ECG Scoring for the Evaluation of Therapy-Naïve Cancer Patients to Predict Cardiotoxicity

Abstract

Objective: To evaluate a new electrocardiographic (ECG) score reflecting domains of electrical and structural alterations in therapy-naïve cancer patients to assess their risk of cardiotoxicity. Methods: We performed a retrospective analysis of 134 therapy-naïve consecutive cancer patients in our two university hospitals concerning four ECG score parameters: Contiguous Q-waves, markers of left ventricular (LV) hypertrophy, QRS duration and JTc prolongation. Cardiotoxicity was assessed after a short-term follow-up (up to 12 months). Results: Of all the patients (n = 25), 19% reached 0 points, 50% (n = 67) reached 1 point, 25% (n = 33) reached 2 points, 5% (n = 7) reached 3 points and 0.7% reached 4 or 5 points (n = 1 respectively). The incidence of cardiotoxicity (n = 28 [21%]) increased with the ECG score, with 0 points at 0%, 1 point 7.5%, 2 points 55%, 3 points 71% and ≥3 points 50%. In the ROC (Receiver operating curves) analysis, the best cut-off for predicting cardiotoxicity was an ECG score of ≥2 points (sensitivity 82%, specificity 82%, AUC 0.84, 95% CI 0.77–0.92, p < 0.0001) which was then defined as a high-risk score. High-risk patients did not differ concerning their age, LV ejection fraction, classical cardiovascular risk factors or cardiac biomarkers compared to those with a low-risk ECG score. Conclusion: ECG scoring prior to the start of anti-cancer therapies may help to identify therapy-naïve cancer patients at a higher risk for the development of cardiotoxicity.

Cardiovascular health‐related quality of life in cancer: a prospective study comparing the ESC HeartQoL and EORTC QLQ‐C30 questionnaire

“…Health‐related quality of life measurements as a reflection of patients′ symptom burden and daily life restrictions have an increasingly prominent role as an important outcome in clinical trials for patients with cancer 38–40 . As we show here and have shown before, 41–43 patients with cancer in general have higher cardiac distress than healthy controls reflected by slightly lower left ventricular ejection fraction, higher resting heart rates and elevated cardiac biomarkers (even though significant cardiovascular disease was an exclusion criterion in this study and patients with cancer more often used beta‐blockers). Other commonly observed problems in patients with advanced cancer include whole body wasting/cachexia and malnutrition 44–46 as well as muscle wasting and sarcopenia 47,48 .…”

“…. before, [41][42][43] patients with cancer in general have higher cardiac distress than healthy controls reflected by slightly lower left ventricular ejection fraction, higher resting heart rates and elevated cardiac biomarkers (even though significant cardiovascular disease was an exclusion criterion in this study and patients with cancer more often used beta-blockers). Other commonly observed problems in patients with advanced cancer include whole body wasting/cachexia and malnutrition [44][45][46] as well as muscle wasting and sarcopenia.…”

Right ventricular and atrial strain in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy

“…New data show that the analyses of electrocardiogram, cardiac biomarkers, and cardiac magnetic resonance imaging and echocardiographic assessment of myocardial function are of great importance. 16 , 46 , 47 , 48 , 49 Because of the high mortality of immune‐related cardiotoxicity, its early detection seems of great importance. New parameters, which could indicate early cardiotoxicity, are therefore desirable.…”

“…Because of the lack of consistency of its clinical manifestation, diagnosis of immune‐related cardiotoxicity is challenging. New data show that the analyses of electrocardiogram, cardiac biomarkers, and cardiac magnetic resonance imaging and echocardiographic assessment of myocardial function are of great importance 16,46–49 . Because of the high mortality of immune‐related cardiotoxicity, its early detection seems of great importance.…”