SynthesisFrontiers in cardiovascular medicine2026
Time-dynamic perspectives on cancer therapy-related cardiotoxicity: a systematic review and time-course evidence synthesis for multibiomarker monitoring.
Synthesis in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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9 authors.
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Abstract
Objective: Current monitoring of cancer therapy-related cardiac dysfunction relies largely on threshold-based interpretation at isolated time points, yet its temporal evolution remains insufficiently characterized. This review aims to map longitudinal monitoring evidence across treatments, biomarkers, and time windows; reconstruct trajectories of key biochemical and imaging markers in evidence-rich settings; and explore temporal patterns between biochemical injury signals and imaging-detected functional changes. Methods: PubMed and Embase were searched from inception to 1 October 2025. A three-dimensional evidence map was constructed across treatment modality, monitoring marker, and time window using a custom four-level evidence grading system based on data completeness and extractability. Quantitative synthesis was restricted to cohorts providing extractable longitudinal absolute values at mappable follow-up times in non-outcome-driven designs. Standardized trajectories of hs-cTnI/T, NT-proBNP, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) were aggregated within predefined time windows. Results: Forty-six independent cohorts yielded 387 raw longitudinal observations; after harmonization and representative-value selection, 173 effect rows from 31 analytic study IDs (29 primary reports) contributed to the trajectory synthesis. Evidence was concentrated in anthracycline-based and anthracycline plus concurrent/sequential HER2 inhibitor settings, whereas data on immune checkpoint inhibitor (ICI) therapy, vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGF-TKI) therapy, and the biomarkers sST2 and GDF-15 were sparse. In evidence-rich settings, hs-cTnI tended to show early elevations (D0-M3), while more pronounced declines in LVEF and GLS were observed mainly after M3. Because estimates were derived from aggregated study-level data, this ordering is descriptive and hypothesis-generating rather than evidence of within-patient temporal precedence. Under anthracycline plus concurrent/sequential HER2 inhibitor exposure, hs-cTnI elevations and later imaging declines were greater in the available windows; data beyond 12 months were sparse, making the apparent absence of recovery provisional. Conclusion: This review provides a unified time-window framework for multimarker longitudinal evidence across anticancer treatment settings, identifies critical evidence gaps, and describes an exploratory temporal pattern that may inform hypotheses about stage-specific monitoring in evidence-rich settings. Patient-level longitudinal studies are required before any monitoring schedule can be validated. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261367699, PROSPERO CRD420261367699.
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