Cardio-Oncology: Preventing Broken Hearts in Women with Breast Cancer

Breast cancer is the leading cause of cancer in Canadian women and as a result constitutes a significant cause of morbidity and mortality in this patient population. Although overall survival is significantly improved by treatment with anti-cancer drugs including Doxorubicin and Trastuzumab, approximately 1 in 4 Canadian women are at risk of developing chemotherapy induced cardiotoxicity. Current guidelines recommend serial cardiac monitoring using transthoracic echocardiography (TTE) or multigated acquisition scan (MUGA) for the non-invasive assessment of left ventricular ejection fraction (LVEF). Recent studies suggest that echocardiographic deformation measures including tissue velocity imaging and strain parameters can detect adverse cardiac changes prior to quantifiable differences in LVEF. Early detection of chemotherapy mediated cardiotoxicity would allow for early intervention with the use of cardioprotective agents in women with breast cancer. The prophylactic use of angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), β-blockers, statins, anti-oxidants, and nutraceutical agents as cardioprotective agents have been studied in the Cardio-Oncology setting. While animal models and initial clinical trials prove promising, further studies are required to prevent the devastating consequences of chemotherapy mediated cardiotoxicity in women with breast cancer.