Baseline vs. on-treatment heart failure with preserved ejection fraction (HFpEF) in a real world cardio-oncology clinic: observational analysis of cancer therapy-related cardiovascular toxicity incidence and cancer treatment implications

Figures

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  Figure 1. Outcomes in pre-existing HFpEF vs. no HF & vs. pre-existing HF(m)rEF. Upon comparison with patients without pre-existing HF (orange bars), and with patients with pre-existing HF(m)rEF (grey bars), we observed in patients with pre-existing HFpEF significantly more HFpEF events (i.e., HFpEF decompensation requiring diuretic intensification and/or hospital admission). We observed a similar mortality in patients with pre-existing HFpEF as in patients with pre-existing HF(m)rEF, thus indicating the high-risk profile of these patients, particularly compared to patients without pre-existing HF (and also a numerically normal left ventricular ejection fraction). No significant differences were observed for the incidence of CTR-CVT or CTRCD, or for cancer treatment alterations. CA trt., cancer treatment; CTRCD, cancer therapy-related cardiac dysfunction; CTR-CVT, cancer therapy-related cardiovascular toxicity; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HF(m)rEF, heart failure with (mildly) reduced ejection fraction; pre-ex., pre-existing.

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  Figure 2. Kaplan–Meier curve for time-to-event analysis (death) per HF stratum. Time-to-event analysis for mortality, stratified for pre-existing HF subtypes. With a caveat of lower absolute event rates, our data showed significantly shorter time-to-event rates for death in patients with pre-existing HFrEF (red line) compared to patients with pre-existing HFmrEF (green line), pre-existing HFpEF (dark blue line) and those without pre-existing HF (light blue line). HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

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  Figure 3. Outcomes in patients developing HFpEF events vs. no CTRCD vs. CTRCD. When comparing to patients without CTRCD, patients who developed HFpEF events after cancer therapy initiation developed significantly more CAD and arrhythmias (comparable to patients developing CTRCD). Furthermore, patients developing HFpEF events required significantly more cancer treatment alterations than patients without CTRCD, again comparable to patients with CTRCD. Cardioprotective treatment or heart failure treatment was initiated significantly less often than in CTRCD but significantly more often than in patients without CTRCD. However, this seemed to imply no significant mortality difference throughout the follow-up period. AHT, arterial hypertension; CAD, coronary artery disease; CA trt., cancer treatment; CPT, cardioprotective treatment; CTRCD, cancer therapy-related cardiac dysfunction; HFpEF, heart failure with preserved ejection fraction; HF trt, heart failure treatment.