Comparison of five different classifications of cardiotoxicity focusing on CHF
| Classification system (reference) . | Grade I . | Grade II . | Grade III . | Grade 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 I . | Grade II . | Grade III . | Grade 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.