The increasing success of cancer therapy, including the long-term survival of cancer patients after therapy, comes at the price of increasing problems from cardiotoxicity, notably heart failure. 1 Is there a specific way to prevent, follow-up and attenuate the cardiotoxicity of cancer chemotherapy, other than the established guidelines for prevention and treatment of heart failure?

Doxorubicin is a prototype chemotherapy which often induces heart failure subsequently; its pathomechanisms in the heart are multifold, but notably include damage by reactive oxygen species, mitochondrial dysfunction and inhibition of survival pathways—thus sharing features with damage by myocardial ischaemia/reperfusion injury. Dexrazoxane, an iron-chelating agent, is advocated to attenuate chemotherapy-related damage and has reduced doxorubicin-induced troponin elevations in children with leukaemia. 2 Of note, it is unclear whether or not dexrazoxane also attenuates the damage to the cancer and whether or not it provides prognostic benefit in clinical outcome. The present study addresses the attenuation of anthracycline-induced cardiac contractile dysfunction by remote ischaemic preconditioning (RIPC). RIPC was originally identified and developed as a cardioprotective strategy to reduce infarct size. However, it is now clear that RIPC is a systemic self-defence response to various noxious stimuli in peripheral tissues (ischaemia/reperfusion, trauma, strong sensory nerve fibre activation), involves a neuronal and humoural transfer of the protective signal and ultimately protects a variety of organs, including heart, brain, kidney, liver, etc. 3 While initial smaller proof-of-concept trials in acute ST-segment elevation myocardial infarction (STEMI) and in cardiosurgery with ischaemic cardioplegic arrest supported a translation of preclinical findings to patients by showing decreased infarct size, larger phase III trials with clinical outcome endpoints were equivocal. The cardiosurgical phase III trials used propofol anaesthesia which is known to abrogate