Dr. Ntobeko Ntusi's presentation at the Global Cardio-Oncology Summit (GCOS) 2025, organized by The International Cardio-Oncology Society, explored the evolving role of cardiovascular imaging in cancer care, particularly in low-resource environments. Her talk emphasized the need for a balanced approach that considers clinical excellence, technological innovation, and equitable access to ensure justice and dignity in healthcare.
Addressing Inequities and Commitment to Justice
Dr. Ntusi highlighted the persistent inequities in healthcare, where access to medical care and technology is not equally distributed. She advocated for institutions to recognize systemic shortcomings and strengthen accountability, transparency, and fairness in healthcare systems. The goal is to ensure that innovation in cardio-oncology benefits everyone, not just those in high-resource settings.
Cardiovascular Involvement in Cancer Therapy
Cancer therapies can significantly impact the cardiovascular system, and Dr. Ntusi discussed the wide range of therapy-related cardiac complications. These include myocarditis, cardiomyopathy, arrhythmias, valvular and pericardial disease, vasculitis, hypertension, and thromboembolism. This underscores the importance of cardiovascular imaging in early detection, diagnosis, and long-term monitoring of treatment-related diseases.
Echocardiography: The Cornerstone in Low-Resource Settings
Echocardiography is a cornerstone in low-resource settings due to its affordability, portability, and non-invasive nature. Dr. Ntusi emphasized that the appropriateness and accessibility of imaging modalities are crucial, rather than their technological sophistication. Echocardiography remains a key tool for risk assessment, monitoring treatment response, and long-term follow-up, making it indispensable in regions with limited access to advanced imaging.
Computed Tomography: Precision and Practical Constraints
Computed tomography (CT) offers exceptional anatomical resolution and structural clarity, making it valuable for assessing coronary arteries, diagnosing cardiomyopathy, and detecting structural abnormalities related to cancer therapy. However, its benefits are often constrained by cost, radiation exposure, and limited availability in many low- and middle-income countries (LMICs). Sustainable implementation requires investment in infrastructure, training, and cost-effective protocols.
Cardiac Magnetic Resonance: The Gold Standard in Tissue Characterization
Cardiac magnetic resonance (CMR) is the gold standard for tissue characterization in cardio-oncology, providing detailed insights into myocardial inflammation, fibrosis, perfusion, and function. Dr. Ntusi noted that CMR can differentiate between malignant and benign cardiac masses, quantify myocardial injury, and evaluate treatment response. However, challenges such as high costs, long scan times, and limited scanner availability persist, particularly in Africa.
Artificial Intelligence: Opportunities and Limitations
Artificial intelligence (AI) is transforming cardiovascular imaging, offering improved early detection, diagnostic consistency, and workflow efficiency. However, its distribution is uneven, with many regions facing challenges in infrastructure, data diversity, trained personnel, and ethical or regulatory barriers. Dr. Ntusi emphasized the need for global collaboration, investment in data equity, and context-sensitive tools to ensure AI's effective integration without amplifying inequality.
Environmental Sustainability in Imaging
Dr. Ntusi addressed the environmental and economic implications of cardiovascular imaging, noting that high-resource modalities like MRI and CT contribute disproportionately to greenhouse gas emissions compared to ultrasound-based techniques. She proposed a 'sustainable value' framework, balancing diagnostic benefit with environmental, social, and economic considerations. Reducing waste, improving energy efficiency, and optimizing imaging protocols are key to minimizing environmental impact without compromising care quality.
Conclusion: Integrating Innovation, Access, and Sustainability
Dr. Ntusi's presentation highlighted the need to align innovation in cardio-oncology with access and sustainability. Advances in imaging and AI offer new opportunities, but their value depends on equitable availability, robust infrastructure, and ethical implementation. She outlined three guiding principles: clinical appropriateness, responsible innovation, and equity as a foundation, emphasizing that equity must guide progress in cardiovascular care.
This comprehensive overview of Dr. Ntusi's presentation at GCOS 2025 underscores the importance of addressing inequities, embracing technological innovation, and ensuring sustainable and equitable access to cardiovascular imaging in cancer care.
