Stress Echocardiography in Cancer Survivors After Chemo- and Radiotherapy

Abstract

In cancer patients evaluated before starting anticancer therapy, a baseline transthoracic echocardiography is recommended since the technique is more informative when each patient acts as his/her control and all confounders are averaged out in the same patients. As stated by the European Society of Medical Oncology recommendations 2020, “nonionizing modalities may be most appropriate due to concern regarding cumulative radiation dose in cancer patients,” who are already highly exposed to oncology diagnosis and follow-up programs. For resting transthoracic echocardiography evaluation, the most appropriate modality is volumetric echocardiography with Simpson’s biplane method for measurement of ejection fraction, with ultrasound enhancing agents as needed. Determination of global longitudinal strain using speckle tracking is recommended at baseline, using three apical views, particularly in moderate- and high-risk patients. The study should be performed during therapy when symptoms occur, or in the absence of symptoms to detect subtle changes which may induce therapy withdrawal or down-titration of therapy when alternatives are possible. The timing of the examination is tailored to the baseline risk of the patient, and the known cardiotoxic potential of the treatment. The guidelines of the European Society of Cardiology 2022 recommend that a stress echo should be considered (class of recommendation 2a) postchest radiotherapy every 5–10 years in asymptomatic patients who received >15 Gray mean heart dose.