Differences in the prevalence of cardiovascular toxicity in a cohort of female breast cancer patients according to the different cardiotoxicity definitions

Abstract

Abstract Background The definition of cancer therapy-related cardiac dysfunction (CTRCD) has evolved in the past ten years, as Cardio Oncology has consolidated as a new medical discipline. However, great heterogeneity is noted among the published criteria of the different types of cardiotoxicities by the different scientific societies. In order to mitigate this variability, a new definition of CTRCD has been recently proposed by the International Cardio-Oncology Society (IC-OS) and endorsed by the latest 2022 ESC Guidelines on cardio-oncology. CTRCD is now classified into different degrees of severity according to symptoms, left ventricular ejection fraction (LVEF) reduction guided by echocardiography and elevation of cardiac biomarkers. Purpose we aimed to assess the impact of the new consensus definition of CTRCD in the reclassification of cardiotoxicity in a breast cancer cohort of female patients receiving potentially cardiotoxic therapies (CT) attended in our third-level hospital. Methods we retrospectively analyzed and compared the incidence of the different subtypes of CTRCD in a cohort of female breast cancer patients evaluated in our hospital from 2018 to 2021 according to both the previous 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity and the latest 2021 ICOS definition. Results a cohort of 193 women with a breast cancer diagnosis and receiving CT was analyzed. Mean age was 58 ± 11 years and 57 % of the patients (110) had a least one cardiovascular risk factor, with no past history of cardiac disease. According to the previous ESC 2016 criteria, 16 patients (8.3%) had cardiac dysfunction associated with cancer treatment whereas with the 2021 IC-OS new definition, a total of 23 women (12%) would have been satisfied the CTRCD criteria. Of Those, 11 were asymptomatic and 7 had severe CTRCD. Overall, this would have translated into a 30% rise in the incidence of patients experiencing any type of cardiotoxicty (p < 0.0001). Conclusion(s) by using the new IC-OS criteria for CTRCD, a significant increase in the prevalence of cardiotoxicity was noted in our population, which may translate the higher sensitivity of the proposed criteria to detect clinical or subclinical cardiovascular damage derived from cancer treatment.