| General recommendations |
| Survivors treated with anthracyclines or chest radiation and their providers should be aware of the risk of cardiomyopathy |
| Who needs cardiomyopathy surveillance? Patients treated with anthracyclines |
| Cardiomyopathy surveillance is recommended for survivors treated with high-dose (≥250 mg/m2) anthracyclines |
| Cardiomyopathy surveillance is reasonable for survivors treated with moderate-dose (≥100 to <250 mg/m2) anthracyclines |
| Cardiomyopathy surveillance may be reasonable for survivors treated with low-dose (<100 mg/m2) anthracyclines |
| Who needs cardiomyopathy surveillance? Patients treated with chest radiation |
| Cardiomyopathy surveillance is recommended for survivors treated with high-dose (≥35 Gy) chest radiation |
| Cardiomyopathy surveillance may be reasonable for survivors treated with moderate-dose (≥15 to <35 Gy) chest radiation |
| No recommendation can be formulated for cardiomyopathy surveillance for survivors treated with low-dose (<15 Gy) chest radiation with conventional fractionation |
| Who needs cardiomyopathy surveillance? Patients treated with anthracyclines plus chest radiation |
| Cardiomyopathy surveillance is recommended for survivors treated with moderate- to high-dose anthracyclines (≥100 mg/m2) and moderate- to high-dose chest radiation (≥15 Gy) |
| What surveillance modality should be used? |
| Echocardiography is recommended as the primary cardiomyopathy surveillance modality for assessment of left ventricular systolic function in survivors treated with anthracyclines or chest radiation |
| Radionuclide angiography or cardiac MRI may be reasonable for cardiomyopathy surveillance in at-risk survivors for whom echocardiography is not technically feasible or optimal |
| Assessment of cardiac blood biomarkers (eg, natriuretic peptides) in conjunction with imaging studies may be reasonable in instances where symptomatic cardiomyopathy is strongly suspected or in individuals who have borderline cardiac function during primary surveillance |
| Assessment of cardiac blood biomarkers is not recommended as the only strategy for cardiomyopathy surveillance in at-risk survivors |
| At what frequency should surveillance be performed for high-risk survivors? |
| Cardiomyopathy surveillance is recommended for high-risk survivors to begin no later than two years after completion of cardiotoxic therapy, repeated at five years after diagnosis and continued every five years thereafter |
| More frequent cardiomyopathy surveillance is reasonable for high-risk survivors |
| Lifelong cardiomyopathy surveillance may be reasonable for high-risk survivors |
| At what frequency should surveillance be performed for moderate- or low-risk survivors? |
| Cardiomyopathy surveillance is reasonable for moderate- and low-risk survivors to begin no later than two years after completion of cardiotoxic therapy, repeated at five years after diagnosis and continue every five years thereafter |
| More frequent cardiomyopathy surveillance may be reasonable for moderate- and low-risk survivors |
| Lifelong cardiomyopathy surveillance may be reasonable for moderate- and low-risk survivors |
| At what frequency should surveillance be performed for survivors who are pregnant or planning to become pregnant? |
| Cardiomyopathy surveillance is reasonable before pregnancy or in the first trimester for all female survivors treated with anthracyclines or chest radiation |
| No recommendations can be formulated for the frequency of ongoing surveillance in pregnant survivors who have normal left ventricular systolic function immediately prior to or during the first trimester of pregnancy |
| What should be done when abnormalities are identified? |
| Cardiology consultation is recommended for survivors with asymptomatic cardiomyopathy following treatment with anthracyclines or chest radiation |
| What advice should be given regarding physical activity and other modifiable cardiovascular risk factors? |
| Regular exercise, as recommended by the AHA and ESC, offers potential benefits to survivors treated with anthracyclines or chest radiation |
| Regular exercise is recommended for survivors treated with anthracyclines or chest radiation who have normal left ventricular systolic function |
| Cardiology consultation is recommended for survivors with asymptomatic cardiomyopathy to define limits and precautions for exercise |
| Cardiology consultation may be reasonable for high risk survivors who plan to participate in high intensity exercise to define limits and precautions for physical activity |
| Screening for modifiable cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity) is recommended for all survivors treated with anthracyclines or chest radiation so that necessary interventions can be initiated to help avert the risk of symptomatic cardiomyopathy |
