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Chemotherapy-induced Cardiotoxicity — EECC MCQ

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HardCardiomyopathyChemotherapy-induced CardiotoxicityEECC

A 62-year-old woman receiving doxorubicin chemotherapy for breast cancer has a baseline LVEF of 58% and GLS of -20%. After her 4th cycle (cumulative dose 240 mg/m²), her LVEF is 54% and GLS has deteriorated to -16% (a >15% relative decrease). She is asymptomatic. What is the most appropriate cardiac management?

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Correct answer: B — Start a cardioprotective ACE inhibitor and beta-blocker; continue chemotherapy with close monitoring

A relative decrease in GLS >15% from baseline is an early marker of subclinical cardiotoxicity and should trigger initiation of cardioprotective therapy (ACE inhibitor/ARB and/or beta-blocker) even before LVEF decline meets the threshold for stopping chemotherapy. The ESC Cardio-Oncology Guidelines (2022) recommend starting cardioprotection at this stage to prevent progression to overt cardiomyopathy. Chemotherapy can generally continue with enhanced cardiac surveillance. Discontinuation of anthracyclines is recommended when LVEF drops below 40% or by >10 percentage points to <50% with symptoms. The decision to modify the oncological regimen should be made jointly by the oncology and cardiology teams.

Reference: ESC (2022): Guidelines on Cardio-Oncology