Cardio-oncology最新文献

{"title":"No detectable early subclinical cardiotoxicity within 12 weeks of thoracic radiotherapy under predominantly low cardiac dose exposure: a prospective cohort study.","authors":"Iván Valdés-Orrego, Francisco Acevedo, Tomas Merino","doi":"10.1186/s40959-026-00539-2","DOIUrl":"10.1186/s40959-026-00539-2","url":null,"abstract":"<p><strong>Background: </strong>Early radiation-induced cardiac injury in patients receiving thoracic radiotherapy (RT) remains insufficiently characterized. Global longitudinal strain (GLS) and circulating biomarkers such as high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) may detect subclinical myocardialdamage.</p><p><strong>Methods: </strong>This prospective single-center cohort study enrolled 47 adults with thoracic malignancies treated with curative-intent RT. Cardiac assessments were performed at baseline, 1 week, and 12 weeks post-RT. GLS was measured by two-dimensional speckle-tracking echocardiography, and hs-cTnT and NT-proBNP were quantified using high-sensitivity immunoassays. Mean heart dose (MHD) was categorized as < 10 Gy or ≥ 10 Gy to explore dose-stratified differences within this predominantly low-dose exposure cohort. Temporal changes and dose-stratified differences were analyzed using non-parametric tests.</p><p><strong>Results: </strong>GLS remained stable across timepoints (median - 18.06% at baseline, - 18.72% at week 1, and - 18.59% at week 12; p = 0.650). Similarly, hs-cTnT showed no significant variation (7.30, 7.50, and 6.60 ng/L, respectively; p = 0.842), and NT-proBNP demonstrated modest, non-significant increases (43.0, 48.5, and 55.5 pg/mL; p = 0.797). Stratification by MHD revealed no significant differences in GLS or biomarker levels at any timepoint. No dose-dependent associations were observed These findings were consistent across subgroups and in sensitivity analyses restricted to completers, in a cohort with a median MHD of 5.1 Gy.</p><p><strong>Conclusions: </strong>Contemporary thoracic RT was not associated with detectable early subclinical cardiotoxicity within the first 12 weeks under predominantly low cardiac dose exposure. Early cardiac alterations may depend on higher radiation exposure or longer follow-up, supporting longitudinal surveillance strategies.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality predictors in cancer patients undergoing transcatheter aortic valve implantation for aortic stenosis: a systematic review and meta-analysis.","authors":"Azin Alizadehasl, Yasamin Afsari Zonooz, Golnar Mortaz Hejri, Hoda Hakimian, Alia Bahramnejad, Ehsan Amini-Salehi, Seyyed Mohammad Hashemi, Roozbeh Narimani-Javid, Seyedeh Fatemeh Hosseini Jebelli, Azam Yalameh Aliabadi","doi":"10.1186/s40959-026-00527-6","DOIUrl":"10.1186/s40959-026-00527-6","url":null,"abstract":"<p><strong>Background: </strong>The coexistence of cancer and aortic stenosis is increasingly common in elderly patients, presenting unique challenges for management. Transcatheter aortic valve implantation (TAVI) offers a less invasive alternative to surgical valve replacement, but the impact of various clinical factors on post-TAVI mortality in cancer patients remains unclear.</p><p><strong>Objective: </strong>To systematically review and meta-analyze the predictors of mortality in cancer patients undergoing TAVI for aortic stenosis.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in Scopus, PubMed, Web of Science, and Embase up to May 2025. Studies assessing mortality predictors in cancer patients post-TAVI were included. Data extraction and quality assessment were performed independently by two reviewers. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Sensitivity analyses addressed within-study correlation assumptions, and heterogeneity was assessed using I² and τ² statistics.</p><p><strong>Results: </strong>Five high-quality case-control studies, encompassing over 7,000 patients, were included. Advanced NYHA class (III/IV), prior myocardial infarction, atrial fibrillation, COPD, diabetes mellitus, and higher STS scores were robustly associated with increased mortality. Active cancer conferred a significantly higher mortality risk (HR 1.64, 95% CI: 1.17-2.30), while preserved left ventricular ejection fraction and renal function were linked to improved survival. Most predictors remained stable across sensitivity analyses, although the impact of cancer status varied with correlation assumptions.