Detection of anthracycline-induced cardiotoxicity

The use of anthracyclines, a group of potent anti-cancer agents incorporate d into the treatment of a wide variety of solid and haematological tumours, is limited by its cardiotoxicity that can result in congestive heart failu re (CHF). The best method to detect cardiotoxicity at an early stage in ord er to prevent severe deterioration, is still an unsolved problem. Although endomyocardial biopsy is considered to be the most sensitive and specific t est for this purpose, its use is limited by its invasiveness. In daily prac tice, oncologists make use of parameters of systolic function (left ventric ular ejection fraction, or fractional shortening) to detect cardiotoxicity, but these methods are not able to identify cardiotoxicity at an early stag e. Based on increasing knowledge into the pathophysiology of anthracycline- induced cardiotoxicity and heart failure in general, new methods including the determination of diastolic function parameters, anti-myosin scintigraph y, assessment of heart rate variability, and the determination of biochemic al markers have been proposed to identify patients at risk of the developme nt of CHF in an early stage. However; most of these newer methods have not yet been adequately evaluated to allow them to be recommended for use in ro utine clinical practice.