Risk-Guided Disease Management To Prevent Heart Failure In Adult Cancer Survivors of Previous Cardiotoxic Cancer Treatments: Baseline Results of the REDEEM Trial.

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-09-16 DOI:10.1016/j.ahj.2025.09.009

Joshua Wong, Joel Smith, Cheng Hwee Soh, Erin Howden, Jack S Talbot, Mark Nolan, Kristyn Whitmore, Leah Wright, Ashleigh-Georgia Sherriff, Eswar Sivaraj, Greg Wheeler, Kirsty Wiltshire, Phillip Campbell, Satish Ramkumar, Constantine Tam, Thomas H Marwick

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引用次数: 0

Abstract

Background: Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.

Objectives: The REDEEM (Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.

Methods: Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multi-disciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO₂peak) over 6 months.

Results: Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8±6.8%), subclinical LV dysfunction was common (GLS 15.6±2.1%) and 39% had evidence of functional impairment (VO₂peak≤18ml/kg/min^-1). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72-1.11], p=0.360).

Conclusions: Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.

Registration: ClinicalTrials.gov NCT04962711, https://www.

Clinicaltrials: gov/study/NCT04962711.

查看原文本刊更多论文

风险引导疾病管理预防既往心脏毒性癌症治疗的成年癌症幸存者心力衰竭：REDEEM试验的基线结果

背景：由于标准危险因素和癌症治疗相关的心功能障碍，成年癌症幸存者发生心力衰竭（HF）的风险增加。然而，亚临床/ B期心力衰竭（shbhf）在这一人群中的患病率和治疗尚不明确。目的：REDEEM（风险引导疾病管理计划，以预防先前接受心脏毒性癌症治疗的患者心力衰竭）试验将评估长期癌症幸存者的心衰筛查和靶向干预。方法：对年龄≥40岁、接受潜在心脏毒性治疗后≥5年、HF危险因子≥1的患者，通过超声心动图筛查shbhf（全身纵缩异常[GLS]、左室肥厚[LVH]、舒张功能不全或三维左室射血分数异常[3D-LVEF]）。shbhf患者被随机分配到多学科心脏肿瘤疾病管理计划（CO-DMP），包括神经激素阻断，运动训练和风险因素优化，或常规护理。主要终点是6个月内心肺功能（VO2peak）的变化。结果：在1124名幸存者中，604人接受了超声心动图检查，145人（24%）患有shbhf（年龄68±18岁，81%为女性）。在符合随机分组条件的患者中，64%患有乳腺癌，35%患有血液恶性肿瘤。虽然保留了基线3D-LVEF(52.8±6.8%)，但亚临床左室功能障碍很常见（GLS 15.6±2.1%），39%有功能障碍的证据（VO2peak≤18ml/kg/min-1）。异常GLS与年龄、BMI、糖尿病和蒽环类药物暴露有关，而功能损害仅与年龄有关。GLS异常与功能障碍无显著相关性（OR 0.90 [95% CI 0.72-1.11], p=0.360）。结论：基于风险的筛查可以识别出患有shbhf的癌症幸存者的高危亚群。注册：ClinicalTrials.gov NCT04962711, https://www.Clinicaltrials: gov/study/NCT04962711。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.