are recommended in adult CS with moderate asymptomatic CTRCD. | Recommendation Table 42 for adult cancer survivors who develop cancer therapy-related cardiac dysfunction late after cardiotoxic cancer therapy |
| p.113 | I | C | A MDT approach is recommended to discuss and define the surgical risk in CS with severe VHD. | Recommendation Table 44 for adult cancer survivors with valvular heart disease |
| p.113 | I | B | Echocardiography, NP, and cTn are recommended for the diagnosis of AL-CA in patients with plasma cell dyscrasia. | Recommendation Table 49 for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |
| p.113 | I | A | CMR is recommended in patients with suspected AL-CA. | Recommendation Table 49 for amyloid light-chain cardiac amyloidosis diagnosis and monitoring |