Cardiotoxicity risk assessment using HFA-ICOS score: a cross-sectional analysis of patients with breast cancer undergoing chemotherapy or anti-HER2 therapies in a tertiary care center

Abstract Introduction Cancer and cardiovascular disease are leading causes of mortality. Advances in oncology have improved survival but increased cardiovascular morbidity. Breast cancer, the most common malignancy in Colombian women (28% of new cases in 2021), has subtypes: HR+ (70%), HER2+ (20–30%), and basal-like (10–15%). Cancer therapy-related cardiac dysfunction (CTRCD) occurs in 15–20% of patients receiving anti-HER2 therapy and up to 48% with anthracyclines. Purpose To assess cardiotoxicity risk using the HFA-ICOS score and evaluate CTRCD incidence based on ESC criteria. Methods A retrospective, cross-sectional study of 94 adults with breast cancer treated with chemotherapy (2022–2024) in Bogotá, Colombia. HFA-ICOS was used for risk stratification, and CTRCD was assessed over 12 months. Results The study included 94 patients (one male), median age 58 years (range: 31–86). No patients developed heart failure symptoms. Molecular subtypes: Luminal A 11.7%, Luminal B 55.3%, HER2-enriched 12.7%, and Basal-like 13.8%. HFA-ICOS stratification showed 6% very high risk, 22% high risk, 9.5% intermediate risk, and 58% low risk. Baseline transthoracic echocardiography (TTE) was performed in all patients, but only 54% had post-treatment imaging. Anthracyclines were used in 29%, and 39% received anti-HER2 therapy. All very high-risk patients were HER2+ and received trastuzumab; two also received anthracyclines. Among high-risk patients, 47% were HER2+, and 38% received anthracyclines. Only 14 high-risk patients had TTE before and after treatment, with GLS measured in seven; two had a 15% GLS reduction. No patients in the very high- or high-risk groups had 10% LVEF decline. However, in the low-risk group, 23 had post-treatment TTE, and 7 (7%) showed 10% LVEF reduction. Baseline troponin was elevated in three patients, and natriuretic peptides in four, all in the intermediate-risk group. Conclusions HFA-ICOS effectively stratifies patients for CTRCD risk, including anthracycline- and anti-HER2-related cardiotoxicity. Limited follow-up restricted comprehensive assessment. Unexpectedly, 7% of low-risk patients had significant LVEF decline, underscoring the need for structured cardiotoxicity monitoring aligned with ESC guidelines and local resources.