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Precision Prediction of Cardiotoxicity: Imaging, Biomarkers, Genetics, Risk Models, and Digital Innovation in Cardio-Oncology

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: 31 August 2026 | Viewed by 408

Editor


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Guest Editor
Cardiology Department, General Anti-Cancer Oncological Hospital, Agios Savvas Athens, 11522 Athina, Greece
Interests: chronic heart failure; acute heart failure; myocardial disease; cardiotoxicity; cardio-oncology

Special Issue Information

Dear Colleagues,

The growing complexity of contemporary cancer therapies has intensified the need for accurate, early, and individualized prediction of cardiotoxicity. Current cardiotoxicity risk scores offer useful frameworks but show limited performance across diverse patient populations and treatment settings, and often fail to incorporate key determinants of vulnerability, including frailty, genetic background, sex-related biological differences, and social, racial, and national factors.

This Special Issue focuses on precision approaches to cardiotoxicity prediction, integrating advanced cardiovascular imaging, circulating biomarkers, multivariable risk scores, and genetic susceptibility with emerging artificial intelligence and machine learning-based models. Particular emphasis is placed on sex-related differences, biological heterogeneity, and the use of digital health technologies, including wearable devices and remote monitoring, to enhance risk stratification and longitudinal surveillance. Contributions spanning methodological innovation, translational research, and clinical implementation are welcome.

By bringing together multimodal data and digital tools, this Special Issue aims to advance personalized prediction strategies and to support more effective prevention and management of cancer therapy-related cardiovascular toxicity.

Dr. Kalliopi Keramida
Guest Editor

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Keywords

  • cardio-oncology
  • imaging
  • biomarkers
  • genetics
  • risk models
  • digital innovation

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Published Papers (1 paper)

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Research

11 pages, 632 KB  
Article
Evaluation of Longitudinal CD40 and CD40L Changes During Adjuvant Breast Cancer Therapy and Their Association with Left Ventricular Dysfunction
by Georgia Efthymiou, Maria Anastasiou, Evangelos Oikonomou, Panagiotis Theofilis, Hector Katifelis, Elias Giallafos, Maria Gazouli, Anastasia Kotanidou and Gerasimos Siasos
Cancers 2026, 18(14), 2340; https://doi.org/10.3390/cancers18142340 - 20 Jul 2026
Viewed by 168
Abstract
Background: Left ventricular (LV) dysfunction is a clinically important complication of anthracycline- and trastuzumab-based treatment in breast cancer. Inflammatory pathways may contribute to cancer therapy-related cardiac dysfunction, and the CD40/CD40 ligand (CD40L) axis has been implicated in vascular inflammation and myocardial injury. [...] Read more.
Background: Left ventricular (LV) dysfunction is a clinically important complication of anthracycline- and trastuzumab-based treatment in breast cancer. Inflammatory pathways may contribute to cancer therapy-related cardiac dysfunction, and the CD40/CD40 ligand (CD40L) axis has been implicated in vascular inflammation and myocardial injury. This study assessed longitudinal changes in CD40 and CD40L during adjuvant treatment and their association with LV dysfunction. Methods: Twenty-eight women with operable breast cancer receiving adjuvant anthracycline-based chemotherapy with or without trastuzumab were prospectively evaluated. Blood samples were collected at baseline, 6 months, and treatment completion at 15 months to measure CD40 and CD40L. Cardiac function was assessed by transthoracic echocardiography, including left ventricular ejection fraction and global longitudinal strain, at baseline and every 3 months. Repeated-measures analysis of variance examined temporal biomarker changes and interactions with LV dysfunction. Results: Participants had a mean age of 52.6 ± 10.7 years and a mean BMI of 25.8 ± 4.8 kg/m2; 64% were postmenopausal, 76% had HER2-positive disease, and 79.3% received radiotherapy and trastuzumab. During follow-up, 15 patients (53.6%) developed LV dysfunction. CD40 levels remained stable overall (p = 0.31), whereas CD40L increased significantly over time (p < 0.001). Baseline CD40 did not differ by LV dysfunction status (p = 0.79). However, CD40 showed a significant time-by-LV dysfunction interaction (p = 0.022), increasing late in patients with LV dysfunction and declining in those without it. CD40L showed no such interaction (p = 0.85). Conclusions: In this small exploratory cohort, CD40 demonstrated differential longitudinal patterns according to subsequent LV dysfunction, whereas CD40L increased over time without a clear association with LV dysfunction. These findings should be interpreted as hypothesis-generating and require validation in larger prospective cohorts. Full article
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