Info

For Hematologists

The ESC Cardio-Oncology Guidelines emphasize that CV risk prevention should start at the time of cancer diagnosis and before initiation of therapy. This allows:

identification of pre-existing CV disease and risk factors; (SCORE2 and SCORE2-OP)
estimation of cardiotoxicity risk related to the planned cancer therapy;
timely optimization of modifiable risk factors;
referral to cardio-oncology services for high-risk patients.

CTR-CVT risk is dynamic — it can evolve throughout cancer therapy and survivorship. Regular reassessment is recommended.

Baseline Cardiovascular Toxicity Risk Assessment

A systematic and personalized baseline assessment is mandatory before potentially cardiotoxic therapy.
The process integrates medical history, physical exam, laboratory evaluation, imaging, and structured risk scoring.

General Approach

Checklist for baseline assessment:

Category	Components
Medical history	Pre-existing cardiovascular disease (CVD) Prior cardiotoxic cancer therapies Traditional CV risk factors: hypertension, diabetes, dyslipidemia, smoking, obesity, sedentary lifestyle, alcohol use
Physical examination	Vital signs Blood pressure Heart rate
Laboratory tests	Lipid profile Fasting glucose, HbA1c Kidney function (eGFR) ± Cardiac biomarkers (hs-troponin, BNP/NT-proBNP) depending on risk and treatment plan. Of note: NTproBNP is not reimbursed in Belgium
ECG	Recommended for all patients Assessment of rhythm, QTc, conduction abnormalities
Transthoracic echocardiography (TTE)	A complete TTE exam is mandatory, including LVEF and GLS measurements if available, consider 3D LVEF)
Other imaging	Cardiac MRI if echocardiography is non-diagnostic
Functional assessment	Optional cardiopulmonary exercise testing (CPET) in selected preoperative or high-risk cases

Risk stratification

Assess global CV risk using SCORE2 or SCORE2-OP for 10-year fatal and non-fatal CV risk.
➜ (HeartScore ; for Belgium: https://heartscore.escardio.org/Calculate/quickcalculator.aspx?model=low)
Perform baseline risk stratification using the Heart Failure Association–International Cardio-Oncology Society (HFA–ICOS) risk tool.
➜ CancerCalc – HFA–ICOS Risk Calculator

Cardiology or Cardio-oncology Referral

Cardio-oncology referral in all patients with (moderate (Class IIb) to) high/very high (Class I) risk before anti-cancer therapy:

Age >65 years

Multiple uncontrolled cardiovascular risk factors

Preexisting heart disease

Uncontrolled arterial hypertension

Any abnormal findings on the baseline TTE or ECG

High or very high risk for cardiotoxicity based on Cardio-Oncology Society (HFA–ICOS) risk calculator (CancerCalc – HFA–ICOS Risk Calculator)

During treatment cardio-oncology referral, if:

Decrease of LVEF by 10% from the baseline, or new LVEF reduction to <50%

Decrease of GLS >15% from the baseline

Development of uncontrolled arterial hypertension

Development of atrial fibrillation or other arrhythmias

New cardiovascular signs and symptoms