Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed.

1 M Sechenov's 1st Moscow State Medical University of Ministry of Health Moscow Russia

1st Department of Medicine Cardioangiology Charles University Prague Medical Faculty and University Hospital Hradec Králové Hradec Kralove Czech Republic

American Medical Center American Heart Institute Nicosia Cyprus

Baker Heart and Diabetes Institute Melbourne Australia

Bristol Heart Institute Bristol NIHR Biomedical Research Centre and Clinical Research and Imaging Centre Bristol University Hospitals Bristol NHS Trust and University of Bristol Bristol UK

Cardio Oncology Clinic Heart Failure Unit Department of Cardiology Athens University Hospital Attikon National and Kapodistrian University of Athens Athens Greece

Cardio Oncology Service Royal Brompton Hospital London UK

Cardiologist in Practice Turin Italy

Cardiology Clinical Academic Group St George's Hospitals NHS Trust University of London London UK

Cardiology Department La Paz University Hospital IdiPAz Ciber CV Madrid Spain

Cardiology Department Military Hospital and CINTESIS CardioCare Faculty of Medicine Porto University Porto Portugal

Cardiology Department University Hospital Ramón y Cajal Madrid Spain

CIBERCV Instituto de Salud Carlos 3 Madrid Spain

Clinic of Cardiac and Vascular Diseases Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Department of Advanced Biomedical Sciences Federico 2 University Hospital Naples Italy

Department of Cardiac Magnetic Resonance Royal Brompton Hospital London UK

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel University of Basel Basel Switzerland

Department of Cardiology and Pneumology University of Göttingen Medical Centre Göttingen Germany

Department of Cardiology CARIM School for Cardiovascular Diseases Faculty of Health Medicine and Life Sciences Maastricht University Maastricht The Netherlands

Department of Cardiology CHVZ Laboratory Universitair Ziekenhuis Brussel Brussels Belgium

Department of Cardiology Inselspital University of Bern Bern Switzerland

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Cardiology Medical University of Vienna Vienna Austria

Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway

Department of Cardiology St Bartholomew Hospital Barts Health Trust London UK

Department of Cardiology University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Cardiovascular Sciences Centre for Molecular and Vascular Biology KU Leuven Leuven Belgium

Department of Health Medicine and Caring Sciences Linköping University Linköping Sweden

Department of Medical Sciences IRCCS San Raffaele Pisana Rome Italy

Department of Medical Sciences Uppsala University Clinical Physiology and Cardiology Akademiska Hospital Uppsala Sweden

Department of Nuclear Medicine Royal Brompton Hospital London UK

Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research Federico 2 University Naples Italy

Division of Cardiology and Metabolism Department of Cardiology Charité; and Berlin Institute of Health Center for Regenerative Therapies partner site Berlin; and Department of Cardiology Charité Campus Benjamin Franklin Berlin Germany

DZHK partner site Berlin Berlin Germany

Emergency Institute for Cardiovascular Diseases C C Iliescu Bucuresti Romania

Faculty of Medicine University of Oslo Oslo Norway

Hannover Medical School Institute of Molecular and Translational Therapeutic Strategies Hannover Germany

Heart Clinic Hirslanden Hirslanden Hospital Zurich Switzerland

Heart Failure Unit Cardiology Guglielmo da Saliceto Hospital Piacenza Italy

IRCCS San Raffaele Pisana Rome Italy

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht and Utrecht University Utrecht The Netherlands

National Heart and Lung Institute Imperial College London Hammersmith Hospital London UK

National Heart and Lung Institute Imperial College London UK

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

State Research Institute Centre For Innovative Medicine Vilnius Lithuania

Tel Aviv Jaffa District Clalit Health Services Tel Aviv Israel

UMR S 942 Cardiology Department Hôpital Lariboisière AP HP Université de Paris Paris France

Unit of Inherited Cardiovascular Diseases Heart Center of the Young and Athletes 1st Department of Cardiology Hippokrateion General Hospital National and Kapodistrian University of Athens Athens Greece

Université de Paris CIC1418 Paris Cardiovascular Research Center INSERM Paris France

University Alcala Madrid Spain

University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland

University of Belgrade Faculty of Medicine and Serbian Academy of Sciences and Arts Belgrade Serbia

University of Cyprus Medical School Nicosia Cyprus

University of Liège Hospital GIGA Cardiovascular Sciences Department of Cardiology CHU SartTilman Liège Belgium

University of Medicine Carol Davila Bucuresti Romania

University of Parma Parma Italy

William Harvey Research Institute Barts Heart Centre Queen Mary University of London Charterhouse Square London UK

Working Group on Cardiovascular Magnetic Resonance Experimental and Clinical Research Center a joint cooperation between the Charité Universitätsmedizin Berlin Department of Internal Medicine and Cardiology and the Max Delbrueck Center for Molecular Medicine and HELIOS Klinikum Berlin Buch Department of Cardiology and Nephrology Berlin Germany

Ziekenhuis Oost Limburg University Hasselt Genk Belgium

Erratum v

Eur J Heart Fail. 2021 Feb;23(2):345. doi: 10.1002/ejhf.2153. PubMed

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