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8.2 Myocardial dysfunction and heart

failure HF treatment in CS should follow the current 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF.14 Treatment with ACE-I/ARB and/or beta-blockers is recommended for both symptomatic and asymptomatic CS who have LVEF , 50% detected on CV assessment.14,61,208,675 In CS with mild asymptomatic CTRCD detected on CV assessment (LVEF . 50% but new fall in GLS and/or cardiac serum biomarker increase), treatment with ACE-I/ARB and/or beta-blockers may be considered.

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. IIa C © ESC 2022

BP, blood pressure; CAD, coronary artery disease; CMR, cardiac magnetic resonance; CS, cancer survivors; CT, computed tomography; CTR-CVT, cancer therapy-related cardiovascular toxicity; CV, cardiovascular; CVD, cardiovascular disease; CVRF, cardiovascular risk factors; ECG, electrocardiogram; HbA1c, glycated haemoglobin; MHD, mean heart dose; NP, natriuretic peptides; RT, radiotherapy. aClass of recommendation. bLevel of evidence. cClinical review, BP, lipid profile, HbA1c. dRT risk categorization based on MHD is recommended over categorization based on prescribed dose (≥35 Gy to a volume exposing the heart if MHD is not available). eRestratification includes evaluation of new or pre-existing CVRF and CVD (including CTR-CVT). fSee Table 12. gStress echocardiography, cardiac CT, stress CMR, single-photon emission CT stress test, according to local protocol.234

Long-term surveillance in asymptomatic CS

High and very high

risk

Moderate

risk

Low risk

Class 1 Class 1Ia Class 1Ib

TTE every 2 years in adults who are childhood

and adolescent CS

TTE at years 1, 3, and 5 after cardiotoxic cancer therapy and every 5 years thereafter in adult CS

Annual CV risk

assessmenta

CV toxicity risk re-stratificationc

at 5 years

Patient education and CVRF optimization

Cardiology referralb if new CV symptoms develop TTE every 5 years in adults who are childhood

and adolescent CS

TTE every 5 years in

adult CS

Figure 38 Long-term follow-up in cancer survivors. BP, blood pressure; CAD, coronary artery disease; CS, cancer survivors; CTR-CVT, cancer therapy-related cardiovascular toxicity; CV, cardiovascular; CVD, cardiovascular disease; CVRF, cardiovascular risk factors; ECG, electrocardiogram; HbA1c, glycated haemoglobin; NP, natriuretic peptides; TTE, transthoracic echocardiography. aClinical review, BP, lipid profile, HbA1c, ECG, NP. In selected patients, non-invasive screening for CAD and carotid or renal diseases every 5–10 years, starting at 5 years after radiation may be considered. bCardio-oncology referral is recommended when available; alternatively, the patient should be referred to a specialized cardiologist with expertise in managing CVD in patients with cancer. cRestratification includes evaluation of new or pre-existing CVRF and CVD (including CTR-CVT). Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026