Heart Failure Seminar: Focus on HF and Chemotherapy (OnDemand)-Focus on Heart Failure and Chemotherapy

Focus on Heart Failure and Chemotherapy

Pdf Summary

This HFSA Heart Failure Seminar focused on the intersection of heart failure and chemotherapy, highlighting two major cardio-oncology topics: immune checkpoint inhibitor (ICI) myocarditis and cancer therapy-related cardiac dysfunction (CTRCD) from anthracyclines and HER2-targeted therapies.<br /><br />The ICI myocarditis section presented a case of a patient on pembrolizumab with chest pain, dyspnea, elevated troponin, reduced LVEF, and arrhythmias. The key teaching point was that ICI myocarditis is rare but highly lethal, often occurring within the first 12 weeks of treatment. Diagnosis relies on symptoms, troponin elevation, ECG abnormalities, imaging, and cardiac MRI, but treatment should begin promptly with high-dose IV methylprednisolone while confirmatory testing is pending. The discussion also emphasized evaluating for overlapping myositis and myasthenia gravis (“3M syndrome”) and noted that additional immunosuppressive strategies are still being studied.<br /><br />The anthracycline/HER2 section reviewed mechanisms, risk factors, timing, and monitoring of cardiotoxicity. Anthracyclines have no truly safe cumulative dose, with heart failure risk rising as exposure increases. Key preventive strategies include dexrazoxane, liposomal anthracyclines, altered dosing schedules, and neurohormonal blockade. Evidence for ACE inhibitors, ARBs, beta-blockers, mineralocorticoid receptor antagonists, statins, and SGLT2 inhibitors is promising but mixed, and benefits appear greatest in higher-risk patients. Dexrazoxane was highlighted as the only FDA-approved cardioprotective agent for anthracycline cardiotoxicity.<br /><br />The seminar also covered trastuzumab and other HER2 therapies, noting that cardiotoxicity is generally lower without prior anthracycline exposure. In selected asymptomatic patients with mildly reduced LVEF, “permissive cardiotoxicity” may allow continuation of cancer therapy with close cardio-oncology follow-up and heart failure medications.<br /><br />Overall, the seminar stressed multidisciplinary care, baseline risk stratification, imaging and biomarker surveillance, and individualized prevention strategies to safely preserve both cardiac function and cancer treatment efficacy.

Keywords

heart failure

cardio-oncology

immune checkpoint inhibitor myocarditis

pembrolizumab

troponin elevation

anthracycline cardiotoxicity

HER2-targeted therapy

dexrazoxane

permissive cardiotoxicity

cardiac dysfunction