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Review Article | DOI: https://doi.org/10.31579/2641-0419/522
1Department of Cardiology, Hitit University Erol Olçok Education and Research Hospital, Corum, Turkey.
2Department of Cardiology, Facult of Medicine, Hitit University, Corum, Turkey
*Corresponding Author: Macit Kalcik, Department of Cardiology, Facult of Medicine, Hitit University, Corum, Turkey.
Citation: Ahmed Ş Begoğlu , Macit Kalçık , Mucahit Yetim , Muhammet C Çelik, Lütfü Bekar, et al, (2025), Molecular Mechanisms, Diagnosis, and Management of Chemotherapy Related Cardiotoxicity, J Clinical Cardiology and Cardiovascular Interventions, 8(15); DOI:10.31579/2641-0419/522
Copyright: © 2025, Macit Kalcik. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 30 September 2025 | Accepted: 24 October 2025 | Published: 06 November 2025
Keywords: cardiotoxicity; cancer therapy; anthracyclines; immune checkpoint inhibitors; cardio-oncology
Cardiotoxicity remains a major limitation of contemporary cancer therapy, affecting both traditional cytotoxic agents and novel targeted and immunotherapeutic drugs. This review summarizes current understanding of the molecular and clinical mechanisms underlying therapy-induced cardiac injury and highlights strategies for prevention, early detection, and management. Classical antineoplastic agents such as anthracyclines, cyclophosphamide, and platinum compounds induce myocardial damage primarily through oxidative stress, mitochondrial dysfunction, calcium handling abnormalities, and apoptotic signaling. Targeted therapies, including HER2 inhibitors and tyrosine kinase inhibitors, cause cardiac dysfunction via interference with survival pathways and endothelial injury, while immune checkpoint inhibitors can trigger fulminant myocarditis through T-cell–mediated inflammation. Despite their diverse mechanisms, these treatments converge on shared molecular pathways involving reactive oxygen species generation, mitochondrial impairment, and inflammasome activation. Advances in biomarkers (troponins, natriuretic peptides) and imaging techniques (strain echocardiography, cardiac magnetic resonance) have enabled earlier recognition of subclinical dysfunction. Preventive interventions, such as dose optimization, liposomal anthracyclines, ACE inhibitors, beta-blockers, and dexrazoxane, reduce risk, while structured cardio-oncology collaboration facilitates safe continuation of oncologic therapy. Emerging approaches, including artificial intelligence–based risk modeling, digital health monitoring, and precision pharmacogenomics, promise to individualize care and integrate cardiac protection into cancer treatment planning. Cardio-oncology is evolving toward a precision-based discipline focused on preserving both life expectancy and long-term cardiovascular health in cancer survivors.
Over the past few decades, remarkable progress in cancer therapy has substantially improved survival rates across many malignancies. However, this therapeutic success has unveiled a new challenge: the growing burden of cardiovascular complications among cancer survivors. Cardiotoxicity induced by cancer treatment has emerged as a leading cause of morbidity and mortality in this population, sometimes surpassing the risk of tumor recurrence itself [1,2].
In clinical practice, the term cardiotoxicity encompasses a broad spectrum of adverse cardiovascular outcomes related to cancer therapies. These range from asymptomatic myocardial injury and declines in left ventricular ejection fraction (LVEF) to overt heart failure, arrhythmias, hypertension, ischemic heart disease, and thromboembolic events [3]. The onset of cardiotoxicity can be acute, occurring during or immediately after treatment; early, within the first year, or delayed, developing years after therapy completion [4]. Importantly, while certain agents, such as anthracyclines, induce irreversible myocardial damage, others, like HER2 inhibitors, typically cause reversible dysfunction if recognized early and managed appropriately (5).
The molecular mechanisms underlying treatment-related cardiotoxicity are multifactorial. Oxidative stress and excessive reactive oxygen species generation, mitochondrial dysfunction, calcium handling abnormalities, DNA damage, endothelial injury, and activation of inflammatory and apoptotic signaling cascades are key contributors [6]. These processes ultimately impair cardiomyocyte viability, promote fibrosis, and compromise contractile performance. Furthermore, the combination or sequential use of different anticancer modalities can amplify cardiac injury through additive or synergistic mechanisms [7].
