Evaluation and Management of Patients With Heart Disease and Cancer: Cardio- Oncology  Joerg Herrmann, MD, Amir Lerman, MD, Nicole P. Sandhu, MD, PhD, Hector R. Villarraga, MD, Sharon L. Mulvagh, MD, Manish Kohli, MD  Mayo Clinic Proceedings  Volume 89, Issue 9, Pages 1287-1306 (September 2014) DOI: 10.1016/j.mayocp.2014.05.013 Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Illustration of the percentage of patients with an improvement in left ventricular ejection fraction to greater than 50%, depending on the timing of the initiation of heart failure therapy after the diagnosis of anthracycline-induced cardiomyopathy (A) and survival free of cardiac events for patients with an improvement in left ventricular ejection fraction less than (partial responders) or greater than 50% (responders) (B). From Cardinale et al,25 with permission. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Outline of a general cardio-oncology algorithm. abn = abnormal; CAD = coronary artery disease; CXR = chest x-ray; CV = cardiovascular; ECG = electrocardiogram; f/u = follow-up; HTN = hypertension; QTc = corrected QT. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Outline of a putative risk assessment, monitoring, and management model for patients undergoing chemotherapy. The central concept is that patient- and medication-related risk factors can be used to generate an overall risk score that can then be used to determine monitoring intervals and thresholds for preventive strategies. Such models need to be accounted for the fact that not all chemotherapeutic agents and patient-related risk factors weigh the same, and hence the ultimate prediction models will need to be more stratified and will need to be verified. ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; CAD = coronary artery disease; cTn = cardiac troponin; ECG = electrocardiogram; HTN = hypertension; PAD = peripheral arterial disease; TTE = transthoracic echocardiography. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Established algorithm for the monitoring of patients undergoing anthracycline-based chemotherapy. A variation of this algorithm is the reassessment before each cycle after administering 250 to 300 mg/kg2 in those at high risk. LVEF = left ventricular ejection fraction. Adapted from Schwartz et al,80 with permission. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 5 Algorithm for the monitoring of patients undergoing Herceptin chemotherapy. HF = heart failure; LVEF = left ventricular ejection fraction. Adapted from Martin et al,106 with permission. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 6 Monitoring algorithm of patients after radiation therapy. CAD = coronary artery disease; CMR = cardiac magnetic resonance; LV = left ventricular; US = ultrasound. From Lancellotti et al, 96 with permission. Mayo Clinic Proceedings 2014 89, 1287-1306DOI: (10.1016/j.mayocp.2014.05.013) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions