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Purpose of Review <p>The advancement of cancer therapeutics has seen a rise in cancer therapy-related cardiac dysfunction. Concomitantly, a rise in heart failure has paralleled an expanding role of guideline-directed medical therapy (GDMT). As the two disease processes intersect, a shifting paradigm in both identification and treatment of cardiomyopathy and of heart failure has emerged for patients with cancer therapy-related cardiac dysfunction (CTRCD).</p> Recent Findings <p>For patients at risk for cardiac dysfunction (stage A heart failure [HF]) these cardioprotective strategies including traditional GDMT - most notably beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and more recently sodium-glucose co-transporter 2 inhibitors. Imaging modalities such as strain echocardiography and cardiac MRI are being explored to identify high-risk cohorts who may benefit from early intervention. In patients with asymptomatic cardiac dysfunction (stage B HF), permissive cardiotoxicity leverages the practice of accepting some level of cardiac dysfunction and increased HF risk in exchange for delivering optimal cancer therapy. This practice has been supported by recent randomized controlled trials demonstrating feasibility and safety in patients with asymptomatic left ventricular dysfunction. Unfortunately, patients with more advanced HF (stages C and D) continue to experience poorer outcomes and receive fewer therapies compared to non-cancer counterparts. As the field evolves, there has been increased willingness to provide advanced therapies to carefully selected individuals with prior or active cancer.</p> Summary <p>When taken as a whole, the majority of data indicates that the use of traditional GDMT and adjunct agents in the cardio-oncology population may have cardioprotective effects. This has been most well-studied in patients with cancer who are at risk for developing CTRCD. In patients with asymptomatic CTRCD, there is also data to suggest that the use and optimization of GDMT could help cardio-oncologists more safely practice permissive cardiotoxicity, the concept of allowing some degree of cardiac dysfunction in return for optimal cancer therapy. Areas that remain relatively unstudied include the use of these agents in stage D HF or cardiogenic shock, as well as the use of newer agents. As newer HF therapeutics find a place within the spectrum of GDMT, future studies should investigate the use of these agents in the population of patients with cardiomyopathy, HF, and cancer.</p>

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Optimizing Heart Failure Management in the Cardio-Oncology Setting: Guideline-Directed Medical Therapy, Permissive Cardiotoxicity, and Personalized Approaches

  • 期刊论文

  • 发表日期：

    2025年12月3日

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  • Stephanie Golob,
  • Sophia Zhou,
  • Mohamed Moussa,
  • Michelle Bloom

摘要

Purpose of Review

The advancement of cancer therapeutics has seen a rise in cancer therapy-related cardiac dysfunction. Concomitantly, a rise in heart failure has paralleled an expanding role of guideline-directed medical therapy (GDMT). As the two disease processes intersect, a shifting paradigm in both identification and treatment of cardiomyopathy and of heart failure has emerged for patients with cancer therapy-related cardiac dysfunction (CTRCD).

Recent Findings

For patients at risk for cardiac dysfunction (stage A heart failure [HF]) these cardioprotective strategies including traditional GDMT - most notably beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and more recently sodium-glucose co-transporter 2 inhibitors. Imaging modalities such as strain echocardiography and cardiac MRI are being explored to identify high-risk cohorts who may benefit from early intervention. In patients with asymptomatic cardiac dysfunction (stage B HF), permissive cardiotoxicity leverages the practice of accepting some level of cardiac dysfunction and increased HF risk in exchange for delivering optimal cancer therapy. This practice has been supported by recent randomized controlled trials demonstrating feasibility and safety in patients with asymptomatic left ventricular dysfunction. Unfortunately, patients with more advanced HF (stages C and D) continue to experience poorer outcomes and receive fewer therapies compared to non-cancer counterparts. As the field evolves, there has been increased willingness to provide advanced therapies to carefully selected individuals with prior or active cancer.

Summary

When taken as a whole, the majority of data indicates that the use of traditional GDMT and adjunct agents in the cardio-oncology population may have cardioprotective effects. This has been most well-studied in patients with cancer who are at risk for developing CTRCD. In patients with asymptomatic CTRCD, there is also data to suggest that the use and optimization of GDMT could help cardio-oncologists more safely practice permissive cardiotoxicity, the concept of allowing some degree of cardiac dysfunction in return for optimal cancer therapy. Areas that remain relatively unstudied include the use of these agents in stage D HF or cardiogenic shock, as well as the use of newer agents. As newer HF therapeutics find a place within the spectrum of GDMT, future studies should investigate the use of these agents in the population of patients with cardiomyopathy, HF, and cancer.