Pasar al contenido principal
Premio 2024 - Mejor Publicación en el Área de Cardiovascular
Cardiovascular

Borja Rivero-Santana 1, Jesús Saldaña-García 1, Juan Caro-Codón 1, Pilar Zamora 2, Pedro Moliner 3, Amparo Martínez Monzonis 4, Eduardo Zatarain 5, Carlos Álvarez-Ortega 1, Pilar Gómez-Prieto 6, Sonia Pernas 7, Isabel Rodriguez 8, Antonio Buño Soto 9, Rosalía Cadenas 10, Patricia Palacios Ozores 11, Sara Pérez Ramírez 12, María Merino Salvador 13, Silvia Valbuena 1, Lucía Fernández Gasso 1, Victor Juárez 14, Andrea Severo 14, Belén Terol 15, Teresa de Soto Álvarez 6, Olaia Rodríguez 9, María Brion 4, José González-Costello 3, Miguel Canales Albendea 16, José R González-Juanatey 4, Raúl Moreno 1, José López-Sendón 17, Teresa López-Fernández 1 15

Affiliations Expand

 

Abstract

Background and aims: Baseline cardiovascular toxicity risk stratification is critical in cardio-oncology. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score aims to assess this risk but lacks real-life validation. This study validates the HFA-ICOS score for anthracycline-induced cardiovascular toxicity.

Methods: Anthracycline-treated patients in the CARDIOTOX registry (NCT02039622) were stratified by the HFA-ICOS score. The primary endpoint was symptomatic or moderate to severe asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), with all-cause mortality and cardiovascular mortality as secondary endpoints.

Results: The analysis included 1066 patients (mean age 54 ± 14 years; 81.9% women; 24.5% ≥65 years). According to the HFA-ICOS criteria, 571 patients (53.6%) were classified as low risk, 333 (31.2%) as moderate risk, 152 (14.3%) as high risk, and 10 (0.9%) as very high risk. Median follow-up was 54.8 months (interquartile range 24.6-81.8). A total of 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD (symptomatic: n = 45; moderate to severe asymptomatic: n = 24; and mild asymptomatic: n = 649). Incidence rates of symptomatic or moderate to severe symptomatic CTRCD and all-cause mortality significantly increased with HFA-ICOS score [hazard ratio 28.74, 95% confidence interval (CI) 9.33-88.5; P < .001, and hazard ratio 7.43, 95% CI 3.21-17.2; P < .001) for very high-risk patients. The predictive model demonstrated good calibration (Brier score 0.04, 95% CI 0.03-0.05) and discrimination (area under the curve 0.78, 95% CI 0.70-0.82; Uno's C-statistic 0.78, 95% CI 0.71-0.84) for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months.

Conclusions: The HFA-ICOS score effectively categorizes patients by cardiovascular toxicity risk and demonstrates strong predictive ability for high-risk anthracycline-related cardiovascular toxicity and all-cause mortality.

Keywords: Anthracycline chemotherapy; Breast cancer; Cardiotoxicity; Heart failure; Lymphoma; Risk stratification.

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.