Table 1

Variation in definitions of cardiotoxicity across standards organisations

Standards organisationDefinition of cardiotoxicityComments
ASE/EACVILVEF fall by >10% to absolute EF <53%Change in LV function may be global or regional (septum)
Symptomatic or asymptomatic for HF
ESCLVEF fall by >10% from baseline to EF <50%Symptomatic or asymptomatic for HF
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)
CCSLVEF 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
ESMOSymptomatic 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.