Understanding these pathways is fundamental to developing effective cardioprotective strategies. This review will first examine the classical antineoplastic drugs, particularly anthracyclines and other cytotoxic agents, whose cardiotoxic effects have been studied for decades and remain clinically relevant. Subsequently, it will discuss the molecular and clinical mechanisms of newer targeted and immunotherapeutic agents, which, despite their selectivity, also impose significant cardiac risks. By integrating mechanistic insights across traditional and modern therapies, this work aims to highlight the biological convergence of cardiotoxic injury and provide a framework for improving cardiac surveillance and prevention in oncology patients.
Classical Antineoplastic Agents and Cardiotoxicity
Anthracyclines, particularly doxorubicin, remain among the most effective and widely used antineoplastic drugs, yet they are also the prototypical cause of chemotherapy-induced cardiotoxicity. Their cardiac effects are dose-dependent and cumulative, with risk increasing sharply above total lifetime exposures of 400–550 mg/m². Despite their clinical efficacy, the mechanisms by which these drugs damage the myocardium are multifactorial and tightly interlinked [8].
A dominant hypothesis attributes anthracycline cardiotoxicity to excessive production of reactive oxygen species (ROS). Doxorubicin undergoes redox cycling through its quinone moiety in the presence of NADPH, generating superoxide anions and hydrogen peroxide. The high mitochondrial density and low antioxidant capacity of cardiomyocytes make them uniquely susceptible to oxidative injury. This ROS surge disrupts mitochondrial membranes, oxidizes lipids and proteins, and triggers DNA damage, ultimately impairing ATP synthesis and leading to necrotic or apoptotic cell death [9].
Another pivotal mechanism involves topoisomerase IIβ (Top2β). In cardiomyocytes, doxorubicin binds to Top2β-DNA complexes, inducing double-strand DNA breaks and transcriptional repression of mitochondrial biogenesis regulators such as PGC-1α and NRF-1. This impairs mitochondrial renewal and accelerates energy failure and apoptosis [10].
Mitochondrial dysfunction represents a convergent endpoint of these pathways. Structural abnormalities, including mitochondrial swelling, cristae loss, and disruption of oxidative phosphorylation, have been documented in both experimental and clinical settings (11). These defects lead to further ROS accumulation, calcium overload, and activation of intrinsic apoptotic signaling via cytochrome c release and caspase-3 activation.
Calcium dysregulation also contributes significantly to cardiomyocyte injury. Doxorubicin alters sarcoplasmic reticulum Ca²⁺ handling by inhibiting SERCA2a and sensitizing ryanodine receptors, causing diastolic calcium leak, contractile dysfunction, and arrhythmogenicity. In parallel, impairment of nitric oxide signaling and direct endothelial toxicity reduce coronary microvascular perfusion, compounding ischemic stress [12].
Inflammatory signaling and maladaptive remodeling further amplify chronic injury. ROS and damaged mitochondria activate NF-κB and NLRP3 inflammasome pathways, promoting cytokine release, fibrosis, and progressive left ventricular remodeling. This molecular cascade explains the delayed onset of anthracycline cardiomyopathy that may emerge years after completion of chemotherapy [13].
Beyond anthracyclines, other cytotoxic agents such as cyclophosphamide and cisplatin also exert cardiotoxic effects through distinct but related mechanisms. Cyclophosphamide metabolites, notably acrolein, provoke endothelial injury, oxidative stress, and hemorrhagic myocarditis, whereas platinum-based drugs induce endothelial dysfunction, increased vascular stiffness, and accelerated atherosclerosis. Although their clinical presentations vary, from acute heart failure to delayed ischemic disease, the underlying mechanisms often converge on oxidative stress and mitochondrial injury [14].
Taken together, classical antineoplastic agents compromise cardiac structure and function through an intricate web of oxidative, mitochondrial, inflammatory, and apoptotic pathways. These foundational insights have guided the development of early detection and cardioprotective strategies discussed in later sections (Table 1).
