It is possible that we have overlooked patients with subclinical cardiac impairment or patients with only vague clinical symptoms, which would not be categorized as CHF in the Danish national patient registry. Furthermore, we have no detailed information on the chemotherapeutic regime, including the cumulative dose of anthracyclines and/or addition of thoracic radiotherapy. This is notable since the cumulative dose of anthracyclines and the addition of other cardiotoxic chemotherapeutics including trastuzumab and also thoracic radiotherapy are established risc factors for developing chemotherapy-related CHF. No baseline medical history with A22 hydrochloride respect to cardiovascular risk factors or concurrent administration of cardiovascular drugs was obtained. Recently, several Lambrolizumab studies have shown that adding cardioprotectans such as ACE-1 or Beta-blockers can prevent LVEF reductions in patients undergoing intensive chemotherapy. Lastly, other specific cardiac biomarkers that are reported to detect subclinical chemotherapy-associated cardiac damage were not measured in the current study. In conclusion, this is the largest patient data set reported till date investigating both plasma BNP concentration and LVEF as predictors of chemotherapy-related cardiotoxicity using distinct clinical end points: hospitalization with a diagnosis of congestive heart failure and overall death. This prospective study shows that for cancer patients treated with cardiotoxic chemotherapy both BNP and LVEF significantly predicted congestive heart failure. Only BNP and not LVEF had diagnostic implications in predicting overall mortality supporting BNP as a clinical relevant factor for monitoring chemotherapy-related cardiac toxicity and death. A future prospective clinical trial should focus on standardization of the use of BNP concentration for diagnosing patients with irreversible cardiac damage, including determining optimal cut-off level and timing of BNP requiring several samples. In addition, a future focus should be on therapeutic-decision making based on BNP concentration compared to the current approach with assessment of LVEF ideally in a randomized study.