Assessment of cardiotoxicity in cancer patients on chemotherapy in a low resource setting: is echocardiography the ultimate tool, or should we look for another?

Abstract

Cancer is a leading cause of death worldwide, and its burden in Africa is projected to rise. Africans have cause to worry over what to do to reduce its morbidity and mortality. Unfortunately, some of the most effective anticancer therapies cause cardiovascular dysfunction and may deny patients with cancer the life-saving benefits of chemotherapy Currently, expert consensus opinion adopts echocardiography to define cancer chemotherapy-induced cardiotoxicity, but the cost is unaffordable in most low-income countries. This review aims to examine the use of Cardiac Troponin (cT) to detect cardiotoxicity, particularly early cardiotoxicity, which routine echo is unable to do. We propose that patients on cancer chemotherapy should first have a cT assessment, and depending on the level of the cT, an echo may be indicated. This will reduce the frequency and cost of echo. Our proposal may also lead to a new definition of cancer chemotherapy-induced cardiotoxicity, taking into consideration the usefulness of cT.