| Drug Class | Representative Agents | Primary Cardiac Effects | Mechanistic Basis | Typical Onset |
| Anthracyclines | Doxorubicin, Daunorubicin | LV systolic dysfunction, heart failure | ROS generation, Top2β inhibition, mitochondrial injury | Dose-dependent, cumulative |
| Alkylating agents | Cyclophosphamide, Ifosfamide | Myocarditis, pericarditis, heart failure | Endothelial injury, oxidative stress, acrolein toxicity | Early (within days) |
| Platinum compounds | Cisplatin, Carboplatin | Hypertension, ischemia, endothelial dysfunction | Oxidative stress, vascular stiffness | Subacute to chronic |
| HER2 inhibitors | Trastuzumab, Pertuzumab | LV dysfunction (often reversible) | ErbB2 signaling inhibition | During therapy |
| VEGF inhibitors / TKIs | Bevacizumab, Sunitinib, Sorafenib | Hypertension, heart failure, ischemia | VEGF blockade, microvascular rarefaction | Variable |
| Immune checkpoint inhibitors | Nivolumab, Pembrolizumab, Ipilimumab | Myocarditis, arrhythmias | T-cell–mediated inflammation | Early (first 2 months) |
Table 1: Major Classes of Antineoplastic Agents and Their Principal Cardiotoxic Effects
Abbreviations: LV: left ventricle; ROS: reactive oxygen species; SR: sarcoplasmic reticulum; VEGF: vascular endothelial growth factor; TKI: tyrosine kinase inhibitor; ICI: immune checkpoint inhibitor.
Targeted Cancer Therapies and Cardiotoxicity
The shift from broad chemotherapeutics to targeted therapies promised greater specificity and fewer off-target toxicities. In practice, this optimism has been tempered by the recognition that even highly selective agents can provoke cardiovascular injury via on-target or off-target mechanisms. These mechanisms frequently overlap with those triggered by classical agents, but also introduce unique pathways specific to growth factor signaling, receptor inhibition, and kinase cross-reactivity.
HER2-targeted Agents (Trastuzumab, Pertuzumab, ADCs)
HER2 (ErbB2) signaling is essential not only in oncogenesis but also in cardiomyocyte survival and stress response. Inhibiting HER2 disrupts neuregulin–ErbB4/ErbB2 axis, compromising cell survival signals under stress, especially in synergy with anthracyclines (15). Trastuzumab cardiotoxicity typically presents as a decline in LVEF, often reversible if managed promptly (16). Real-world and trial data show that patients with prior anthracycline exposure, older age, hypertension, or borderline cardiac reserve are at higher risk [17]. A meta-analysis of trials combining trastuzumab with chemotherapy demonstrated that the incidence of cardiac adverse events was roughly 10–14%, with higher rates when anthracyclines were included [18]. Emerging HER2-directed agents (antibody–drug conjugates, small molecules) appear to have lower cardiotoxic rates, but long-term surveillance remains limited [19].
VEGF / Angiogenesis Inhibitors (Bevacizumab, Sunitinib, Sorafenib, etc.)
VEGF inhibitors cause a spectrum of cardiovascular toxicities, most commonly hypertension, but also myocardial ischemia, left ventricular dysfunction, thromboembolism, and vascular rarefaction [20]. The pathophysiology is multifactorial: endothelial dysfunction from VEGF blockade reduces nitric oxide bioavailability and impairs microvascular integrity; microvascular rarefaction increases peripheral resistance; and interference with repair pathways predisposes to ischemic injury in susceptible myocardium [21]. A network meta-analysis of VEGF-TKIs in cancer patients found that less selective agents (e.g. sorafenib, sunitinib) were associated with significantly higher risk of major adverse cardiovascular events and heart failure [22]. Animal models have confirmed that anti-VEGF therapy reduces capillary density and worsens pressure overload stress tolerance in the heart.
Other Kinase Inhibitors (BRAF/MEK, mTOR, EGFR, multitarget TKIs)
Beyond VEGF, many small-molecule inhibitors target multiple kinases and can exert unintended cardiac effects. BRAF/MEK inhibitors may alter cardiomyocyte metabolism and increase oxidative stress due to dysregulation of MAPK/ERK signaling. mTOR inhibitors impair mitochondrial biogenesis and stress adaptation. Some agents inhibit kinases involved in ion channel regulation, promoting QT prolongation or arrhythmia. A review summarizing targeted agents noted that many share downstream mechanisms: ROS generation, mitochondrial injury, impaired autophagy, and microvascular rarefaction [23].
Immunotherapy-Induced Cardiotoxicity
Immune checkpoint inhibitors (ICIs) have revolutionized oncology by enabling durable tumor control through T-cell activation. However, this immune re-engagement may also trigger autoimmune reactions against cardiac tissue, leading to potentially fatal myocarditis and other cardiovascular complications [24]. Although the reported incidence of ICI-related myocarditis is low, generally under 1%, its case-fatality rate may exceed 25% in severe presentations [25].
