Following the recognition of anthracycline chemotherapy impact on cardiovascular risk, both immediate and long-term, intensive surveillance strategies have been proposed to improve the outcome of cancer patients treated with this class of drugs. Current European Society of Cardiology (ESC) guidelines suggest to perform a complete cardiac evaluation of these patients both pre and post-treatment, to search for cancer therapy-related cardiac dysfunction (CTRCD), with left ventricular (LV) ejection fraction (EF) being the most used surrogate parameter for systolic function.1 According to guidelines, it is recommended to perform trans-thoracic echocardiography before the beginning of chemotherapy and within 12 months after completing the treatment (class IB), as well as every two cycles and within 3 months after completing treatment in high and very-high risk patients (class IC).1 Notwithstanding the institution of these clear follow-up schemes, many patients still hold a negative outcome, mainly due to the fact that declines in LVEF may become manifest only in the final part of the cardiotoxicity process, when the damage at a tissue-level, is already extensive. Consequently, growing interest is directed toward the identification of early tissue damage through non-invasive myocardial tissue-characterization. Cardiovascular magnetic resonance (CMR) has become the imaging technique of choice to answer this clinical query given that it is the gold standard for the assessment of LVEF, and its ability to perform non-invasive myocardial tissue characterization. CMR derived native T1 relaxation time and post-contrast extracellular volume fraction (ECV) have been demonstrated to correlate with myocardial fibrosis on histology (endomyocardial biopsy), and may represent emerging biomarkers for the identification of abnormal expansion in the extracellular space.2,3 However, currently CMR does not find any indication in the monitoring of anthracyclines-treated patients, and it is indicated only in patients with suspect immune checkpoint inhibitors myocarditis.1

To date, there are few clinical studies investigating the role of native T1 mapping and ECV in the field of cardiotoxicity, with a limited number of patients enrolled as well. The aim of this study was to analyze the available literature to investigate the role of these CMR parameters in identifying any changes in myocardial tissue composition in anthracyclines-treated patients compared to healthy controls.