Decoding anthracycline- and trastuzumab-related cardiac dysfunction prediction: HFA-ICOS scores versus strain imaging

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Hai Hoang Nguyen, Nhat Minh Giang, Duc Tan Vo, Tri Huynh Quang Ho, Chau Ngoc-Hoa
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引用次数: 0

Abstract

Aims

Baseline Heart Failure Association–International Cardio-Oncology Society (HFA-ICOS) scores and serial left ventricular global longitudinal strain (LV-GLS) measurements have been found to be useful in predicting cancer therapy-related cardiac dysfunction (CTRCD). However, their integration for the purpose of improving prognostic accuracy remains unclear; and we aimed to develop a predictive model for CTRCD using baseline HFA-ICOS scores and the relative decline of LV-GLS in patients on anthracycline or trastuzumab.

Methods

We prospectively enrolled 443 chemotherapy-naïve women with breast cancer and cardiovascular risk factors, scheduled to receive anthracycline (n = 333) or trastuzumab (n = 110). Participants were stratified by the HFA-ICOS risk score. The left ventricular ejection fraction (LVEF) and LV-GLS were evaluated using echocardiography at baseline, before each treatment cycle, and every 3 months in the first year post-chemotherapy. CTRCD was a new LVEF reduction ≥10 percentage points to an LVEF < 50%, irrespective of symptoms.

Results

In terms of HFA-ICOS stratification, 258 patients (58.2%) were low risk, 180 (40.6%) were moderate risk and 5 (1.2%) were high risk. The proportions of low- and moderate-risk patients were similar in the anthracycline and trastuzumab groups. Twenty-four (7.2%) and seven (6.4%) patients treated with anthracycline and trastuzumab, respectively, displayed asymptomatic CTRCD. The addition of the baseline HFA-ICOS risk score did not improve the performance of the significant relative decline of LV-GLS > 15% in predicting both anthracycline [area under the receiver-operating characteristic curve (AUC) 0.93, 95% confidence interval (CI) 0.89–0.96, sensitivity 87.5%, specificity 93.2%] and trastuzumab (AUC 0.97, 95% CI 0.88–0.99, sensitivity 85.7%, specificity 93.2%)-related cardiac dysfunction.

Conclusions

Contemporary anthracycline and trastuzumab-based regimens resulted in similarly low incidences of CTRCD. In this context, LV-GLS evolution was the best predictor of CTRCD.

Abstract Image

解码蒽环类和曲妥珠单抗相关心功能障碍预测:HFA-ICOS评分与应变成像。
目的:基线心力衰竭协会-国际心脏肿瘤学会(HFA-ICOS)评分和左心室整体纵向应变(LV-GLS)测量被发现可用于预测癌症治疗相关的心功能障碍(CTRCD)。然而,为了提高预后准确性而将它们整合起来仍不清楚;我们的目标是利用基线HFA-ICOS评分和蒽环类或曲妥珠单抗患者LV-GLS的相对下降来开发CTRCD的预测模型。方法:我们前瞻性地招募了443名chemotherapy-naïve患有乳腺癌和心血管危险因素的女性,计划接受蒽环类药物(n = 333)或曲妥珠单抗(n = 110)。根据HFA-ICOS风险评分对参与者进行分层。在基线、每个治疗周期前和化疗后第一年每3个月使用超声心动图评估左心室射血分数(LVEF)和LV-GLS。结果:在HFA-ICOS分层中,258例(58.2%)为低危患者,180例(40.6%)为中度危患者,5例(1.2%)为高危患者。在蒽环类药物组和曲妥珠单抗组中,低危和中度危患者的比例相似。分别接受蒽环类药物和曲妥珠单抗治疗的24例(7.2%)和7例(6.4%)患者显示无症状CTRCD。基线HFA-ICOS风险评分的增加并没有改善LV-GLS在预测蒽环类药物[受体-工作特征曲线下面积(AUC) 0.93, 95%可信区间(CI) 0.89-0.96,敏感性87.5%,特异性93.2%]和曲珠单抗(AUC 0.97, 95% CI 0.88-0.99,敏感性85.7%,特异性93.2%)相关心功能障碍方面显著相对下降的表现。结论:当代以蒽环类药物和曲妥珠单抗为基础的治疗方案导致CTRCD的发生率同样较低。在这种情况下,LV-GLS进化是CTRCD的最佳预测因子。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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