ICI-associated myocarditis typically occurs early, often within the first two months of therapy, and is more frequent when PD-1 and CTLA-4 inhibitors are administered in combination. The clinical presentation varies widely, ranging from asymptomatic troponin elevation to fulminant heart failure or malignant arrhythmias [26]. Endomyocardial biopsy findings reveal dense infiltration of CD4⁺ and CD8⁺ T lymphocytes with myocyte necrosis, indicating a T-cell–mediated cytotoxic process (27). Experimental studies confirm that loss of PD-1 signaling predisposes to spontaneous myocarditis and dilated cardiomyopathy, supporting an autoimmune pathogenesis [28].
Byond myocarditis, other cardiovascular toxicities of immunotherapy include pericarditis, vasculitis, Takotsubo-like cardiomyopathy, and conduction abnormalities. Cytokine release syndrome associated with chimeric antigen receptor T-cell (CAR-T) therapy also contributes indirectly to cardiac dysfunction by causing systemic inflammation, endothelial activation, and myocardial depression.
Early recognition of ICI-related cardiac toxicity is critical. Cardiac biomarkers such as troponin and natriuretic peptides, electrocardiographic surveillance, and echocardiography are recommended at baseline and during therapy in high-risk patients [29]. Management generally involves prompt discontinuation of immunotherapy and initiation of high-dose corticosteroids; in steroid-refractory cases, additional immunosuppressive agents such as mycophenolate mofetil, infliximab, or abatacept may be required [30].
Although rare, ICI-induced cardiotoxicity underscores the delicate balance between immune activation and self-tolerance. Ongoing research aims to identify genetic, immunologic, and biomarker-based predictors to individualize therapy and reduce the risk of cardiovascular complications.
Shared Molecular Pathways of Cardiotoxicity
Although the clinical manifestations of cardiotoxicity vary across drug classes, multiple molecular and cellular mechanisms converge on common pathogenic pathways. These shared processes, oxidative stress, mitochondrial dysfunction, calcium handling abnormalities, endothelial injury, inflammation, and apoptosis, form the biological foundation of treatment-induced cardiac injury across both classical and targeted cancer therapies [31] (Table 2).
| Pathophysiologic Process | Key Molecular Events | Cellular Consequence | Representative Agents |
| Oxidative stress | Excess ROS, lipid peroxidation | DNA and membrane damage | Anthracyclines, Cisplatin |
| Mitochondrial dysfunction | ETC disruption, cytochrome c release | ATP depletion, apoptosis | Anthracyclines, TKIs |
| Calcium dysregulation | SERCA2a inhibition, RyR sensitization | Ca²⁺ overload, arrhythmia | Anthracyclines |
| Endothelial injury | NO depletion, inflammation | Microvascular ischemia | VEGF inhibitors, Cyclophosphamide |
| Immune activation | T-cell infiltration, NLRP3 inflammasome | Myocarditis, fibrosis | ICIs |
Table 2: Shared Molecular Mechanisms of Cancer Therapy–Induced Cardiotoxicity
Abbreviations: ROS: reactive oxygen species; ETC: electron transport chain; SERCA2a: sarco/endoplasmic reticulum Ca²⁺-ATPase 2a; RyR: ryanodine receptor; NO: nitric oxide; NLRP3: NOD-like receptor pyrin domain containing 3; ICI: immune checkpoint inhibitor; DNA: deoxyribonucleic acid.
Oxidative stress is among the most universal mechanisms. Many anticancer agents, including anthracyclines, tyrosine kinase inhibitors (TKIs), and immune checkpoint inhibitors (ICIs), increase the generation of reactive oxygen species (ROS) in cardiomyocytes. Excess ROS impairs mitochondrial respiration, oxidizes lipids and contractile proteins, and damages DNA, leading to functional deterioration and cell death (11). Persistent oxidative imbalance also triggers maladaptive activation of nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK) signaling, amplifying inflammation and apoptosis [8].
Mitochondrial dysfunction plays a pivotal role in both acute and chronic cardiotoxicity. Mitochondria are not only the main ROS source but also the primary target of oxidative injury. Doxorubicin and other chemotherapeutics disrupt the electron transport chain and promote mitochondrial permeability transition pore opening, resulting in cytochrome c release and caspase activation. In targeted therapy, inhibition of kinases such as mTOR and AMPK interferes with mitochondrial biogenesis and metabolic homeostasis, reducing cardiomyocyte resilience to stress [32].
