Cardiotoxicity monitoring and cancer therapy-related cardiac dysfunction in a heterogeneous cancer population A retrospective study

Abstract

Background: Chemotherapy-related cardiotoxicity can lead to significant heart damage, at times manifesting as cancer therapy-related cardiac dysfunction (CTRCD) or a decline in left ventricular ejection fraction (LVEF) by over 10% to below 53%. Current guidelines recommend cardiovascular risk assessments for cancer patients, yet standardized risk stratification is lacking. This study aimed to evaluate chemotherapeutic effects on LVEF in relation to risk factors for CTRCD, along with quality of surveillance and cardiotoxicity monitoring.

Methods: This study is a retrospective chart review at a single center to assess the incidence of CTRCD in patients referred for transthoracic echocardiography due to cardiotoxicity risk. Statistical analysis of 532 patients included Wilcoxon signed-rank tests for overall LVEF changes, multivariable linear regression for comorbidity and medication effects in relation to LVEF, and multivariable logistic regression for associations between comorbidities and CTRCD incidence.

Results: Among those assessed, the median LVEF decreased from 60% to 58%, with 11.8% meeting CTRCD criteria postchemotherapy. Lung disease and previous transient ischemic attacks were associated with more significant LVEF declines of 2.5% and 3.5%, respectively. Hyperlipidemia was associated with an increased risk of developing CTRCD. Of 262 patients with pre- and postchemotherapy echocardiograms, only 13 (5.0%) had left ventricular global longitudinal strain measurements on both pre- and postechocardiograms.

Conclusions: This study examines CTRCD incidence in a heterogeneous cancer population and explores associations between comorbidities, LVEF decline, and CTRCD development. It highlights gaps in echocardiographic monitoring for chemotherapy patients at risk of cardiomyopathy. Future efforts should focus on improving clinical gaps and advancing risk stratification research. Abbreviations: COPD = chronic obstructive pulmonary disease, CTRCD = cancer therapy-related cardiac dysfunction, ESC = European Society of Cardiology, IQR = interquartile range, LVEF = left ventricular ejection fraction, LVGLS = left ventricular global longitudinal strain, OR = odds ratio, TIA = transient ischemic attack, TTE = transthoracic echocardiography.

Keywords

cancer / cardiac biomarkers / cardiac dysfunction / cardiac monitoring / cardiotoxicity / chemotherapy / echocardiography / left ventricular ejection fraction

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