Cardiotoxicity of Chemotherapeutic Agents: A Systematic Review of Mechanisms and Cardio-Protective Strategies

Chemotherapy-induced cardiotoxicity is a significant concern in oncology, affecting cancer patients' long-term cardiovascular health. Various chemotherapeutic agents, including anthracyclines, HER2 inhibitors, tyrosine kinase inhibitors (TKIs), and immune checkpoint inhibitors, exhibit distinct cardiotoxic mechanisms, leading to complications such as left ventricular dysfunction, arrhythmias, heart failure, and vascular toxicity. Early detection and cardioprotective strategies are crucial in mitigating these adverse effects. This systematic review aims to evaluate the mechanisms, clinical impact, and cardioprotective strategies associated with chemotherapy-induced cardiotoxicity. The review explores pharmacological interventions, non-pharmacological strategies, and emerging cardio-oncology approaches to enhance cardiovascular outcomes in cancer patients. A systematic literature search was conducted using databases such as PubMed, Scopus, and Web of Science, focusing on peer-reviewed studies published in the last two decades. Studies assessing the pathophysiology of chemotherapy-induced cardiotoxicity, pharmacological and non-pharmacological interventions, and emerging cardio-oncology strategies were included. Data were synthesized through qualitative analysis, and findings were structured into key thematic areas. Anthracyclines exert irreversible cardiac damage via oxidative stress and mitochondrial dysfunction, while HER2 inhibitors induce reversible myocardial dysfunction. Pharmacological cardio-protection, including beta-blockers (carvedilol, nebivolol), ACE inhibitors (enalapril, ramipril), and dexrazoxane, effectively mitigates chemotherapy-induced cardiac dysfunction. Non-pharmacological strategies such as structured exercise programs, dietary modifications, and routine biomarker-based monitoring (troponins, NT-proBNP, echocardiographic strain imaging) aid in early detection and prevention. Emerging cardio-oncology approaches, including genetic risk stratification, precision medicine, and stem cell therapy, show promise in personalized cardio-protection. Chemotherapy-induced cardiotoxicity remains a major challenge in oncology, requiring a multidisciplinary approach to prevention, early detection, and management. Pharmacological and non-pharmacological interventions play a crucial role in mitigating cardiovascular risks, while precision medicine and regenerative therapies represent future directions in cardio-oncology. Standardized guidelines integrating biomarker-based monitoring and patient-specific cardioprotective strategies are essential to optimize cardiovascular outcomes in cancer patients. Further research is needed to refine existing interventions and explore novel therapeutic approaches to enhance long-term cardiac health in oncology care.