Calcium dysregulation is another unifying feature. Dysregulated sarcoplasmic reticulum (SR) calcium cycling due to SERCA2a inhibition or ryanodine receptor sensitization leads to intracellular Ca²⁺ overload, contractile dysfunction, and arrhythmogenesis. Mitochondrial Ca²⁺ accumulation further exacerbates ROS generation and apoptotic signaling [33].
Endothelial dysfunction bridges vascular and myocardial injury. Antiangiogenic drugs such as VEGF inhibitors diminish nitric oxide (NO) bioavailability, promote vascular stiffness, and impair myocardial microcirculation. Similarly, cyclophosphamide and cisplatin damage endothelial cells directly through oxidative and inflammatory mechanisms, compromising coronary perfusion and promoting ischemic injury [14].
Finally, inflammatory and apoptotic signaling are central amplifiers of injury. Damaged mitochondria release damage-associated molecular patterns (DAMPs), activating pattern recognition receptors and inflammasomes such as NLRP3. This initiates cytokine release, leukocyte infiltration, and fibrosis, leading to chronic myocardial remodeling. These inflammatory processes are further intensified in immune checkpoint inhibitor–associated myocarditis, where T-cell–mediated cytotoxicity parallels the molecular cascades observed in chemotherapy-induced cardiomyopathy [34].
Overall, these interconnected mechanisms underscore the concept that cancer therapy–related cardiac injury is not agent-specific but the product of converging molecular stress pathways. Understanding these shared targets provides a mechanistic basis for future cardio-protective interventions, such as antioxidant modulation, mitochondrial stabilizers, or anti-inflammatory therapies.
Diagnostic and Monitoring Strategies
Early identification of cardiotoxicity is fundamental to prevent irreversible cardiac injury and to maintain oncologic treatment continuity. Current cardio-oncology practice emphasizes a multimodal surveillance approach combining circulating biomarkers, cardiac imaging, and clinical risk assessment [35] (Table 3).
| Modality | Diagnostic Marker/Technique | Diagnostic Role | Sensitivity for Early Detection | Limitations |
| Biomarkers | Troponin I/T, NT-proBNP, ST2 | Early detection of injury | High | Limited specificity |
| Echocardiography | LVEF, Global Longitudinal Strain (GLS) | Functional monitoring | High | Operator-dependent |
| Cardiac MRI | LGE, T1/T2 mapping, ECV | Tissue characterization | Very high | Limited availability |
| ECG / Holter | QT prolongation, arrhythmia | Rhythm assessment | Moderate | Nonspecific |
| Nuclear imaging | MUGA scan | LVEF quantification | Moderate | Radiation exposure |
Table 3: Diagnostic Modalities for Cardiotoxicity Surveillance
Abbreviations: LVEF: left ventricular ejection fraction; GLS: global longitudinal strain; LGE: late gadolinium enhancement; CMR: cardiac magnetic resonance; ECV: extracellular volume; ECG: electrocardiogram; MUGA: multigated acquisition scan; NT-proBNP: N-terminal pro–B-type natriuretic peptide; ST2: suppression of tumorigenicity 2.
Cardiac biomarkers are the most sensitive indicators of early myocardial injury. Elevations in cardiac troponins (I or T) reflect direct cardiomyocyte damage, while increases in natriuretic peptides (BNP, NT-proBNP) signal myocardial strain or subclinical dysfunction [36]. Prospective studies have shown that patients developing chemotherapy-related troponin elevation are at significantly higher risk for later LVEF reduction and symptomatic heart failure. Novel biomarkers such as soluble ST2 and galectin-3 are under evaluation for their potential to detect early fibrosis and inflammation [37].
Echocardiography remains the cornerstone of cardiac monitoring because of its accessibility, safety, and reproducibility. Traditional assessment based on LVEF is complemented by strain imaging, particularly global longitudinal strain (GLS), which detects subclinical systolic dysfunction before overt ejection fraction decline. A relative GLS reduction of ≥15% from baseline reliably predicts subsequent cardiotoxicity [38].
