Cancer Therapy Cardiac Dysfunction Remains Common but Most Cases are Mild.

Abstract

Background: Incidence and severity of cancer therapy related cardiac dysfunction (CTRCD) may be improving. More data is required to confirm this, to help optimise monitoring and management. Aim(s): To assess rate, severity and course of CTRCD. Method(s): Echocardiograms and medical records were assessed for a cohort of breast cancer patients who received trastuzumab or an anthracycline, and underwent serial echocardiographic monitoring. CTRCD was defined as a decline in left ventricular ejection fraction (LVEF) of >10% to <55%. Management and outcomes were assessed. Result(s): 258 patients were included with 38 (15%) meeting CTRCD criteria. The distribution of severity was: EF 50-55%, 15; EF 40-49%, 12; EF 30-39%, 8 and EF <30%, 3. Thirty-four (89%) were asymptomatic and no heart failure (HF) related deaths occurred. In 32 patients (84%), LVEF recovered to or remained >50%. Eighteen CTRCD patients did not have cancer therapy withheld after LVEF decline, all having a mild decline to the 40-55% range. In all these EF recovered to or remained >50%. Compared to other CTRCD patients this subset were younger (average age 52 vs 61 years, p<0.01), had higher average GLS at baseline (-21.7 vs -18.4, p<0.01) and were less likely to have a cardiovascular risk factor (6% vs 40%, p<0.02). Conclusion(s): CTRCD remains common although most cases are mild and outcomes favourable. Cancer therapy may not need to be withheld in many cases and management should be individualised, highlighting the importance of cardio-oncology collaboration. These results should also inform the risk-benefit ratio of overly sensitive monitoring strategies.Copyright � 2024