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Table 1.

Comparison of five different classifications of cardiotoxicity focusing on CHF

Classification system (reference)Grade IGrade IIGrade IIIGrade IV
NYHA No limitation of activities Mild limitation of activity Marked limitation of activity Confined to bed or chair 
American College of Cardiology/American Heart Association (3) Stage A; at high risk but without structural heart disease or symptoms Stage B; structural heart disease but without signs or symptoms Stage C; Structural heart disease with prior or current symptoms Stage D; Refractory CHF requiring specialized interventions 
Clinical toxicity criteria, version 2.0* Asymptomatic decline of resting EF ≥10% but <20% of baseline value Asymptomatic but resting EF less than LLN for laboratory or decline of resting EF of ≥20% of baseline value; <24% SF CHF responsive to treatment Severe or refractory CHF or requiring intubation 
Common terminology criteria for adverse events version 3.0 Asymptomatic, resting EF <60%-50%; SF <30%-24% Asymptomatic, resting EF <50%-40%; SF <30%-24% Symptomatic CHF responsive to intervention; EF <40%-20%; SF <15% Refractory CHF or poorly controlled; EF <20%, intervention such as ventricular assist device, ventricular reduction surgery, or heart transplant indicated 
Cardiac review and evaluation committee (5) Decline in LVEF of at least 10% to <55% without signs or symptoms of CHF Global decrease in LVEF Signs or symptoms of CHF Decline in LVEF of at least 5% to <55% with signs or symptoms of CHF 
Classification system (reference)Grade IGrade IIGrade IIIGrade IV
NYHA No limitation of activities Mild limitation of activity Marked limitation of activity Confined to bed or chair 
American College of Cardiology/American Heart Association (3) Stage A; at high risk but without structural heart disease or symptoms Stage B; structural heart disease but without signs or symptoms Stage C; Structural heart disease with prior or current symptoms Stage D; Refractory CHF requiring specialized interventions 
Clinical toxicity criteria, version 2.0* Asymptomatic decline of resting EF ≥10% but <20% of baseline value Asymptomatic but resting EF less than LLN for laboratory or decline of resting EF of ≥20% of baseline value; <24% SF CHF responsive to treatment Severe or refractory CHF or requiring intubation 
Common terminology criteria for adverse events version 3.0 Asymptomatic, resting EF <60%-50%; SF <30%-24% Asymptomatic, resting EF <50%-40%; SF <30%-24% Symptomatic CHF responsive to intervention; EF <40%-20%; SF <15% Refractory CHF or poorly controlled; EF <20%, intervention such as ventricular assist device, ventricular reduction surgery, or heart transplant indicated 
Cardiac review and evaluation committee (5) Decline in LVEF of at least 10% to <55% without signs or symptoms of CHF Global decrease in LVEF Signs or symptoms of CHF Decline in LVEF of at least 5% to <55% with signs or symptoms of CHF 

Abbreviations: EF, ejection fraction; LLN, lower limit of normal; SF, shortening fraction.

*

Adverse events are cardiovascular (general) and cardiac left ventricular function; http://ctep.cancer.gov.forms/CTCv20_4-30-992.pdf.

Adverse events are cardiac general and left ventricular systolic dysfunction; http://ctep.cancer.gov/forms/CTCAEv3.pdf.

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