Scientific publications

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

May 1, 2020 | Magazine: European Heart Journal

José López-Sendón  1 , Carlos Álvarez-Ortega  1 , Pilar Zamora Auñon  1 , Antonio Buño Soto  1 , Alexander R Lyon  2 , Dimitrios Farmakis  3   4 , Daniela Cardinale  5 , Miguel Canales Albendea  1 , Jaime Feliu Batlle  1 , Isabel Rodríguez Rodríguez  1 , Olaia Rodríguez Fraga  1 , Ainara Albaladejo  1 , Guiomar Mediavilla  1 , Jose Ramón González-Juanatey  6 , Amparo Martínez Monzonis  6 , Pilar Gómez Prieto  1 , José González-Costello  7 , José María Serrano Antolín  8 , Rosalía Cadenas Chamorro  9 , Teresa López Fernández  1

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.

CITA DEL ARTÍCULO  Eur Heart J. 2020 May 7;41(18):1720-1729. doi: 10.1093/eurheartj/ehaa006

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