Incidence and Predictors of Doxorubicin-Induced Cardiotoxicity in Breast Cancer Patients at a Tertiary Academic Hospital in Indonesia: A Retrospective Cohort Study

Abstract

Background:

Doxorubicin, as part of the chemotherapy regimen for breast cancer, has long been associated with cardiotoxicity, primarily manifested by a reduction in left ventricular ejection fraction (LVEF). Early detection of cardiac dysfunction is essential to prevent the progression of heart failure and ensure patient safety. This study aimed to analyze trends in LVEF reduction, the incidence of cardiotoxicity, and associated risk factors in breast cancer patients receiving doxorubicin-based chemotherapy at Dr. Hasan Sadikin General Hospital, Bandung.

Methods:

We conducted a retrospective cohort study of 130 patients and further reviewed the medical records. The LVEF values were obtained from echocardiographic assessments performed before and after each chemotherapy cycle. The Mann-Whitney U test and Wilcoxon Signed Rank test were used to assess LVEF trends, while bivariate analysis was applied to evaluate the association between clinical variables and cardiotoxicity.

Results:

The results showed a statistically significant reduction in LVEF beginning after the third chemotherapy cycle and continuing through the sixth (P < .05), with a median decline of approximately 4% to 5%. The incidence of cardiotoxicity was 4.62%, with an additional 3.85% of patients classified as having borderline low LVEF. The age factor (P = .047) and a history of hypertensive heart disease (HHD) (P = .034) showed a statistically significant association with the incidence of left ventricular dysfunction, but no factors showed a statistically significant association with the incidence of cardiotoxicity.

Conclusions:

The early onset of LVEF reduction highlights the critical role of routine cardiac monitoring during chemotherapy as a preventive strategy against cardiotoxicity progression. Identification of risk factors such as older age and preexisting cardiovascular conditions is essential for risk stratification and the implementation of safer and individualized treatment approaches.