Chemotherapy-Induced Cardiotoxicity: Comprehensive Review of Mechanisms, Diagnosis, and Management

Authors

  • Mohammed Jamal Ahmed Hawler Medical University, Hawler, Iraq.
  • Abdulrahman Ahmed Mahmood College of Health and Medical Techniques, Northern Technical University. Kirkuk, Iraq.
  • Ali Mohammed Salih Technical College of Engineering, Sulaimani Polytechnic University, Sulaimani, Iraq.
  • Daban Noori Hama Saeed Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.
  • Akam Dler Latif Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.
  • Klaudia Chuchracka Faculty of Chemistry, Adam Mickiewicz University, UniwersytetuPoznańskiego, Poznań, Poland, Iraq
  • Rebaz Ramadhan Abdulrahman Bakrajo Technical Institute, Sulaimani Polytechnic University, Iraq

DOI:

https://doi.org/10.22270/ajprd.v13i3.1558

Abstract

Background: Chemotherapy-induced cardiotoxicity is a perilous consequence that limits the use of potent anticancer medicines, especially anthracyclines. Notwithstanding progress in oncology, cardiovascular toxicity continues to be a significant contributor to morbidity and mortality among cancer survivors.

Objective: This review examines the molecular mechanisms, diagnostic approaches, and management strategies for chemotherapy-induced cardiotoxicity, emphasizing the need for early detection and interdisciplinary collaboration between cardiologists and oncologists.

Key Findings: Cardiotoxicity manifests as left ventricular dysfunction (LVD), arrhythmias, or heart failure (HF), with anthracyclines and trastuzumab being the most implicated agents. Advanced imaging (e.g., strain echocardiography, cardiac MRI) and biomarkers (troponin, NT-proBNP) enable early detection before irreversible damage occurs. Dexrazoxane, ACE inhibitors, and beta-blockers show promise in prevention and treatment, though optimal protocols remain under investigation.

Conclusion: Proactive monitoring and personalized cardioprotective strategies are essential to balance oncological efficacy with cardiovascular safety. The following studies require concentrating on extensive trials to enhance risk classification and therapy strategies.

 

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Author Biographies

Mohammed Jamal Ahmed, Hawler Medical University, Hawler, Iraq.

Hawler Medical University, Hawler, Iraq.

Abdulrahman Ahmed Mahmood, College of Health and Medical Techniques, Northern Technical University. Kirkuk, Iraq.

College of Health and Medical Techniques, Northern Technical University. Kirkuk, Iraq.

Ali Mohammed Salih, Technical College of Engineering, Sulaimani Polytechnic University, Sulaimani, Iraq.

Technical College of Engineering, Sulaimani Polytechnic University, Sulaimani, Iraq.

Daban Noori Hama Saeed, Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.

Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.

Akam Dler Latif, Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.

Medical Lab Science, Komar University of Science and Technology, Sulaimani, Iraq.

Klaudia Chuchracka, Faculty of Chemistry, Adam Mickiewicz University, UniwersytetuPoznańskiego, Poznań, Poland, Iraq

Faculty of Chemistry, Adam Mickiewicz University, UniwersytetuPoznańskiego, Poznań, Poland, Iraq

Rebaz Ramadhan Abdulrahman, Bakrajo Technical Institute, Sulaimani Polytechnic University, Iraq

Bakrajo Technical Institute, Sulaimani Polytechnic University, Iraq

References

Aquaro GD, De Gori C, Faggioni L, Parisella ML, Cioni D, Lencioni R, Neri E. Diagnostic and prognostic role of late gadolinium enhancement in cardiomyopathies. Eur Heart J Suppl. 2023; 25(Suppl_C):C130–C136. https://doi.org/10.1093/eurheartjsupp/suad015

Fernández AE. Chemotherapy-induced dysfunction. E-Journal of Cardiology Practice. 2017;14. European Society of Cardiology. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Chemotherapy-induced-dysfunction

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240–e327. https://doi.org/10.1161/CIR.0b013e31829e8776

Curigliano G, Cardinale D, Suter T, Plataniotis G, De Azambuja E, Sandri M, Criscitiello C, Goldhirsch A, Cipolla C, Roila F. Cardiovascular toxicity induced by chemotherapy, targeted agents, and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol. 2012;23(Suppl 7):vii155–vii166. https://doi.org/10.1093/annonc/mds293

