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