Predictive risk factors associated with cancer therapy-related cardiac dysfunction: A retrospective cohort study

Abstract

Introduction

The increasing cardiovascular events in cancer patients underscore the importance of identifying preexisting risk factors as predictors of heart disease outcomes. This study aimed to assess the predictive risk factors associated with cancer therapy-related cardiac dysfunction (CTRCD) in female patients with breast cancer undergoing treatment with anthracyclines and/or anti-HER-2 therapies.

Methods

A cohort study was conducted at a university hospital outpatient clinic from 2019 to 2024. CTRCD was defined according to the European Society of Cardiology criteria as an absolute LVEF reduction of >10 percentage points to <50% during treatment.

Results

A total of 161 female patients were analyzed (mean age: 51.2 ± 11.6 years), with most being white/Caucasian (83.8%). The most prevalent cardiovascular risk factors were hypertension (47.2%), obesity (31.7%), smoking (31.0%), dyslipidemia (14.3%), and type 2 diabetes mellitus (12.4%). CTRCD occurred in 18 patients (11.1%), with a markedly higher prevalence (27.3%) in those with four or more cardiovascular risk factors. The median time (IQR) from the initiation of chemotherapy to CTRCD was 395 (248–674) days. Multivariable analysis identified the Charlson comorbidity index (HR 1.2; 95% CI: 1.0–1.4), chemotherapy duration (HR 1.0; 95%CI: 1.0–1.0) and LVEF before (HR 0.8; 95%CI: 0.7–0.9) and after chemotherapy (HR 0.8; 95%CI: 0.8–0.9) as independent factors for CTRCD. Breast cancer patients had a 17.7% risk of developing CTRCD within the first two years of antineoplastic treatment.

Conclusion

Hypertension, obesity, and smoking were the most prevalent cardiovascular risk factors. Independent predictors of CTRCD included the Charlson comorbidity index, chemotherapy duration, and LVEF before and after treatment.