Key result
High HFA-ICOS baseline risk linked to ~3.6-fold higher risk of cancer therapy-related cardiac dysfunction.
Why the study?
The external performance of the HFA-ICOS baseline cardiovascular risk classification across diverse populations remains incompletely characterized.
Does the HFA-ICOS baseline cardiovascular risk classification predict cancer therapy-related cardiac dysfunction in women with breast cancer receiving anthracycline-containing therapy?
Cohort (n=108)
No
Does the HFA-ICOS baseline cardiovascular risk classification predict cancer therapy-related cardiac dysfunction in women with breast cancer receiving anthracycline-containing therapy?
The HFA-ICOS risk classification correctly identifies ordinal risk gradients for cardiotoxicity in breast cancer patients receiving anthracyclines, but has limited individual-level discrimination, underscoring the need for ongoing cardiovascular surveillance.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In our view, our simple score should not replace HFA-ICOS score but rather serve as an adjunct. When used together, the two models provided additive prognostic value, outperforming either one alone.”
“Until further evidence substantiates its performance, caution is warranted when applying this model in routine practice.”
“After this baseline CV toxicity risk stratification, every patient fits in one of these 3 categories: low risk, moderate risk, high or very high risk, and this enables the oncology team to make appropriate treatment choices, to educate patients on their own CV risk, and also to organise a preventive and surveillant personalised plan during treatment.”
May inform HFA-ICOS risk stratification before anthracycline therapy in breast cancer; leaves open optimal surveillance intensity pending larger validation.
Background/Objectives: The HFA-ICOS baseline cardiovascular risk classification was developed to standardize pretreatment risk stratification before potentially cardiotoxic cancer therapy, but its external performance across diverse populations remains incompletely characterized. We prospectively evaluated its performance in women with breast cancer receiving anthracycline-containing therapy in Central Asia. Methods: This prospective single-center external validation study used data from the PREDICATE cohort (ISRCTN12628444). Participants were classified at baseline as being at low, moderate, high, or very high cardiovascular risk according to the HFA-ICOS classification before treatment and outcome ascertainment; the high- and very-high-risk categories were pooled for analysis because of small numbers. Participants underwent serial cardiovascular surveillance, including echocardiographic assessment of left ventricular ejection fraction and global longitudinal strain, together with serial cardiac biomarker measurements. The primary outcome was cancer therapy-related cardiac dysfunction (CTRCD), defined according to the 2022 ESC cardio-oncology criteria. Results: The analysis included 108 participants. CTRCD occurred in 43 of 108 participants (39.8%). The observed proportion of participants who developed CTRCD increased from 30.0% in the low-risk group to 47.5% in the moderate-risk group and 75.0% in the high/very-high-risk group (p = 0.026). Kaplan–Meier analysis demonstrated significant separation of CTRCD-free survival across HFA-ICOS risk categories (log-rank χ2 = 10.12; p = 0.006). Compared with the low-risk group, the hazard of CTRCD was higher in the moderate-risk group (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.13–4.13) and high/very-high-risk group (HR, 3.59; 95% CI, 1.42–9.11). Discrimination was modest (area under the curve, 0.630; 95% CI, 0.530–0.724). Conclusions: The HFA-ICOS classification demonstrated a clear ordinal gradient in CTRCD risk and significant time-to-event separation but showed limited discrimination at the individual-patient level. It may guide initial risk stratification but should be complemented by longitudinal cardiovascular surveillance rather than used as a stand-alone predictor.
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Amanova et al. (2026) conducted a cohort in Breast cancer (n=108). High/very-high HFA-ICOS baseline cardiovascular risk classification vs. Low HFA-ICOS baseline cardiovascular risk classification was evaluated on Cancer therapy-related cardiac dysfunction (CTRCD) (HR 3.59, 95% CI 1.42-9.11, p=0.006). A high/very-high HFA-ICOS baseline cardiovascular risk classification was associated with a higher risk of cancer therapy-related cardiac dysfunction compared to low risk.
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