The cardiotoxicity of antitumor drugs has become the “heart disease” of oncologists. This is mainly because oncologists have difficulties in dealing with cardiac problems, while general hospital cardiologists have little access to patients with cardiac complications due to antineoplastic therapy. This is an area that everyone is concerned about but none of them can penetrate deeply. Currently, many large clinical trials of antineoplastic drugs are mostly simplistic in regard to cardiac toxicity. There are numerous antineoplastic drugs in common clinical use, and the mechanisms of cardiotoxicity vary, and there is no reliable test method to determine cardiotoxicity. Although the clinical manifestations of cardiotoxicity from antineoplastic drugs are diverse, heart failure (HF) is the most threatening to patients. The onset of HF due to antineoplastic drugs is insidious, but once it occurs, the prognosis is very poor and the mortality rate is high. Therefore, early detection and treatment of HF is particularly important. Combining multiple index indicators for early prediction Left ventricular ejection fraction Previous monitoring methods mainly measured left ventricular ejection fraction (LVEF), which is not truly representative of the incidence of cardiotoxicity, much less an indicator for early diagnosis, because a large number of cardiomyocytes are already damaged by the time LVEF decreases. Studies have found that HF with preserved LVEF (i.e., HF with normal LVEF) accounts for 20% to 50% of all HF, and even 27% of patients with acute left heart failure have LVEF ≥50%. Thus, LVEF is a less sensitive index. Troponin I and B-type natriuretic peptide Probably the most promising tests for early prediction of cardiotoxicity are troponin I (TNI) and B-type natriuretic peptide (BNP). TNI is the most specific serum marker for myocardial injury and is the most sensitive indicator. According to the study, its sensitivity is 97%, specificity is 98%, and positive predictive value is 99.8%. TNI can be abnormal when >1 g of myocardium is injured. However, if there is chronic or cumulative myocardial damage, TNI may change little or nothing, and thus cannot truly and dynamically reflect the toxicity of the heart, but is only a marker to reflect real-time acute myocardial damage. BNP is closely related to HF and can reflect the dynamic changes and degree of cardiac function, and has high sensitivity and specificity for the diagnosis of HF. The sensitivity and specificity of BNP are both high. It is found that if the standard is >100 pg/ml, the sensitivity of BNP is 90% and the specificity is 76%, and the level of BNP is positively correlated with cardiac function, which can be used as an indicator of dynamic observation of cardiac function changes, so it can also be used as an indicator of clinical efficacy and prognosis. However, BNP also has a shortcoming, that is, its level is positively correlated with the change of left ventricular wall tension. If the HF is severe but chronic in course, therefore, the change of left ventricular wall tension is small or absent, the correlation between BNP level and HF may be reduced. In conclusion, until a sensitive method for diagnosing cardiotoxicity is found, LVEF, TNI and BNP should be analyzed in a comprehensive manner, but also in combination with medical history, clinical examination and other ancillary tests, such as ECG and chest radiograph. For patients who are at high risk of cardiotoxicity from antineoplastic drugs or those who have already experienced cardiotoxicity, the effect of treatment according to current guidelines such as cardiology HF is not satisfactory, which may be related to the fact that the mechanism of myocardial damage from antineoplastic drugs is different from that of myocardial damage from general cardiac diseases. Finding better treatments and drugs becomes the key to the problem. Myocardial cytoprotective agent research Myocardial cytoprotective agents may be a promising treatment for antineoplastic drug cardiotoxicity. There are few studies in this area, and although some results have been achieved, they are mostly results of application to general heart disease, and the effect of cardiotoxicity against antineoplastic drugs is uncertain, and further studies are needed on how to apply them, whether they are used alone or in combination. Fructose 1,6 diphosphate is an important intermediate in cellular energy metabolism, and can exert significant cardiomyocyte protective effects by improving