Variation in definitions of cardiotoxicity across standards organisations
| Standards organisation | Definition of cardiotoxicity | Comments |
| ASE/EACVI | LVEF fall by >10% to absolute EF <53% | Change in LV function may be global or regional (septum) Symptomatic or asymptomatic for HF |
| ESC | LVEF fall by >10% from baseline to EF <50% | Symptomatic or asymptomatic for HF |
| NCI | CTCAE HF grade 1–5 | Grade 1 (asymptomatic) Grade 2 (mild to moderate symptoms) Grade 3 (symptomatic on minimal exertion or at rest) Grade 4 (life-threatening) Grade 5 (death) |
| CCS | LVEF fall by >10% from baseline or LVEF <53% | Guidelines also recommend (1) 3D echocardiography or same imaging modality during cancer therapy, (2) myocardial strain imaging and (3) cardiac biomarkers (N-terminal pro brain natriuretic peptide, troponin) for early detection |
| ESMO | Symptomatic decline in LVEF of at least 5% to <55% or asymptomatic decline in LVEF of at least 10% to <55% | Symptoms for congestive HF with signs including but not limited to S3 gallop, tachycardia or both Decline in LVEF either global or more severe in the septum |
Adapted from CCS guidelines by Virani et al CJC 2016 (32) 831–841 and ESMO statement Curigliano et al Annals Oncol 2012 23 (suppl 7); vii 155–vii 166.
ASE, American Society of Echocardiography; CCS, Canadian Cardiovascular Society; CTCAE, Common Terminology Criteria for Adverse Events; EACVI, European Association of Cardiovascular Imaging; EF, ejection fraction; ESC, European Society of Cardiology; ESMO, European Society of Medical Oncology; HF, heart failure; LVEF, left ventricular ejection fraction; NCI, National Cancer Institute.