A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity

Figures

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  Figure 1. Cumulative Incidence of Cardiotoxicity by HFA-ICOS Risk Categories The curves show the cumulative incidence of anthracycline-induced cardiotoxicity according to HFA-ICOS risk category (low, moderate, high) in the derivation cohort. This figure illustrates the discriminative ability of the HFA-ICOS score to stratify baseline risk and highlights differences in cardiotoxicity rates among risk groups over a 2-year follow-up period. HFA-ICOS = Heart Failure Association–International Cardio-Oncology Society.

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  Figure 2. Observed vs Predicted Cardiotoxicity by RE-ACT Score in Derivation Cohort Concordance plots comparing the predicted probability of cardiotoxicity by the RE-ACT score with the observed incidence in the derivation cohort, stratified by quintiles of risk at 1 year. The figure demonstrates calibration and accuracy of the RE-ACT model in quantifying individual cardiotoxicity risk, supporting its utility for postchemotherapy risk stratification. RE-ACT = REassessment of Anthracycline Cardiotoxicity risk after Therapy.

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  Figure 3. ROC Curves Comparing HFA-ICOS, RE-ACT, and Combined Models ROC curves illustrating the discriminative performance of the HFA-ICOS score, RE-ACT score, and their combination for predicting cardiotoxicity at 1 year in the derivation cohort. Area under the curve (AUC) values with 95% CI are shown. The combined model demonstrates superior predictive accuracy, highlighting the complementary value of baseline and post-treatment risk assessment. HFA-ICOS = Heart Failure Association–International Cardio-Oncology Society; RE-ACT = REassessment of Anthracycline Cardiotoxicity risk after Therapy; ROC = receiver operating characteristic.

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  Figure 4. Observed vs Predicted Cardiotoxicity by RE-ACT Score in Validation Cohort Concordance plots comparing predicted probabilities of cardiotoxicity by the RE-ACT score with observed incidence in the validation cohort, stratified by quintiles of risk at 1 year. The figure demonstrates calibration and accuracy of the RE-ACT model in an independent population, supporting its reliability for post-treatment risk assessment and individualized surveillance planning. RE-ACT = REassessment of Anthracycline Cardiotoxicity risk after Therapy.

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  Central Illustration. Two-Step Risk Stratification for Anthracycline-Induced Cardiotoxicity Cardiotoxicity risk is greatest within the first year after completion of anthracycline therapy. Baseline assessment with the HFA-ICOS score provides initial risk stratification. A post-treatment re-evaluation, integrating left ventricular ejection fraction and cumulative anthracycline dose, refines prediction accuracy and supports a 2-step strategy for individualized surveillance. AUC = area under the curve (prediction of cardiotoxicity occurrence at 1 year and 2 years); HFA-ICOS = Heart Failure Association–International Cardio-Oncology Society; LVEF = left ventricular ejection fraction; RE-ACT = REassesment of Anthracycline Cardiotoxicity risk after Therapy.