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The State of the Art in Cardio-Oncology
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The State of the Art in Cardio-Oncology

A Special Issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: 20 December 2026 | Viewed by 2693

Editor

Dr. Fabio Maria Turazza

E-Mail Website
Guest Editor
1. Former Director of Fondazione IRCCS National Cancer Institute, 20133 Milan, Italy
2. Consultant Cardiologist for AICARM (Italian Association for Cardiomyopathies), 50122 Florence, Italy
Interests: cardio-oncology; radiation-induced heart diseases; cardiomyopathies; advanced heart failure; heart transplantation

Special Issue Information

Dear Colleagues,

Cardio-oncology is undergoing a significant transformation. What began as a niche field primarily concerned with investigating and managing cardiotoxicity resulting from cancer therapies has, in recent years, evolved into a well-established subspecialty. The scope of cardio-oncology now encompasses not only the prevention of cardiotoxicity but also the management of both longstanding and emerging cardiovascular risk factors in cancer patients. It focuses on delivering optimal cardiac care, including interventional procedures when necessary, to this growing patient population.

A deeper understanding of the pathophysiological mechanisms behind various cardiotoxicities has given rise to a new area within the field, referred to as “reverse cardio-oncology.” Notably, cancer and cardiovascular diseases—the two leading causes of mortality in Western countries—have been found to share not only several risk factors but also certain underlying pathophysiological mechanisms. This bidirectional relationship underscores the importance of cardio-oncology for both cardiologists and oncologists, considering the vast number of patients affected.

Insights into the mechanisms of specific cardiotoxicities have also facilitated the identification of potential new therapeutic targets for heart diseases in patients without cancer. As advances in cancer treatments yield a growing population of long-term survivors, including those with metastatic disease, the need for comprehensive cardiovascular care becomes increasingly critical.

Central to the modern approach is the concept of “precision cardio-oncology,” which emphasizes tailoring patient management throughout the entire cancer journey—from initial diagnosis through treatment and long-term follow-up—based on individual patient and cancer characteristics. In addition, innovative imaging technologies such as computed tomography and cardiac magnetic resonance imaging, combined with the expanding use of artificial intelligence, are opening new avenues for research and clinical practice in cardio-oncology.

This Special Issue is dedicated to exploring the history, development, and future directions of cardio-oncology, highlighting its expanding role and the ongoing innovations shaping its trajectory.

Dr. Fabio Maria Turazza
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardio-oncology
  • cardiotoxicity
  • cancer therapeutics
  • reverse cardio-oncology
  • precision cardio-oncology
  • genetics in cardio-oncology

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Published Papers (4 papers)

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Research

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14 pages, 1009 KB  
Article
Cardiovascular Complications and Subclinical Myocardial Dysfunction in Patients Undergoing Hematopoietic Stem Cell Transplantation
by Sabina Caciolli, Andrea Grasso Granchietti, Francesco Vanni, Meghi Murati, Martina Vito, Matteo Vannini, Leandro Cosco, Giacomo Coltro, Andrea Pasquini, Chiara Nozzoli and Maurizio Pieroni
Cancers 2026, 18(12), 1871; https://doi.org/10.3390/cancers18121871 - 8 Jun 2026
Viewed by 407
Abstract
Background: Cardiovascular complications are increasingly recognized in patients undergoing hematopoietic stem cell transplantation (HSCT). Early detection of subclinical myocardial dysfunction may improve risk stratification, and global longitudinal strain (GLS) is emerging as a sensitive marker of early cardiac impairment. Methods: We [...] Read more.
Background: Cardiovascular complications are increasingly recognized in patients undergoing hematopoietic stem cell transplantation (HSCT). Early detection of subclinical myocardial dysfunction may improve risk stratification, and global longitudinal strain (GLS) is emerging as a sensitive marker of early cardiac impairment. Methods: We conducted a single-center observational cohort study including 518 adult patients undergoing autologous (n = 64) or allogeneic (n = 454) HSCT between 2004 and 2025. Baseline cardiovascular risk factors, transplant characteristics, and echocardiographic parameters—including GLS in a subset—were recorded. Abnormal GLS was defined as less negative than −20%. The primary outcome was the occurrence of cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, atrial fibrillation/flutter, pericardial effusion, pulmonary embolism, and left ventricular systolic dysfunction). Multivariable logistic regression was used to identify independent predictors. Results: Median age was 53 years; 58% were male. Cardiovascular events were predominantly atrial fibrillation, pericardial effusion, and reduced left ventricular function, whereas ischemic events were rare. Over 90% of events occurred within 100 days post-transplant. Multivariable analysis identified older age (OR 1.28 per 10-year increment; 95% CI 1.10–1.48; p = 0.002), chronic kidney disease (OR 2.44; 95% CI 1.18–5.02; p = 0.01), pre-transplant atrial fibrillation (OR 2.12; 95% CI 1.04–4.31; p = 0.03), and abnormal baseline GLS (OR 1.89; 95% CI 1.02–3.52; p = 0.04) as independent predictors. Importantly, the prognostic value of GLS remained significant after excluding clinically insignificant pericardial effusions from the composite endpoint. GLS deterioration during follow-up occurred more frequently in patients receiving reduced-intensity conditioning compared with myeloablative conditioning (25% vs. 12.7%; p = 0.006). Conclusions: Subclinical myocardial dysfunction detected by GLS identifies HSCT recipients at increased cardiovascular risk. These findings support the incorporation of strain imaging into routine pre- and post-transplant cardiovascular evaluation to enable earlier detection and guide targeted interventions. Full article
(This article belongs to the Special Issue The State of the Art in Cardio-Oncology)
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Review