Lyon AR, Dent S, Stanway S, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: A position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22(11):1945–1960. https://doi.org/10.1002/ejhf.1920

Zamorano JL, Lancellotti P, Muñoz DR, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity. Eur Heart J. 2016;37(36):2768–2801. https://doi.org/10.1093/eurheartj/ehw211

Mahmood AA, Zhang J, Liao R, Pan X, Xu D, Xu H, Zhou Q. Evaluation of non-targeting, C- or N-pH (low) insertion peptide modified superparamagnetic iron oxide nanoclusters for selective MRI of liver tumors and their potential toxicity in cirrhosis. RSC Adv. 2019; 9:14051–14059. https://doi.org/10.1039/c9ra02430a

Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced cardiotoxicity. Maedica. 2013;8(1):59–67.

Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015; 131(22):1981–1988.

Angsutararux P, Luanpitpong S, Issaragrisil S. Chemotherapy-induced cardiotoxicity: Overview of the roles of oxidative stress. Oxid Med Cell Longev. 2015;2015:795602. https://doi.org/10.1155/2015/795602

Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin. Cancer. 2003;97(11):2869–2879. https://doi.org/10.1002/cncr.11407

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140(11):e596–e646. https://doi.org/10.1161/CIR.0000000000000678

Jones DN, Jordan JH, Meléndez GC, et al. Frequency of transition from stage A to stage B heart failure after initiating potentially cardiotoxic chemotherapy. JACC Heart Fail. 2018;6(12):1023–1032. https://doi.org/10.1016/j.jchf.2018.07.006

Lyon AR, López-Fernández T, Couch LS, et al. ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229–4361. https://doi.org/10.1093/eurheartj/ehac244

Gharib MA, Burnett A. Chemotherapy-induced cardiotoxicity: Current practice and prospects of prophylaxis. Eur J Heart Fail. 2002;4(3):235–242. https://doi.org/10.1016/S1388-9842(01)00201-X

McGowan JV, Chung R, Maulik A, et al. Anthracycline chemotherapy and cardiotoxicity. Cardiovasc Drugs Ther. 2017;31(1):63–75. https://doi.org/10.1007/s10557-016-6711-0

Wei Y, Liao R, Mahmood AA, Xu H, Zhou Q. pH-responsive pHLIP (pH low insertion peptide) nanoclusters of superparamagnetic iron oxide nanoparticles as a tumor-selective MRI contrast agent. ActaBiomater. 2017;55:194–203. https://doi.org/10.1016/j.actbio.2017.03.046

American Cancer Society. Cancer treatment & survivorship facts & figures 2019–2021. American Cancer Society; 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2019-2021.pdf

Jurczyk M, Król M, Midro A, et al. Cardiotoxicity of fluoropyrimidines: Epidemiology, mechanisms, diagnosis, and management. J Clin Med. 2021;10(19):4426. https://doi.org/10.3390/jcm10194426

Teles ML, de Freitas LSLR, Dias LTF, Vasconcelos LFG, Blackman AO. Arrhythmias caused by chemotherapy agents used in the treatment of triple-negative breast cancer: A mini-review of literature. Biomed J Sci Tech Res. 2020;27(4):20943–20947.

Cardinale D. Monitoring and treatment of cardiovascular complications during cancer therapies: Part I Anthracyclines, HER2-targeted therapies, and fluoropyrimidines. J Clin Med. 2023;12(3):1–15.

Trapani D, Zagami P, Nicolò E, Pravettoni G, Curigliano G. Management of cardiac toxicity induced by chemotherapy. J Clin Med. 2020;9(9):2885. https://doi.org/10.3390/jcm9092885

Qiu S, Zhou T, Qiu B, et al. Risk factors for anthracycline-induced cardiotoxicity. Front Cardiovasc Med. 2021;8:736854. https://doi.org/10.3389/fcvm.2021.736854

Cardinale D, Colombo A, Lamantia G, et al. Anthracycline-induced cardiomyopathy: Clinical relevance and response to pharmacologic therapy. J Am CollCardiol. 2010;55(3):213–220.

Seth AK, Barrett AB, Barnett L. Granger causality analysis in neuroscience and neuroimaging. J Neurosci. 2015;35(8):3293-3297.

Henriksen PA, Hall P, MacPherson IR, et al. Multicenter, prospective, randomized controlled trial of high-sensitivity cardiac troponin I–guided combination angiotensin receptor blockade and beta-blocker therapy to prevent anthracycline cardiotoxicity: The Cardiac CARE Trial. Circulation. 2023;148(21):1680–1690.

