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European Journal of Heart Failure 2002 4(3):235-242; doi:10.1016/S1388-9842(01)00201-X
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© 2002 European Society of Cardiology

Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis

M.I. Gharib and A.K. Burnett*

Department of Haematology University of Wales College of Medicine, Heath Park, Cardiff CF14 4XW, UK

* Corresponding author. Telephone: +44-29-207-42375; fax: +44-29-207-44655. E-mail address: burnettak{at}cardiff.ac.uk


  Abstract

Cardiotoxicity is a potential side effect of few chemotherapeutic agents. The anthracycline class of cytotoxic antibiotics are the most famous, but other chemotherapeutic agents can also cause serious cardiotoxicity and are not so well recognised. Examples include cyclophosphamide, ifosfamide, mitomycin and fluorouracil. Prediction and hence prophylaxis has always been a difficult task. Ideal monitoring techniques, upon which efficient prophylaxis depends, are yet to be determined. Current prophylaxis relies upon early detection of systolic and/or diastolic dysfunction. While somewhat useful, in some cases by the time defects are detected progression of chemotherapy-induced cardiomyopathy is beyond prevention. Prophylaxis would be much more efficient if a biochemical marker of myocardiocyte damage could be reliably used to stop further chemotherapy at the correct time before irreversible progressive ‘macroscopic’ damage becomes evident upon imaging. Work is currently progressing to identify the role of markers such as troponins and natriuretic peptides in this regard.

Key Words: Chemotherapy • Anthracyclines • Cyclophosphamide • Cardiotoxicity • Cardiomyopathy • Heart

Received March 21, 2001; Revised July 17, 2001; Accepted September 19, 2001


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