Cancer survivorship - heart failure risk factor or potentiator?

Abstract

Abstract Introduction An emerging challenge in cancer survivorship is the increased incidence of heart failure (HF) in long term adult survivors. This has been attributed to shared risk factors found between cancer and HF, cancer treatment-related cardiac dysfunction (CTRCD) and cancer itself. However, determining the magnitude and interplay of these risks can refine the process of risk-stratifying which survivors are most vulnerable to the development of HF. Objective This study investigates the relationship between traditional HF risk factors and subclinical HF (Stage B/SBHF) in adult cancer survivors compared to non-cancer controls. Methods 102 adult survivors ≥10 years post cardiotoxic cancer treatment were prospectively recruited. All participants were evaluated with clinical review and echocardiography for presence of SBHF. SBHF was defined as the presence of left ventricular hypertrophy, abnormal global longitudinal strain (GLS) or diastolic dysfunction. Participants were matched to non-cancer controls by traditional HF risk factors - hypertension (HTN), type-2 diabetes (T2DM), obesity and age. Participants were excluded if they were symptomatic, had a prior history of HF or moderate/severe valvular regurgitation. Results Approximately 50% of cancer survivors did not have any of the 3 main HF risk factors (HTN, T2DM, obesity). The mean ARIC-HF 4-year risk score in cancer survivors was 3.1% [1.8, 5.6]. When matched by HF risk factors (HTN, T2DM, obesity and age), there was no difference in SBHF prevalence and GLS between cancer survivors (38%, -18.7%) and non-cancer controls (43%, -18.7%, (SBHF p=0.53%, GLS p=0.92%). However, the association between HF risk factors and impaired GLS (<-16%) was stronger in cancer survivors compared to non-cancer controls (Table 1). Conclusion Our investigation indicates that cancer survivorship alone may not directly contribute to the development of SBHF. However, it appears to exert a synergistic influence when coupled with established risk factors such as HTN, T2DM or obesity, potentially exacerbating the progression of SBHF.Table 1:HF risk factors & abnormal GLS