Cardiac imaging in oncology: the detection of cardiotoxicity

Cardio-oncology has emerged as a rapidly growing subspecialty within both cardiology and oncology, bridging the gap between these two disciplines to address the cardiovascular complications associated with cancer therapies. The development of novel therapies and targeted agents has revolutionised cancer treatment and patient survival. However, these advances have been accompanied by an increase in cardiovascular complications, commonly referred to simply as ‘cardiotoxicity’, or more recently, as cancer therapy–related cardiovascular toxicity (CTR-CVT). CTR-CVT encompasses a broad spectrum of adverse cardiac effects, ranging from asymptomatic left ventricular systolic dysfunction to life-threatening heart failure, myocarditis, arrhythmias and ischaemic events. Early detection of cardiotoxicity is crucial to prevent irreversible cardiac damage and maintain patients’ quality of life. Timely intervention may facilitate modifications in cancer treatment or the implementation of cardioprotective strategies to halt or reverse cardiac damage. Cardiac imaging in general—and echocardiography in particular—plays a pivotal role in achieving this goal by enabling clinicians to monitor, detect and manage cardiac dysfunction in patients with cancer. Improved survival rates have transformed many cancers into manageable chronic conditions. Cardiovascular disease is now a leading cause of morbidity and mortality among cancer survivors, emphasising the need for vigilant cardiovascular monitoring before, during and after cancer treatment. This review will focus on imaging tools and strategies in the detection of cardiotoxicity. We will explore conventional and emerging imaging modalities, highlighting their strengths, limitations and the evolving guidelines that shape clinical practice.