Cardiac magnetic resonance imaging (CMR) provides high-resolution tissue characterization and is invaluable for diagnosing myocarditis, fibrosis, or diffuse myocardial edema. Quantitative mapping techniques (T1, T2, extracellular volume fraction) allow noninvasive detection of early structural injury. CMR has proven especially useful in confirming immune checkpoint inhibitor-associated myocarditis and anthracycline-induced fibrosis, even when LVEF remains preserved [39].
Electrocardiography (ECG) and rhythm monitoring are necessary adjuncts for detecting arrhythmic and repolarization abnormalities, particularly with tyrosine kinase inhibitors and immune therapies that prolong QT intervals or induce conduction block [40].
Finally, integrated risk stratification, incorporating demographic, clinical, therapeutic, and imaging variables, forms the basis of modern cardio-oncology protocols. Both the European Society of Cardiology (ESC) and the American Society of Clinical Oncology (ASCO) recommend baseline cardiovascular assessment before initiation of potentially cardiotoxic regimens and structured follow-up during and after therapy [7]. Machine learning–assisted predictive models that combine biomarker trends and imaging data are being developed to improve individualized monitoring and minimize treatment interruptions.
Cardioprotective and Management Strategies
Preventing and mitigating cardiotoxicity have become integral components of cancer care. The current approach combines pharmacologic cardioprotection, careful treatment planning, and multidisciplinary collaboration between oncologists and cardiologists [7]
Pharmacologic prevention remains the cornerstone of cardioprotection. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers have consistently demonstrated benefit in attenuating chemotherapy-induced cardiac dysfunction. Randomized studies have shown that agents such as enalapril and carvedilol reduce both troponin elevation and left ventricular ejection fraction (LVEF) decline during anthracycline-based therapy [41]. Dexrazoxane, an iron-chelating agent, remains the only drug specifically approved for preventing anthracycline-induced cardiotoxicity, primarily by limiting free radical formation [42].
Treatment modification is another critical preventive strategy. Using lower cumulative anthracycline doses, liposomal drug formulations, or prolonged infusion regimens significantly reduces cardiac risk. In targeted therapy, sequential rather than concurrent administration of anthracyclines and HER2 inhibitors minimizes additive toxicity. For tyrosine kinase inhibitors and immune checkpoint inhibitors, dose adjustment and temporary suspension are often effective when early cardiac dysfunction or myocarditis occurs [7].
Lifestyle and risk factor management, including strict blood pressure control, avoidance of smoking, and correction of dyslipidemia, complement pharmacologic measures. In survivors, exercise-based cardiac rehabilitation programs have shown improvement in cardiorespiratory fitness and endothelial function [43].
Multidisciplinary care is essential. Cardio-oncology teams coordinate surveillance and intervention, ensuring that cancer therapy continues safely without compromising cardiovascular health. This team-based model allows individualized balancing of oncologic efficacy and cardiac safety (Table 4).
| Strategy | Mechanism / Rationale | Evidence Level | Clinical Outcome |
| Dexrazoxane | Iron chelation, limits ROS | High | Reduces anthracycline-induced HF |
| ACE inhibitors / ARBs | Neurohormonal blockade | High | Prevents LVEF decline |
| Beta-blockers | Sympathetic inhibition | High | Preserves LV function |
| Liposomal anthracyclines | Reduced myocardial exposure | Moderate | Lower incidence of HF |
| Sequential HER2 therapy | Avoids synergistic toxicity | Moderate | Reduces cardiac events |
| Cardiac rehabilitation | Improves endothelial and exercise function | Moderate | Enhances survivorship quality |
Table 4: Evidence-Based Strategies for Prevention and Management of Cardiotoxicity
Abbreviations: ACE: angiotensin-converting enzyme; ARB: angiotensin II receptor blocker; HF: heart failure; LVEF: left ventricular ejection fraction; LV: left ventricle; HER2: human epidermal growth factor receptor 2.
Emerging cardioprotective approaches include statins, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and mitochondrial-targeted antioxidants, which are currently under investigation. These novel strategies aim to preserve cardiac energetics and reduce oxidative stress during therapy.
Future Directions and Emerging Concepts
Rapid advances in both oncology and cardiovascular science are redefining the landscape of cardio-oncology. Future progress depends on translating mechanistic knowledge into precise, individualized strategies for early detection and prevention of cardiotoxicity [44].