Van Dalen EC, Van Der Pal HJ, Kremer LC. Different dosage schedules for reducing cardiotoxicity in people with cancer receiving anthracycline chemotherapy. Cochrane Database Syst Rev. 2016; 2016(6):CD005008. https://doi.org/10.1002/14651858.CD005008.pub4

Mulrooney DA, Yeazel MW, Kawashima T, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: Retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ. 2009; 339:b4606. https://doi.org/10.1136/bmj.b4606

Cardinale D, Salvatici M, Sandri MT. Role of biomarkers in cardio-oncology. ClinChem Lab Med. 2011; 49(12):1937–1948. https://doi.org/10.1515/CCLM.2011.692

Scalia IG, Gheyath B, Tamarappoo BK, et al. Chemotherapy-related cardiotoxicity evaluation: A contemporary review with a focus on cardiac imaging. J Clin Med. 2024;13(13):3714. https://doi.org/10.3390/jcm13133714

Chovanec M, Abu Zaid M, Hanna N, et al. Natriuretic peptides in cardio-oncology: An emerging biomarker for cardiac dysfunction. J Clin Med. 2023;12(5):1–12. https://doi.org/10.3390/jcm12051807

Morelli MB, Bongiovanni C, Da Pra S, et al. Cardiotoxicity of anticancer drugs: Molecular mechanisms and strategies for cardioprotection. Front Cardiovasc Med. 2022;9:847012. https://doi.org/10.3389/fcvm.2022.847012

Shaikh AY, Shih JA. Chemotherapy-induced cardiotoxicity. Curr Heart Fail Rep. 2012;9(2):117–127. https://doi.org/10.1007/s11897-012-0083-y

Rahman A, Khazini L, Salih AM. Origins of water pollution in Tanjaro River. In: Third National Congress of Chemistry and Nanochemistry from Research to National Development. DOI: 10.5281/zenodo.14959441.

Omar ZO, Hamasalih IK, Salih AM, et al. Gypsum calcination in order to clear impurities and to use phosphogypsum at its entire cycle microbial bioremediation. Int J Sci R Tech. 2025;2(3).

Salih AM, Williams C, Khanaqa PA. Synthesis of zeolite A from Iraqi natural kaolin using a conventional hydrothermal synthesis technique. UKH J Sci Eng. 2020;4(2):11-23.

Salih AM, Williams C, Khanaqa P. Synthesis of zeolite Na-LSX from Iraqi natural kaolin using alkaline fusion prior to hydrothermal synthesis technique. UKH J Sci Eng. 2019;3(1):10-17.

Mohammed A, Salih A, Raof H. Vipulanandan constitutive models to predict the rheological properties and stress–strain behavior of cement grouts modified with metakaolin. J Test Eval. 2020;48(5):3925-3945.

Salih AM, Williams C, Khanaqa P. Kinetic studies of heavy metal removal from industrial wastewater using natural zeolite. UKH J Sci Eng. 2021;5(1):18-25.

Ghareeb OA, Ali QA. Pathotoxic impact of zinc oxide nanoparticles on liver function and protective role of silymarin. CurrInnov Dis Health Res. 2023;3:154–161. https://doi.org/10.9734/bpi/cidhr/v3/10703F

Salih AM. The purification of industrial wastewater to remove heavy metals and investigation into the use of zeolite as a remediation tool [Doctoral dissertation, University of Wolverhampton]. University of Wolverhampton Open Research; 2018.

Ghareeb OA, Sheikhzadeh S. Single dose of chloroform induces hepatic dysfunction with pro-inflammatory cytokines response in vivo. South East Eur J Public Health. 2024;XXIV(Suppl 4):747–753. https://doi.org/10.70135/seejph.vi.1329.

Published

2025-06-15

How to Cite

Mohammed Jamal Ahmed, Abdulrahman Ahmed Mahmood, Ali Mohammed Salih, Daban Noori Hama Saeed, Akam Dler Latif, Klaudia Chuchracka, & Rebaz Ramadhan Abdulrahman. (2025). Chemotherapy-Induced Cardiotoxicity: Comprehensive Review of Mechanisms, Diagnosis, and Management. Asian Journal of Pharmaceutical Research and Development, 13(3), 59–67. https://doi.org/10.22270/ajprd.v13i3.1558