Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry

Abstract

Aim Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40–49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22–40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5–19.2) (P < 0.001). Conclusions The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.

Predictors of new-onset heart failure and overall survival in metastatic breast cancer patients treated with liposomal doxorubicin

“…In our hypothesis HF with reduced ejection fraction below 40% may be the real reason for terminating cancer therapy and can have a significant impact on the overall survival of patients with metastatic BC 49 . The definition of HF with reduced ejection fraction proposed by the European Society of Cardiology was adopted in the study 50 .…”

Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

“…AIC is one of the most feared side effects of these efficacious chemotherapy agents. Most recent data show that up to 30% of patients treated with anthracyclines develop some degree of cardiotoxicity, and AIC manifests as significant cardiac dysfunction in up to 10% of patients 3,6 . Severe AIC is more frequent among especially vulnerable populations, such as the elderly.…”

“…Several definitions of cardiotoxicity have been proposed, with a consensus conception of cancer-therapy-related cardiac dysfunction as a reduction in left ventricular ejection fraction (LVEF) of 10 absolute points to a value below the normal range for the imaging technique [3][4][5][6] .…”

Câncer e Doenças Cardiovasculares na Pandemia de COVID-19

“…Nos últimos anos, diversas estratégias de monitorização e rastreio de toxicidade precoce, com diagnóstico ainda na fase subclínica, foram incorporadas na prática clínica para evitar que esses pacientes desenvolvam disfunção ventricular e insuficiência cardíaca. [55][56][57][58] Lopez-Sendon et al 59 identificaram a incidência de cardiotoxicidade em 37% dos pacientes previamente submetidos a terapia com elevado potencial cardiotóxico e que tiveram monitoramento cardíaco durante a quimioterapia. 59 Entretanto, no cenário atual da pandemia, avaliando-se o risco potencial de contaminação por COVID-19 em pacientes com câncer sob quimioterapia, considera-se rediscutir a indicação desses exames, reorganizando-se a marcação de exames de maneira personalizada.…”