Risk Stratification, Preventive Therapy, and Surveillance of Trastuzumab-treated Patients.

Blue arrows symbolize cardio-oncological chronological point of intervention.

*Dependent on the availability of alternative therapies and following cardio-oncology team discussion. Holding trastuzumab and re-challenge following EF normalization (LVEF>50%) is one potential strategy. ^†LVEF should be assessed using 2D Simpson’s LVEF or preferably 3D-based LVEF. ^‡One risk stratification criterion required. ^§dLVEF>10%: reduction in LVEF>10% and LVEF<50%.

AC, anthracyclines; dLVEF, difference in left ventricular ejection fraction; EF, ejection fraction; GLS, global longitudinal strain; HsTnI, high-sensitivity troponin I; LV, left ventricular; RT, radiation therapy.