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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Cardio-Oncology · Anthracycline-Induced Cardiomyopathy

Monitoring and Surveillance: Tracking Your Heart Health

At a Glance

Regular echocardiograms and blood tests before, during, and after anthracycline chemotherapy can detect heart stress before symptoms appear. LVEF, GLS, troponin, and BNP results are interpreted together to guide follow-up and possible heart-protective treatment.

Monitoring your heart is a proactive way to ensure your cancer treatment is as safe as it is effective. Because early heart changes often do not cause symptoms, your medical team uses advanced imaging and blood tests to “look under the hood” at regular intervals tailored to your specific risk [1][2]. These tests help detect subclinical dysfunction—stress on the heart muscle that is happening before you feel it or before the heart’s overall pumping power drops [3][4].

Advanced Imaging: Beyond the Pumping Number

The primary tool for monitoring is the echocardiogram, a painless ultrasound that takes about 45 minutes to capture images of your heart in motion. For the best accuracy, it is highly recommended to have your scans done at the same laboratory using the same imaging method each time [1].

  • Left Ventricular Ejection Fraction (LVEF): This is the percentage of blood the heart’s main chamber pumps out with each beat. A “normal” LVEF is typically 50–70% [5][6]. An LVEF drop of more than 10 percentage points to a level below 50% is a common signal of heart stress [7][6].
  • Global Longitudinal Strain (GLS): This is a more sensitive measure that tracks how the heart muscle fibers stretch and contract [3]. GLS can often detect changes before the LVEF begins to fall [8].
  • Interpreting GLS: Current guidelines from the European Society of Cardiology (ESC) identify a relative decline in GLS of more than 15% from your starting baseline as a key threshold [9][5]. This result is an important signal, but it is not an automatic trigger to start medication. Your team will interpret it alongside the image quality, your LVEF, blood tests, and symptoms to decide whether you need closer follow-up or a prescription [10][11].

Cardiac Biomarkers: Early Warning Signals

In addition to scans, your team may use blood tests called biomarkers to check for heart stress or injury [12]. Depending on your risk, these might be checked periodically rather than at every single chemo cycle.

  • Troponin: This is a protein released when heart muscle cells are injured [13]. A new rise in troponin levels beyond normal laboratory reference ranges can signal myocardial injury and predict a future drop in heart function [12][14].
  • BNP or NT-proBNP: These are markers of “wall stress”—they rise when the heart is working harder than it should [12][7]. Note that these numbers can also fluctuate due to age, kidney function, and fluid levels.

Your Surveillance Schedule

The frequency of these tests depends on your individual risk score, the chemotherapy regimen, and whether you already have heart disease.

  1. Baseline: A full heart scan and biomarker check before the first dose to establish your “normal” [1][12].
  2. During Treatment: Higher-risk patients or those receiving very high doses may have periodic scans during treatment [15][16]. Low-risk patients may have different schedules based on local protocols [17].
  3. After Treatment: A thorough check is commonly performed in the first year after chemotherapy ends, as this is when many changes are detected [16].
  4. Long-Term: Survivors may require “survivorship” scans every few years depending on their total dose and other health factors [16][18].

What Happens If a Result Is Abnormal?

It is important to remember that an abnormal heart test does not automatically mean stopping your cancer treatment [19]. Cancer treatments are vital. If your LVEF or GLS drops, your oncology and cardiology teams will jointly decide the next steps. They may confirm the result with a repeat scan, refer you to a cardio-oncologist, or consider medications like ACE inhibitors or beta-blockers [17][20][11]. Early detection creates an opportunity for intervention, which may improve function over time [16][10].

Common questions in this guide

What do LVEF results tell me about my heart?
LVEF is the percentage of blood pumped out of the heart's main chamber with each beat. A typical normal range is about 50% to 70%; a drop of more than 10 percentage points to below 50% can signal heart stress. Your team will interpret the result with your other tests and symptoms.
What does a 15% decline in GLS mean?
Global longitudinal strain, or GLS, measures how the heart muscle fibers stretch and contract and may change before LVEF falls. A relative decline of more than 15% from baseline is an important warning signal, but it does not automatically mean you need medication. Clinicians also consider image quality, LVEF, blood tests, and symptoms.
Why are troponin and BNP or NT-proBNP checked?
Troponin can rise when heart muscle cells are injured, while BNP and NT-proBNP can rise when the heart is under increased wall stress. These results may provide early warning of heart changes, but BNP-related values can also vary with age, kidney function, and fluid levels. Your team may check them periodically based on your risk.
How often will my heart be checked during and after anthracycline chemotherapy?
A baseline echocardiogram and biomarker check are commonly done before the first dose. The timing of repeat tests depends on your cardiovascular risk, chemotherapy regimen, treatment dose, and existing heart disease; higher-risk patients may be monitored during treatment. A check is commonly done during the first year after treatment, with later scans for some survivors.
Does an abnormal heart test mean I must stop chemotherapy?
No, an abnormal LVEF, GLS, or blood test does not automatically mean that cancer treatment must stop. Your oncology and cardiology teams may repeat the test, involve a cardio-oncologist, or consider heart-protective medicines such as an ACE inhibitor or beta-blocker. The plan is individualized to balance cancer treatment with heart safety.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my current LVEF, and has my Global Longitudinal Strain (GLS) changed since my baseline scan?
  2. 2.Is a relative decline of 15% in my GLS considered a signal to start heart-protective medications in my case?
  3. 3.How often will my troponin and BNP/NT-proBNP levels be checked, and what do these numbers tell you about my heart's stress levels?
  4. 4.If one of my heart tests comes back 'abnormal,' does that mean I have to stop my chemotherapy, or can we manage it with other medications?
  5. 5.Based on my overall risk score, what is the exact schedule for my heart scans during and after my treatment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

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This page explains heart monitoring during and after anthracycline chemotherapy for educational purposes and does not replace medical advice. Your oncology and cardiology teams should interpret your results and set your personal surveillance schedule.

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