Abstract Introduction Advances in cancer prevention and treatment have significantly improved breast cancer (BC) survival, but chemotherapy-related cardiac dysfunction (CTRCD) is a growing concern. The 2022 ESC Guidelines on Cardio-Oncology recommend baseline cardiovascular risk stratification using the risk assessment tools proposed by the Heart Failure Association (HFA) and the International Cardio-Oncology Society (ICOS) for patients scheduled to receive anthracyclines (AC) and anti-human epidermal growth factor receptor-2 (HER2) agents. However, its ability to predict severe CTRCD lacks real-life validation, particularly in the Portuguese population. Purpose To evaluate the clinical application of HFA/ICOS risk score in BC patients undergoing chemotherapy with AC or anti-HER2 agents and its utility in predicting the development of CTRCD in a Portuguese population. Methods BC patients treated with AC or anti-HER2 agents and followed in Cardio-oncology consultation in a local portuguese hospital were retrospectively divided according to the HFA-ICOS risk proforma. The primary endpoint was moderate to severe CTRCD. All-cause and cardiovascular (CV) mortality were secondary endpoints. Results We included 65 pts (100% women; mean age 60 ± 10 years; 38% ≥65 years). 15 (23%) had metastatic disease. Regarding chemotherapy regimens, 45% were exposed to AC only, 10% to anti-HER2 only and 45% to AC plus anti-HER2. According to the HFA-ICOS tool, 22 pts (34%) were classified as low risk, 24 (37%) as moderate risk, 11 (17%) as high risk, and 8 (12%) as very high risk. Median follow-up was 36 months (interquartile range 23-70). 15 pts (23%) developed CTRCD: 14 (93%) moderate to severe, 9 (60%) symptomatic. 9 pts (14%) died, 2 by CV cause. A statistically significant association between very high basal CV risk and development of moderate to severe CTRCD was found (p 0.009; OR=8.9, 95% CI 1.8;43).The same was verified for all-cause mortality (p 0.01; OR=10, 95% CI 1.9;54) and CV mortality (p 0.01; OR=1.3, 95% CI 0.9;2). Conclusion This study supports the HFA/ICOS score's ability to predict moderate to severe CTRCD in breast cancer pts treated with AC or anti-HER2 agents, highlighting the importance of close monitoring, especially in very-high risk pts.
Andrade et al. (Fri,) studied this question.