Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry
Key result
Severe cardiotoxicity from high-risk anticancer therapy is linked to ~10-fold higher mortality.
- HR 10.2
Why the study?
Cardiotoxicity is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking.
What is the prevalence and prognostic impact of anticancer therapy-induced cardiotoxicity?
Population
865 patients scheduled for anticancer therapy related with moderate/high CTox risk
Design
Prospective registry
Follow-up
Median of 24 months
Authors
Discussion
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Member takes
Implication
Severe cardiotoxicity was associated with high mortality in cancer patients; extends prior observations but leaves causal inference and practice change open.
Key Points
- To establish uniform diagnostic criteria for anticancer therapy-induced cardiotoxicity and assess its prevalence, severity distribution, and prognostic impact on mortality.
- Prospective cohort study (CARDIOTOX registry) following 865 patients (aged 54.7 ± 13.9 years; 16.3% men) receiving anticancer treatments with moderate-to-high cardiotoxicity risk for a median of 24 months.
- Classified myocardial damage and dysfunction into four tiers based on biomarkers (high-sensitivity troponin T and NT-proBNP) and left ventricular ejection fraction (LVEF): normal, mild (abnormal biomarkers or LVD with LVEF ≥50%), moderate (LVEF 40–49%), and severe (LVEF ≤40% or symptomatic heart failure).
- Cardiotoxicity developed in 37.5% of patients (95% CI 34.22–40.8%), with 31.6% experiencing mild, 2.8% moderate, and 3.1% severe myocardial damage or dysfunction.
- Mortality was 22.9 deaths per 100 patient-years in the severe cardiotoxicity group versus 2.3 deaths per 100 patient-years across other groups (HR 10.2, 95% CI 5.5–19.2; P < 0.001).
Structured PICO
What is the prevalence and prognostic impact of anticancer therapy-induced cardiotoxicity?
P
Population
865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high cardiotoxicity risk.
I
Intervention
Anticancer therapy related with moderate/high cardiotoxicity risk
O
Outcome
Cardiotoxicity (defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up)composite
While mild cardiotoxicity is common during or after cancer therapy, severe cardiotoxicity is rare but strongly associated with increased mortality.
Cite This Study
López‐Sendón et al. (2020) studied this question. Cardiotoxicity was identified in 37.5% of patients, with severe cases exhibiting a mortality rate of 22.9 deaths per 100 patient-years compared to 2.3 in other groups (HR 10.2).