Key result
Baseline ECG parameters added to clinical risk scores improve CTRCD prediction by ~35%.
Why the study?
Strategies to estimate the risk of cancer therapy-related cardiac dysfunction prior to initiating cardiotoxic cancer therapy are needed.
Do baseline ECG markers improve the prediction of cancer therapy-related cardiac dysfunction in female patients with HER2-positive breast cancer?
Cohort (n=1,278)
Do baseline ECG markers improve the prediction of cancer therapy-related cardiac dysfunction in female patients with HER2-positive breast cancer?
p-value: p=<0.001
Baseline ECG markers provide independent and incremental value over established clinical risk factors for predicting cancer therapy-related cardiac dysfunction in breast cancer patients.
May refine CTRCD risk stratification in breast cancer; leaves open prospective validation before clinical use.
Background Strategies to estimate risk of cancer therapy‐related cardiac dysfunction (CTRCD) before initiating cardiotoxic cancer treatment are needed. We hypothesized that baseline ECG markers could identify patients at risk for CTRCD. Methods and Results In this retrospective cohort study, 1278 female patients with stage I–III HER2 (human epidermal growth factor receptor 2)‐positive breast cancer meeting the following inclusion criteria were included: baseline ECG with QRS <120 milliseconds, baseline echocardiogram, and ≥1 follow‐up echocardiogram. Quantitative measurements of ECG waveform parameters were performed using MUSE (GE Healthcare). The primary outcome of interest was CTRCD at 1 year, defined by left ventricular ejection fraction decline (≥10% to <53% or ≥16% from baseline), or clinical heart failure (New York Heart Association class III/IV). Mean age was 51.7±11.1 years, 990 (77%) received anthracyclines, and all received HER2‐targeted therapy. CTRCD occurred in 160 (13%) patients. In a multivariable Cox proportional hazards model adjusting for our previously published CTRCD risk score (composed of patient and treatment‐specific factors), 4 ECG markers remained independently associated with CTRCD risk: QRS axis, R‐wave duration (lead II), ST segment deviation (lead II), and Sokolow–Lyon voltage (all P <0.05). Compared with a model using only clinical CTRCD risk variables, addition of ECG parameters provided incremental value for predicting CTRCD risk ( P <0.001, likelihood ratio test) with continuous net reclassification improvement of 34.9% and integrated discrimination improvement of 3.4%. Conclusions Baseline ECG variables are predictive of subsequent CTRCD and provide incremental value to established clinical risk factors for CTRCD risk classification.
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Ibtida et al. (2025) conducted a cohort in Stage I–III HER2-positive breast cancer (n=1,278). Baseline ECG markers vs. Clinical CTRCD risk variables alone was evaluated on CTRCD at 1 year, defined by left ventricular ejection fraction decline (≥10% to <53% or ≥16% from baseline), or clinical heart failure (New York Heart Association class III/IV) (p=<0.001). Baseline ECG parameters added to clinical risk variables provided incremental value for predicting cancer therapy-related cardiac dysfunction risk (P<0.001, net reclassification improvement 34.9%).
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