Heart failure with preserved ejection fraction in cancer patients and survivors. A scientific statement of the Heart Failure Association of the ESC and the ESC Council of Cardio-Oncology.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre-existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targeted and hormonal therapies and radiotherapy) in the pathogenesis of HFpEF. Special emphasis is given on the importance of considering HFpEF from cancer diagnosis throughout treatment and survivorship and provides useful insights for cardiologists and oncologists in the monitoring and management of these patients. Finally, it highlights the key gaps in current knowledge that require further investigation through well-designed research trials to enhance our understanding and improve clinical outcomes.