Breast cancer survivors had a 49% higher odds of low LVEF (≤55%) early post-treatment, with cardiac dysfunction risk declining over time.
Is a history of cancer associated with subclinical cardiac dysfunction in asymptomatic individuals?
Asymptomatic cancer survivors, particularly those with breast cancer, have a significantly higher risk of subclinical left ventricular dysfunction, especially in the early post-treatment period.
Abstract Introduction Cancer survivors face an elevated risk of heart failure due to shared risk factors and cardiotoxic cancer treatments. While current guidelines recommend cardiac surveillance in this population, the optimal timing and intensity of monitoring remain poorly defined. Furthermore, the prevalence of subclinical cardiac dysfunction in asymptomatic cancer survivors are not well characterized, particularly in relation to time since cancer treatment. Purpose This study investigated the association between cancer history and cardiac function in asymptomatic individuals. Methods This cross-sectional study included participants with documented cancer history from cancer registries and matched with non-cancer controls using propensity scoring based on age, sex, diabetes and blood pressure. Cardiac function, primarily left ventricular ejection fraction (LVEF), was assessed using cardiac magnetic resonance (CMR). Results Of 23,854 cancer survivors (age 61.0±6.8 years, 60.9% female) and an equal number of matched controls, 1,051 survivors and 1,538 controls underwent CMR. Survivors from breast or haematological malignancies demonstrated minor differences in LVEF (59.5±6.4 vs 60.1±6.4, p0.001) and global circumferential strain (-22.4±3.5 vs -22.6±3.5, p0.001) compared to controls. Analysis stratified by time since cancer diagnosis revealed that both LVEF (p=0.014) and global circumferential strain (p=0.045) were less likely to be impaired with increasing time from diagnosis. More participants with a history of cancer (OR=1.29 1.09-1.53, p=0.004), particularly breast cancer (OR=1.49 1.22-1.81, p0.001), were associated with low LVEF (=55%) after adjusting for age, sex, years since cancer diagnoses and blood pressure medication. Conclusion This study identifies a critical window for cardiac surveillance in cancer survivors, with the highest risk of subclinical dysfunction occurring in the early post-treatment period. The findings support implementing targeted cardiac monitoring strategies, particularly for breast cancer survivors, with potential for reducing monitoring intensity over time in those without early dysfunction. These results can inform the development of more cost-effective, risk-stratified cardiac surveillance protocols in cancer survivorship care, potentially enabling earlier intervention in high-risk periods while avoiding unnecessary testing in long-term survivors with stable cardiac function.Flowchart of included participants Violin plot of participants' lvef
Soh et al. (2025) studied this question. Breast cancer survivors had a 49% higher odds of low LVEF (≤55%) early post-treatment, with cardiac dysfunction risk declining over time.