[Current recommendations for diagnostic echocardiography in cancer patients : Is echocardiography too late or too early?]

Cardiac dysfunction caused by cardiotoxic treatment can appear at any time during or after therapy and sometimes even after years. To evaluate systolic left ventricular (LV) function assessment of the ejection fraction (EF), especially using 3D technology, is the established base value for cancer therapy-related cardiac dysfunction (CTRCD). It has been found that additional analysis of the LV function using deformation imaging is a more accurate and sensitive tool for detecting subclinical systolic LV dysfunction. Diastolic function parameters are not recommended for screening. The decision to modify oncological treatment and/or to begin specific cardiac treatment after detecting LV dysfunction is based on known data taking both the prognosis and quality of life into consideration and performed in individual cases by a cardio-oncological team of experts. There is a widely held consensus that these patients should be examined in an echocardiographic laboratory which has the appropriate equipment and diagnostic expertise. The lack of multicenter studies and the paucity of outcome data do not yet answer the question if echocardiography is carried out too early or too late. Recommendations on the frequency of standardized follow-up examinations and standardized echocardiographic parameter vary between the specialist societies. Although increased morbidity and mortality due to cardiotoxic treatment are now well known facts, too few patients undergo appropriate examinations.