Systematic evaluation of risk factors for acquired heart disease in sarcoma survivors.

Abstract

127 Background: Sarcoma survivors are at high risk for severe heart disease at a young age. The study objective is to evaluate risk factors for cardiac disease in sarcoma survivors receiving more than 300 mg/m2 of Doxorubicin. Left ventricular ejection fraction is a routinely used test but is not predictive. It is imperative to determine which modifiable cardiovascular risk factors increase cardiac risk. Methods: Our unique Sarcoma Survivorship Clinic was established to evaluate high risk sarcoma patients for the long-term and late effects of cancer and its treatment. Each patient regularly electronically completes NIH’s PROMIS questionnaires developed for this clinic. Family medical history is reviewed. Chemotherapy doses are abstracted from original medical records. Data collected includes: blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), basic metabolic panel, chemistries, renal and pulmonary function, echocardiography. We will compare standardized cardiac risk assessments with mediastinal calcification and epicardial fat on serial chest CT scans. All patients signed an informed consent. Results: The 24 patient cohort had a cumulative dose of > 300 mg/m2 of Doxorubicin. No patient had chest radiation. All patients had normal left ejection fractions (median= 60%). Eight patients (33%) had an elevated hs-CRP (>3) and 10 patients (42%) had elevated blood pressure. Framingham risk may underestimate risk in this relatively young population and other metrics may be required. Conclusions: Our findings suggest high risk sarcoma survivors' follow-up management requires a comprehensive approach to establish the patient's overall cardiac risk profile. Symptoms may be discounted and/or attributed to other causes, leading to delayed and/or inappropriate treatment of cardiovascular disease. We must improve our knowledge of the long-term cardiac risk associated with surviving a bone or soft tissue sarcoma to effectively counsel survivors and offer effective intervention strategies to prevent or minimize the impact of adverse late effects.