Prognosis After Withdrawal of Cardioprotective Therapy in Patients With Improved Cancer Therapeutics–Related Cardiac Dysfunction

Figures

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  Figure 1. Trajectory of LVEF This figure illustrates the changes in left ventricular ejection fraction (LVEF) over time segmented by cardioprotective therapy (CPT) maintenance status and baseline LVEF at the time of cancer therapeutics–related cardiac dysfunction diagnosis. The shaded area represents the 95% CI. Asterisks (∗) indicate significant differences in LVEF changes (P < 0.001), and the dagger (†) denotes a significant difference (P = 0.001).

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  Figure 2. Trajectory of LV GLS Depicts the changes in left ventricular (LV) global longitudinal strain (GLS) categorized by the CPT maintenance status and baseline LVEF at the time of cancer therapeutics–related cardiac dysfunction diagnosis. The shaded area indicates the 95% CI. Abbreviations as in Figure 1.

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  Figure 3. Major Clinical Outcomes Kaplan-Meier curves illustrate the major clinical events, including hospitalization for heart failure or a decrease in LVEF ≥10 percentage points within 2 years after cancer therapeutics–related cardiac dysfunction improvement. The outcomes are displayed as follows: (A) a composite of hospitalization for heart failure and a decrease in LVEF by ≥10 percentage points, (B) hospitalization for heart failure, and (C) decreased in LVEF by ≥10 percentage points, based on the maintenance status of CPT. CG = control group; WG = withdrawn group; other abbreviations as in Figure 1.

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  Central Illustration. Cardioprotective Therapy Maintenance and Outcomes In patients with improved cancer therapeutics–related cardiac dysfunction (CTRCD), those who discontinued cardioprotective therapy (CPT) experienced worse clinical outcomes, defined as a composite of hospitalization for heart failure or a decrease in left ventricular ejection fraction (LVEF) ≥10 percentage points within 2 years after CTRCD improvement. A significant decrease in LVEF was observed in patients with a baseline LVEF <45% at the time of CTRCD diagnosis after CPT withdrawal. However, patients with a baseline of LVEF ≥45% did not exhibit a significant decrease in LVEF even after CPT withdrawal. CG = continued group; WG = withdrawn group.