Multimodality Cardiac Imaging in the Era of Emerging Cancer Therapies

R ecently, the field of oncology has witnessed a surge of new therapeutic agents that have collectively led to improved rates of progression-free and overall survival for many cancers. However, these advances have also led to increased morbidity attributable to treatment-related side effects, in particular, cardiac toxicities. Cancer therapeutics may negatively affect the heart in a host of ways, whether it is through direct tissue damage or indirectly by exacerbating cardiovascular risk factors. Given that cardiovascular disease is the most common cause of death among cancer survivors, increased recognition and understanding of these cardiovascular toxicities is paramount to successful management of this ever increasing survivorship population. Cardiac imaging has been essential to elucidating mechanisms for a growing number of cardiotoxicities, and its role in toxicity surveillance and management continues to evolve. Approaching this review from the perspective of treatmentrelated cardiovascular toxicities, we examine evolving applications of imaging in contemporary cardio-oncology with specific focus on the more novel and emerging anticancer therapies. In doing so, we will examine broad categories of cancer therapeutics, highlight specific agents that have been implicated in cardiotoxicity, and discuss optimal cardiac imagingmodalities for each class. We will also consider amyloidosis, in light of recent interest. Guideline-driven recommendations and position paper statements pertaining to cardiac imaging will be highlighted wherever possible. We recognize that cardiac imaging position statements are largely unavailable for certain drug categories, particularly for more novel agents. In these instances, primary literature and specific clinical cases pertaining to cardiac imaging applications for each cardiotoxicity will be reviewed. Prominent cardiotoxicities as related to cancer therapies are detailed below: