Common Toxicity Criteria (CTC) for Cardiovascular Complications Associated with Cancer Therapy

acute vascular leak syndrome

none

0

symptomatic but not requiring fluid support

2

respiratory compromise, or requires fluids

3

life threatening, requires pressor support or ventilatory support

4

cardiac ischemia and/or infarction

none

0

nonspecific T-wave flattening or changes

1

asymptomatic ST and T wave changes suggesting ischemia

2

angina without evidence of infarction

3

acute myocardial infarction

4

left ventricular function

normal

0

asymptomatic decline in resting ejection fraction >= 10% but < 20% of baseline value; shortening fraction >= 24% but < 30%

1

asymptomatic but resting ejection fraction below the lower limit of normal for laboratory, or decline of resting ejection fraction >= 20% of baseline value, or < 24% shortening fraction

2

CHF responsive to therapy

3

severe or refractory CHF or requiring intubation

4

cardiac troponin I

normal

0

level consistent with unstable angina

3

levels consistent with myocardial infarction

4

cardiac troponin T

normal (< 0.03 ng/mL

0

borderline (0.03 - 0.0499 ng/mL)

1

level consistent with stable angina (0.05 - 0.099 ng/mL)

2

level consistent with unstable angina  (0.10 to 0.199 ng/mL)

3

levels consistent with myocardial infarction (>= 0.2 ng/mL)

4

edema

none

0

asymptomatic, not requiring therapy

1

symptomatic, requiring therapy

2

symptomatic edema that limits function, unresponsive to therapy or requiring drug discontinuation

3

anasarca (severe, massive generalized edema)

4

hypertension

none

0

asymptomatic, transient increase not requiring therapy (> 150/100 if previously normal, or increase by 20 mm Hg diastolic)

1

recurrent or persistent or symptomatic increase by > 20 mm Hg (diastolic) or to > 150/100 if previously normal; does not require therapy

2

requires therapy or more intensive therapy then previously

3

hypertensive crisis

4

hypotension

none

0

not requiring therapy, includes transient orthostatic hypotension

1

requires brief fluid replacement or other therapy but not hospitalization; no permanent physiologic consequences

2

requires therapy and sustained medical attention but resolves without persistent physiologic consequences

3

shock with organ failure from tissue hypoperfusion

4

myocarditis

none

0

CHF responsive to treatment

3

severe or refractory CHF

4

operative injury of artery or vein

none

0

primary suture repair for injury but not requiring transfusion

1

primary suture repair for injury and requires transfusion

2

vascular occlusion requiring surgery or bypass for injury

3

myocardial infarction; resection of organ

4

pericardial effusion or pericarditis

none

0

asymptomatic effusion not requiring treatment

1

pericarditis (rub on auscultation, ECG changes, chest pain)

2

with physiologic consequences

3

tamponade; drainage or pericardial window required

4

peripheral arterial ischemia

none

0

brief episode of ischemia managed nonsurgically and without permanent deficit

2

requires surgical intervention

3

life-threatening or with permanent functional deficit or amputation

4

phlebitis, superficial

none

0

present

2

thrombosis and/or embolism

none

0

deep vein thrombosis not requiring anticoagulation

2

deep vein thromobosis requiring anticoagulation

3

embolic event (including pulmonary embolism)

4

visceral (non-myocardial) arterial ischemia

none

0

brief episode of ischemia managed nonsurgically and without permanent deficit

2

requires surgical intervention

3

life-threatening or with permanent functional deficit

4

other cardiovascular adverse event

none

0

mild

1

moderate

2

severe

3

life-threatening or disabling

4