Artificial intelligence (AI) and machine learning (ML) are emerging as powerful tools for risk prediction. By integrating data from imaging, biomarkers, electrocardiography, and clinical variables, AI-based algorithms can detect subtle patterns predictive of future cardiac dysfunction long before symptoms or measurable LVEF decline occur [45]. These models are being trained to identify high-risk patients who may benefit from intensified surveillance or prophylactic cardioprotective therapy.
Omics-based approaches, including genomics, transcriptomics, proteomics, and metabolomics, are uncovering patient-specific susceptibility to cardiotoxicity. Genetic polymorphisms in drug transporters, oxidative stress pathways, and mitochondrial enzymes influence individual risk profiles for anthracycline and tyrosine kinase inhibitor–induced cardiomyopathy. Integration of these molecular insights with clinical data could enable truly personalized cardio-oncology care [46].
Digital health and remote monitoring technologies are also transforming survivorship management. Wearable sensors and mobile platforms capable of tracking heart rate variability, physical activity, and early signs of heart failure are being validated for real-time detection of cardiac stress during cancer treatment. Such systems can allow timely clinical intervention while reducing hospital visits [47].
Finally, novel therapeutic strategies targeting oxidative stress, mitochondrial dysfunction, and inflammation are under active investigation. Agents such as mitochondrial-targeted antioxidants, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and modulators of the NLRP3 inflammasome show potential for cardioprotection in both preclinical and early clinical studies [48].
The long-term vision of cardio-oncology is to transition from reactive management to precision prevention—a model where individual cardiovascular risk is predicted, monitored, and mitigated dynamically alongside cancer therapy. Achieving this will require close collaboration between oncologists, cardiologists, data scientists, and basic researchers to harmonize personalized medicine with compassionate, evidence-based care (Table 5).
| Research Area | Emerging Approach | Clinical Potential | Current Challenges |
| Artificial intelligence | Risk prediction models integrating biomarkers and imaging | Early individualized prevention | Data standardization, validation |
| Omics-based precision medicine | Pharmacogenomics, proteomics | Tailored cardioprotection | Cost, accessibility |
| Digital health | Wearable monitoring, tele-cardiology | Real-time detection | Regulatory and privacy issues |
| Novel pharmacotherapy | SGLT2 inhibitors, mitochondrial antioxidants | Mechanistic cardioprotection | Limited clinical data |
| Multidisciplinary care | Cardio-oncology teams, survivorship clinics | Integrated long-term management | Implementation in practice |
Table 5. Future Perspectives in Cardio-Oncology
Abbreviations: AI: artificial intelligence; SGLT2: sodium–glucose cotransporter 2; HF: heart failure; ROS: reactive oxygen species; ECG: electrocardiogram; LV: left ventricle; TKI: tyrosine kinase inhibitor.
Cancer therapy–related cardiotoxicity represents one of the most significant challenges of modern oncology. As therapeutic efficacy and patient survival continue to improve, cardiovascular complications increasingly determine long-term outcomes and quality of life. The interplay between anticancer efficacy and cardiac safety demands a paradigm shift—from reactive management of symptomatic heart failure to proactive prevention and early detection of subclinical injury.
Over the past two decades, substantial progress has been made in elucidating the molecular and cellular mechanisms of cardiotoxicity. Shared pathways involving oxidative stress, mitochondrial dysfunction, calcium dysregulation, endothelial injury, and immune-mediated inflammation have emerged as central mediators of cardiac damage across drug classes. These insights have enabled the development of more sophisticated surveillance methods, such as biomarker-based monitoring and strain imaging, that allow detection of early myocardial injury long before irreversible remodeling occurs.
The integration of cardioprotective strategies, including pharmacologic interventions, treatment modification, and lifestyle optimization, has already shown clear benefits in high-risk populations. However, the future of cardio-oncology will depend on the successful translation of novel scientific and technological advances into personalized prevention programs. Artificial intelligence, digital health tools, and molecular profiling promise to identify patients most vulnerable to cardiac injury and tailor therapy intensity accordingly
Ultimately, the success of cardio-oncology hinges on interdisciplinary collaboration. Effective partnership between oncologists, cardiologists, and primary care physicians ensures that treatment decisions are both life-saving and heart-preserving. The goal is not merely to cure cancer but to safeguard cardiovascular health throughout survivorship.
All of the authors contributed planning, conduct, and reporting of the work. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
No financial funding was received for this study.
All of the authors have no conflict of interest.
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"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
