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There are many causes of heart failure such as ischaemic heart disease,1,2 genetic cardiomyopathies,3–5 and storage disease.6,7 More recently, iatrogenic forms of heart failure have been shown to occur in patients undergoing cancer therapy.8 The increasing complexity of chemotherapies and the large variety of cardiac complications thereof have led to a novel specialty of cardiology, i.e. cardio-oncology.9 The CARDIOTOX registry provides insight into this issue in the article ‘Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity’ by José Luis López-Sendón and colleagues from the Hospital Universitario La Paz in Madrid, Spain.10 They prospectively studied 865 patients, mainly women, scheduled for anticancer therapy. Four groups of myocardial dysfunction were considered: (i) normal: normal biomarkers and left ventricular ejection fraction (LVEF); (ii) mild: abnormal biomarkers and/or LVEF ≥50%; (iii) moderate: LVEF 40–49%; and (iv) severe: LVEF ≤40% and/or symptomatic heart failure. Cardiotoxicity was defined as new or worsening ventricular dysfunction over 24 months. Cardiotoxicity occurred in 31.6% of those with mild, 2.8% with moderate, and 3.1% with severe LV dysfunction. Mortality in the severe group was 22.9/100 patient-years compared with 2.3 deaths/100 patient-years in the remainder. Most patients undergoing cancer therapy develop myocardial dysfunction. Nevertheless, severe cardiotoxicity with a 10-fold higher mortality was comparatively rare. The clinical implications are discussed in an Editorial by Jose Luis Zamorano from the University Hospital Ramón y Cajal in Madrid, Spain.11
