My Approach to the Echocardiographic Assessment of a Pediatric Patient with Cancer

What is the importance of cardiovascular assessments in pediatric patients with cancer?

Pediatric oncology has greatly progressed in recent decades due to the development of more effective treatment protocols; in fact, 5-year disease-free survival rates now exceed 80%. However, despite improved survival rates, the cardiovascular risks arising from these therapies are 5- to 6-fold greater in long-term surviving oncology patients than the general pediatric population.^, Thus, cardiovascular events, such as myocardial infarction, heart failure, and stroke, are the major cause of non-cancer death in these patients.

Cardiotoxicity is defined as any structural or functional damage incurred by the heart and circulation during or after cancer treatment. These changes may be caused by chemotherapeutic agents, radiotherapy, or even the disease itself (). Cardiotoxicity may present as symptomatic or asymptomatic heart failure, pericardial changes, arrhythmias, thromboembolic events, arterial hypertension, or valve and coronary diseases^, and can be classified by time of onset as follows:

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