Key result
Pre-existing HFpEF in cancer patients is linked to ~53% incidence of cardiotoxic events.
Why the study?
HFpEF is not included in baseline risk stratification or CTRCD definitions in cancer patients undergoing potentially cardiotoxic treatments, and data on HFpEF in this population are scarce.
Does pre-existing HFpEF increase the risk of cardiotoxic events, heart failure events, and mortality in cancer patients undergoing potentially cardiotoxic treatments compared to those without pre-existing HF or with HF(m)rEF?
Observational (n=665)
Does pre-existing HFpEF increase the risk of cardiotoxic events, heart failure events, and mortality in cancer patients undergoing potentially cardiotoxic treatments compared to those without pre-existing HF or with HF(m)rEF?
Pre-existing HFpEF in cancer patients is associated with significant cardiotoxicity and mortality risks comparable to HFrEF, underscoring the need for its inclusion in baseline cardio-oncology risk stratification.
Clinicians should assess HFpEF history before cancer therapy; observational data leaves open its prognostic value for cardiotoxicity.
Background The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) increases due to improved diagnostic tools and treatments. In cancer patients undergoing potentially cardiotoxic treatments, HFpEF is not included in baseline risk stratification, nor in cancer therapy-related cardiac dysfunction (CTRCD) definitions. Data on HFpEF in this population are scarce. Purpose We described baseline HFpEF prevalence in cancer patients, and compared the incidence of cardiotoxic and HF events (CTRCD + HFpEF decompensation) and mortality in this subgroup compared to patients without pre-existing HF and to patients with pre-existing HF(m)rEF. Secondly, we investigated the incidence of HFpEF events (new HFpEF diagnosis or decompensation of pre-existing HFpEF) during or after cancer therapy, identifying predictors for developing on-treatment HFpEF. Methods & Results This observational, retrospective real-world analysis included 665 patients (54.1% female, mean age 62.1 years, median follow-up 485 days), of whom 36 (5.4%) had known HFpEF prior to cancer therapy initiation. In this subgroup, 19/36 (52.8%) developed cardiotoxic events, 16/36 (44.4%) developed HF events and 10/36 (27.8%) died. Independent of baseline characteristics, 96/665 patients (14.4%) developed HFpEF events, of whom 46/96 (47.9%) had pre-existing CVD yet only 15/96 (15.6%) a previous HFpEF diagnosis. Cancer therapy required adaptation in 12/96 patients (12.5%). Older age, female sex, arterial hypertension and previous arrhythmias predicted on-treatment HFpEF events in multivariate analysis. Conclusion Pre-existing HFpEF carries a significant cardiotoxicity and mortality risk comparable to HF(m)rEF, but is likely underdiagnosed in cancer patients. On-treatment HFpEF events are common and may have important cancer treatment (and prognosis) implications. . Risk predictors for HFpEF events during or after cancer therapy are female sex, symptom referral, age >65 years, AHT, pre-existing arrhythmia and immunomodulatory myeloma therapy. Further investigations are required to evaluate whether specific management strategies may improve prognosis in these patientsGraphic Abstract
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Kemp et al. (2026) conducted an observational in Cancer requiring potentially cardiotoxic treatments (n=665). Pre-existing heart failure with preserved ejection fraction (HFpEF) vs. Patients without pre-existing HF and patients with pre-existing HF(m)rEF was evaluated on Cardiotoxic events. Among cancer patients with pre-existing HFpEF, 52.8% developed cardiotoxic events, 44.4% developed HF events, and 27.8% died, highlighting a significant cardiotoxicity and mortality risk.
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