Heart failure in cardio-oncology: Current approaches to diagnosis, prevention, and treatment (a literature review)

Aiganym Amanova, Ж. Тлегенова, B Zholdin, Saule K. Balmagambetova, Gulnara Kurmanalina, Iliada Talipova

2026

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DOI 10.52532/2663-4864-2026-1-745
Data confidence 70 medium
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Abstract

Relevance: Advances in modern oncology have significantly improved patient survival. However, the increasing number of cancer survivors is accompanied by a rise in the prevalence of cardiovascular complications, driven both by the direct cardiotoxicity of anticancer therapy and by the accelerated progression of preexisting cardiovascular disease and risk factors.The study aimed to present the current state of knowledge on heart failure (HF) as the most frequent and clinically significant manifestation of chemotherapyrelated cardiotoxicity, drawing on up-to-date international guidelines and contemporary studies.Materials and Methods: We conducted an analytical literature review of PubMed, Scopus, and Google Scholar (2015-2025) and examined the 2022 European Society of Cardiology (ESC) guidelines and HFA-ICOS consensus documents. We included systematic reviews, meta-analyses, and large clinical studies relevant to the diagnosis and management of HF in oncology patients.Results: Two main types of cardiotoxicity have been identified: irreversible (associated with anthracyclines) and reversible (associated with HER2 inhibitors). Both types can manifest as acute HF or early or late chronic HF. The most sensitive methods for early detection of subclinical dysfunction are echocardiography with global longitudinal strain (GLS) assessment and measurement of cardiac biomarkers (hsTnI, BNP/NT-proBNP). A key determinant of management strategy and follow-up frequency is baseline risk stratification using the HFA-ICOS score, which categorizes patients into low, moderate, high, and very high risk groups. Evidence-based cardioprotective strategies include risk factor modification, the use of ACE inhibitors/ARBs, β-blockers, and statins, and the use of liposomal anthracyclines and dexrazoxane in high-risk patients. Joint comanagement by oncologists and cardiologists increases the likelihood of completing anticancer therapy with minimal HF risk.Conclusion: HF remains the most clinically meaning ful manifestation of anticancer therapy-related cardiotoxicity. Optimization of its diagnosis, prevention, and treatment requires a multidisciplinary approach encompassing regular cardiac monitoring, risk-factor control, and targeted cardioprotective strategies in high-risk groups.