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11 pages, 594 KB  
Review
The Current Landscape of Pulmonary Hypertension in Myeloproliferative Neoplasms
by Monica Ferrante, Hyeon-Ju Ali, Gabriela Hobbs and Orly Leiva
Cancers 2026, 18(17), 2775; https://doi.org/10.3390/cancers18172775 - 26 Aug 2026
Viewed by 136
Abstract
Pulmonary hypertension (PH) is an increasingly recognized complication of Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs). Recent data suggest prognostic implications of both cardiovascular morbidity and mortality and hematologic progression. Additionally, PH and MPNs share common pathophysiologic mechanisms that bridge these two seemingly different disorders. [...] Read more.
Pulmonary hypertension (PH) is an increasingly recognized complication of Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs). Recent data suggest prognostic implications of both cardiovascular morbidity and mortality and hematologic progression. Additionally, PH and MPNs share common pathophysiologic mechanisms that bridge these two seemingly different disorders. The landscape of PH in MPNs is evolving in the face of improved survivorship and reduced disease progression, leading to increased incidence and prevalence of concurrent and/or consequent cardiovascular disease. Prospective studies are necessary to refine screening protocols, risk stratification, and prognostic and therapeutic implications of PH in this population. Full article
(This article belongs to the Special Issue The State of the Art in Cardio-Oncology)
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25 pages, 1250 KB  
Review
Sex Differences in Cancer and Cardiotoxicity: Mechanisms, Outcomes, and Clinical Implications Across Solid and Hematological Malignancies
by Kalliopi Keramida, Marianne C. Aznar, Jutta Bergler-Klein, Giuseppe Boriani, Daniela Cardinale, Susan Dent, Alexandra Drakaki, Jose J. Fuster, Mamas A. Mamas, Tochi Okwuosa, Lydia Scarfo, Peter Van Der Meer, Eric H. Yang and Teresa Lopez-Fernandez
Cancers 2026, 18(11), 1677; https://doi.org/10.3390/cancers18111677 - 22 May 2026
Cited by 2 | Viewed by 884
Abstract
Sex differences influence cancer incidence, treatment response, and susceptibility to cardiovascular toxicity. Males exhibit higher rates and poorer outcomes in most non-sex-specific cancers, while females more frequently experience treatment-related adverse events, including cancer therapy-related cardiac dysfunction. Biological factors such as hormonal status, genetic [...] Read more.
Sex differences influence cancer incidence, treatment response, and susceptibility to cardiovascular toxicity. Males exhibit higher rates and poorer outcomes in most non-sex-specific cancers, while females more frequently experience treatment-related adverse events, including cancer therapy-related cardiac dysfunction. Biological factors such as hormonal status, genetic polymorphisms, immune responses, and pharmacokinetics contribute to these disparities. In cardio-oncology, women—particularly premenopausal or with specific genotypes—may be at increased risk for cardiotoxicity after treatment with anthracyclines, immune checkpoint inhibitors or radiotherapy. Clonal hematopoiesis and certain germline genetic variants such as single nucleotide polymorphisms (e.g., RARG rs2229774, HAS3 rs2232228) are emerging as potential sex-informed biomarkers for predicting cardiotoxicity risk. Despite growing evidence, sex remains insufficiently integrated into clinical trials and guideline development in cardio-oncology. This review highlights the importance of sex-specific surveillance, prevention, and multi-omic risk stratification to advance precision cardio-oncology and support better outcomes for patients across the cancer care continuum. Full article
(This article belongs to the Special Issue The State of the Art in Cardio-Oncology)
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21 pages, 1069 KB  
Review
Precision Cardio-Oncology and Nuclear Imaging: Current Applications, Molecular Innovations, and Future Trajectories
by Biruk Demisse Ayalew, Muhammad Areeb Ul Haq, Talha Farooq, Moosa Mubarika, Muhammad Umar, Urvah Shafique, Abdullah Rehman, Hassan H. Eladl, Abad Ahmad Toor, Eman Fatima, Temesgen Mamo Sharew, Mirza Mohammad Ali Baig, David N. Smith and Daniel Addison
Cancers 2026, 18(10), 1625; https://doi.org/10.3390/cancers18101625 - 18 May 2026
Viewed by 645
Abstract
Cardiovascular toxicity has emerged as a major determinant of long-term outcomes in cancer survivors as advances in oncologic therapies continue to improve survival. Conventional cardiac surveillance strategies predominantly rely on functional and structural changes, often identifying myocardial injury after clinically significant damage has [...] Read more.
Cardiovascular toxicity has emerged as a major determinant of long-term outcomes in cancer survivors as advances in oncologic therapies continue to improve survival. Conventional cardiac surveillance strategies predominantly rely on functional and structural changes, often identifying myocardial injury after clinically significant damage has occurred. The aim of this narrative review is to critically evaluate the role of nuclear imaging in advancing precision cardio-oncology by enabling earlier, mechanism-based detection and characterization of cancer therapy-related cardiotoxicity. We summarize current clinical applications of PET- and SPECT-based imaging, examine molecular and tracer-level innovations, and discuss emerging hybrid imaging and analytic approaches relevant to individualized cardiovascular risk stratification. Current literature indicates that nuclear imaging provides unique insights into myocardial perfusion, metabolism, inflammation, and microvascular dysfunction, facilitating detection of subclinical injury across diverse anticancer therapies, including anthracyclines, targeted agents, and immune checkpoint inhibitors. By integrating molecular imaging with conventional modalities, nuclear techniques support more personalized surveillance and management strategies. This narrative review highlights nuclear imaging as an emerging complementary modality within precision cardio-oncology supporting earlier detection and risk stratification, and outlines future directions required to optimize its clinical integration and impact on cardiovascular outcomes across the cancer care continuum. Full article
(This article belongs to the Special Issue The State of the Art in Cardio-Oncology)
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