cellular energy metabolism, stabilizing cellular membranes to inhibit inflammatory responses, inhibiting oxygen free radicals, reducing intracellular inorganic phosphorus and extracellular free calcium concentrations, positive inotropic effects and antagonizing doxorubicin-induced cardiomyocyte apoptosis. Trimetazidine improves myocardial energy metabolism and thus protects cardiomyocytes by increasing the level of adenosine triphosphate and decreasing the concentration of adenosine diphosphate and adenosine monophosphate. This drug has been widely used in ischemic cardiomyopathy and the protection of myocardial injury after cardiac intervention, and has achieved good results. Levocarnitine is a naturally occurring energy metabolizer in the body and has been used in the past as a supplemental therapy for hemodialysis patients. It is now found to promote lipid metabolism, improve myocardial energy supply, and increase tissue tolerance to ischemia and hypoxia, which can achieve the effect of protecting cardiomyocytes. It is currently used to treat HF with good results. Creatine phosphate is a high-energy phosphate compound, which can directly enter the cardiomyocyte to increase the energy supply of cardiomyocytes, and also has the effects of increasing the stability of phospholipid bilayer, inhibiting peroxidation of cardiomyocytes, promoting calcium inward flow to improve myocardial contractile function, and inhibiting platelet aggregation, etc. It is now widely used in the treatment of myocarditis, cardiomyopathy, HF, coronary heart disease, etc. Studies on myocardial protection against antineoplastic drugs Total flavonoids Its main components, quercetin and naringenin, can inhibit erythromycin-induced apoptosis in H9c2 cardiomyocytes, and researchers believe that flavonoids may be beneficial in regulating or preventing the cardiotoxicity of erythromycin. Carbon monoxide (CO) and bilirubin inhibited doxorubicin-induced apoptosis in H9c2 cardiomyocytes, which in turn may improve doxorubicin-induced cardiac cytotoxic damage. Erythropoietin inhibited doxorubicin-induced apoptosis in rat ventricular cardiomyocytes in a dose-dependent manner. Plant phenolics Such as apigenin, baicalein, kaempferol, lignan, quercetin, coffee, chlorogenic acid and rosemary have attenuated cardiac membrane, mitochondrial and particulate damage in breast rat cardiomyocytes and iron-dependent doxorubicin-induced lipid peroxidation. L-carnitine blocks doxorubicin-induced cardiomyocyte damage by inhibiting ceramide production. Unfortunately, research in this area is still limited to the laboratory stage, with no results from clinical trials yet, and there appears to be a long way to go. Related research in the field of Chinese medicine Finally, we would like to talk about the research in the field of myocardial cell protection in Chinese medicine. Ginseng and wheat injection The active ingredient is mainly ginsenoside. It was found that its pretreatment significantly reduced the reperfusion injury in rats and presented good cardiomyocyte protection, as well as cardiotonic and antihypertensive effects. Astragalus, whose main component is astragaloside, has enhanced and regulated immunity, regulated cytokine secretion and good free radical scavenging effect, and thus achieved myocardial cytoprotective effect. Other herbs that may have cardioprotective effects include Radix Paeoniae, He Shou Wu, Dandelion, Radix Angelicae Sinensis, Chuanxiong Zin, Gastrodia, Tanshinone IIA sodium sulfonate, and some compound preparations. Conclusion In conclusion, there is no sensitive detection method for cardiotoxicity of antitumor drugs, and cardiotoxicity is mainly manifested as HF, but there is a lack of effective treatment means. Therefore, at this stage, the comprehensive evaluation of cardiotoxicity and monitoring of high-risk patients using multiple indicators such as LVEF, TNI and BNP may be a better choice, and cardiomyocyte protection agents may be the hope for the treatment and prevention of cardiotoxicity. We further hope that through extensive collaboration between oncologists and cardiologists, we will go deep into the clinic, observe carefully, accumulate data, find out the occurrence of cardiotoxicity of antitumor drugs in China, formulate treatment plans for actual conditions, and carry out randomized controlled clinical studies under the guidance of biostatisticians and according to the principles of GCP, from which we can conclude effective treatment methods supported by solid evidence.