Echocardiographic monitoring in cancer therapy: clinical guidance for cardiologists and oncologists

Transthoracic echocardiography has a central role in the diagnosis and monitoring of cancer therapy-related cardiac dysfunction, offering a reliable, non-invasive, and cost-effective tool for the early detection of myocardial damage and the timely and effective management of cardiotoxicity. This review provides a practical and comprehensive framework for the echocardiographic assessment of oncology patients, focusing on both traditional and emerging ultrasound parameters of left and right ventricular function, and their diagnostic and prognostic value in the field of cardio-oncology. Moreover, the review discusses key aspects of pericardial disease, valvular heart disease, and intracardiac masses, which may be consequences of cancer therapy or tumor progression. Finally, the role of multimodal imaging, in particular cardiac magnetic resonance and computed tomography, is examined, especially in selected cases to supplement echocardiographic findings or when echocardiography presents limitations. Based on current guidelines and clinical experience, this review aims to provide both cardiologists and oncologists with a practical tool for interpreting echocardiographic reports in cancer patients. Additionally, a therapeutic algorithm is proposed to guide decisions on cancer treatment management and timely initiation of cardioprotective strategies in selected contexts. Close collaboration between cardiologists and oncologists remains essential to reduce cancer patients’ cardiovascular risk, allowing them to access the best possible treatment and optimize outcomes by balancing anticancer therapy efficacy with cardiovascular safety.