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Table of contents

1. Preamble ........................................................................................................ 4236 2. Introduction ................................................................................................. 4238 2.1. Cancer and cardiovascular needs of patients with cancer 4238 2.2. Role of cardio-oncology services ............................................... 4238 2.3. General principles of cardio-oncology ..................................... 4239 3. Cancer therapy-related cardiovascular toxicity definitions ..... 4242 4. Cardiovascular toxicity risk stratification before anticancer therapy ................................................................................................................. 4244 4.1. General approach to cardiovascular toxicity risk in patients with cancer ................................................................................................... 4244 4.2. History and clinical examination ................................................. 4249 4.3. Electrocardiogram ............................................................................. 4249 4.4. Cardiac serum biomarkers ............................................................ 4251 4.5. Cardiovascular imaging ................................................................... 4252 4.6. Cardiopulmonary fitness assessment ....................................... 4253 4.7. Cardiovascular risk evaluation before cancer surgery ...... 4254 4.8. Genetic testing ................................................................................... 4254 5. Prevention and monitoring of cardiovascular complications during cancer therapy ................................................................................... 4254 5.1. General principles ............................................................................. 4254 5.2. Primary prevention strategies ...................................................... 4256 5.2.1. Primary prevention of cancer therapy-related cardiovascular toxicity during anthracycline chemotherapy .................................................................................. 4256 5.2.2. Primary prevention of radiation-induced cardiovascular toxicity .................................................................. 4256 5.3. Secondary prevention strategies ................................................ 4257 5.4. Cardiovascular surveillance during cancer therapies ......... 4257 5.4.1. Cardiac serum biomarkers ............................................. 4257 5.4.2. Cardiac imaging .................................................................... 4257 5.5. Cancer therapy-related cardiovascular toxicity monitoring protocols ....................................................................................................... 4259 5.5.1. Anthracycline chemotherapy ......................................... 4259 5.5.2. HER2-targeted therapies ................................................. 4259 5.5.3. Fluoropyrimidines ............................................................... 4261 5.5.4. Vascular endothelial growth factor inhibitors ........ 4261 5.5.5. Multitargeted kinase inhibitors targeting BCR-ABL 4264 5.5.6. Bruton tyrosine kinase inhibitors ................................. 4267 5.5.7. Multiple myeloma therapies ........................................... 4268 5.5.8. Rapidly accelerated fibrosarcoma and mitogenactivated extracellular signal-regulated kinase inhibitor treatment ............................................................................................ 4271 5.5.9. Immune checkpoint inhibitors ...................................... 4273 5.5.10. Androgen deprivation therapies for prostate cancer ................................................................................................... 4274 5.5.11. Endocrine therapies for breast cancer ................... 4276 5.5.12. Cyclin-dependent kinase 4/6 inhibitors .................. 4276 5.5.13. Anaplastic lymphoma kinase inhibitors ................... 4277 5.5.14. Epidermal growth factor receptor inhibitors ...... 4277 5.5.15. Chimeric antigen receptor T cell and tumour-infiltrating lymphocytes therapies ..... 4278 5.5.16. Radiotherapy ...................................................................... 4279 5.5.17. Haematopoietic stem cell transplantation ............ 4279 5.5.18. Other cancer treatments ............................................. 4282 6. Diagnosis and management of acute and subacute cardiovascular toxicity in patients receiving anticancer treatment 4282 6.1. Cancer therapy-related cardiac dysfunction .......................... 4282 6.1.1. Anthracycline chemotherapy-related cardiac dysfunction ......................................................................................... 4282 6.1.2. Human epidermal receptor 2-targeted therapyrelated cardiac dysfunction ......................................................... 4284 6.1.3. Immune checkpoint inhibitor-associated myocarditis and non-inflammatory heart failure ............... 4286 6.1.4. Chimeric antigen receptor T cell and tumourinfiltrating lymphocytes therapies and heart dysfunction 4290 6.1.5. Heart failure during haematopoietic stem cell transplantation ................................................................................. 4291 6.1.6. Takotsubo syndrome and cancer ................................ 4291 6.2. Coronary artery disease ................................................................. 4291 6.2.1. Acute coronary syndromes ............................................ 4291 6.2.2. Chronic coronary syndromes ....................................... 4293 6.3. Valvular heart disease ...................................................................... 4293 6.4. Cardiac arrhythmias ......................................................................... 4294 6.4.1. Atrial fibrillation ................................................................... 4294 6.4.2. Long corrected QT interval and ventricular arrhythmias ........................................................................................ 4298 6.4.3. Bradyarrhythmias ................................................................ 4300 6.5. Arterial hypertension ....................................................................... 4300 6.6. Thrombosis and thromboembolic events .............................. 4303 6.6.1. Venous thromboembolism ............................................. 4303 6.6.2. Arterial thromboembolism ............................................ 4304 6.6.3. Intracardiac thrombosis ................................................... 4304 6.6.4. Anticoagulation therapy ................................................... 4305 6.7. Bleeding complications .................................................................... 4306 6.7.1. High-risk patients ................................................................ 4306 6.7.2. Antiplatelet therapy ........................................................... 4306 6.7.3. Management of bleeding .................................................. 4306 6.8. Peripheral artery disease ................................................................ 4307 6.9. Pulmonary hypertension ................................................................ 4307 6.10. Pericardial diseases ......................................................................... 4308 6.10.1. Pericarditis ........................................................................... 4308 6.10.2. Pericardial effusion ........................................................... 4308 7. End-of-cancer therapy cardiovascular risk assessment ............. 4309 7.1. Cardiovascular evaluation during the first year after cardiotoxic anticancer therapy ............................................................ 4309 7.2. Which cancer survivors require cardiovascular surveillance in the first year after cancer treatment? .......................................... 4309 7.3. Management of cancer therapy-related cardiac dysfunction at the end-of-therapy assessment ...................................................... 4310 7.4. Cardiopulmonary exercise testing and fitness during the end-of-therapy assessment .................................................................... 4310 7.5. The role of cardiac rehabilitation ............................................... 4310 8. Long-term follow-up and chronic cardiovascular complications in cancer survivors .......................................................................................... 4312 8.1. Cancer survivors ................................................................................ 4312 8.1.1. Adult survivors of childhood and adolescent cancer ................................................................................................... 4312 8.1.2. Adult cancer survivors ...................................................... 4313 8.2. Myocardial dysfunction and heart failure ................................ 4315 8.3. Coronary artery disease ................................................................. 4316 8.4. Valvular heart disease ...................................................................... 4317 8.5. Peripheral artery disease and stroke ........................................ 4317 8.6. Pericardial complications ................................................................ 4317 8.7. Arrhythmias and autonomic disease ......................................... 4318 Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026