</p><p><strong>Conclusion: </strong>Both traditional cardiovascular and cancer-specific factors significantly influence mortality in cancer patients undergoing TAVI. These findings underscore the need for individualized, multidisciplinary risk assessment and highlight the importance of further research to refine patient selection and optimize outcomes in this growing patient population.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prevention and management of cardiovascular disease in adults with cancer: an International Cardio-Oncology Society (IC-OS) and Multinational Association of Supportive Care in Cancer (MASCC) clinical practice statement.","authors":"Susan Dent, Michelle B Nadler, Anne Blaes, Ahamed Iqbal, Hannah Naa Gogwe Ayettey, Jose Alvarez-Cardona, Alexandre Chan, Eng-Siew Koh, Raul Cordoba Mascunano, Mridula George, Naa Adorkor Aryeetey, Erin J Howden, Sase Kazuhiro, Nida Latif, Aya F Ozaki, Cherith J Semple, Sivatharshini Ramalingam, Neil M Iyenger, Hope S Rugo, Bogda Koczwara","doi":"10.1186/s40959-026-00533-8","DOIUrl":"10.1186/s40959-026-00533-8","url":null,"abstract":"","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chimeric antigen receptor T cell therapy cardiotoxicity: a narrative review.","authors":"G Sinigiani, G Scapinello, T Berno, F Piazza, A Cipriani","doi":"10.1186/s40959-026-00499-7","DOIUrl":"10.1186/s40959-026-00499-7","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T cell therapy has transformed the management of some relapsed/refractory hematologic malignancies. However, cardiovascular (CV) toxicity has emerged as a clinically relevant concern, particularly given its increasing use in older patients with CV comorbidities. Cytokine release syndrome (CRS) plays a central role in the development of cardiotoxicity, with interleukin-6 identified as a key mediator. Atrial arrhythmias and heart failure are among the most frequently reported complications. Their management relies on early detection and supportive care, although current strategies are largely extrapolated from general cardio-oncology guidelines. Significant gaps remain in risk stratification, surveillance protocols, and therapeutic approaches tailored to the unique inflammatory profile of CAR T cell-related toxicity. Addressing these gaps is essential to improve CV outcomes in this growing patient population.This narrative review aims to offer clinical cardiologists and hematologists a practical and current framework for the recognition and management of CAR T cell -related cardiotoxicity, with a focus on pathophysiological mechanisms, clinical presentation, and management strategies.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of cardiovascular diseases in breast cancer survivors: a 9-year retrospective cohort study based on regional medical data in Inner Mongolia China.","authors":"Qiaorui Wen, Yunjing Zhang, Liying Qiao, Meng Qi, Ying Yan, Weiwei Kang, Guozhen Liu, Mingyuan Wang, Siyan Zhan, Yunfeng Xi, Shengfeng Wang","doi":"10.1186/s40959-026-00531-w","DOIUrl":"10.1186/s40959-026-00531-w","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer (BC) and cardiovascular diseases (CVD) shared many risk factors. Hitherto no studies revealing the burden of CVD and its subtypes in mainland Chinese BC patients exist. This study aimed to describe the incidence, prognosis and economic burden of CVD among BC survivors in Inner Mongolia.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted during 2012-2021, using data from the Inner Mongolia Regional Health Information Platform. BC patients were identified using diagnosis characters and ICD-10 code, and followed-up till new-onset CVD, death, or March 2021. New-onset CVD was documented by hospitalization, outpatient or medication records, and categorized into 12 subtypes. The incidence density, mortality density and medical costs were calculated. Subgroup analyses were also conducted by BC therapy status, nationality, GDP level and CVD subtypes.</p><p><strong>Results: </strong>In 29 516 BC patients included, the mean age was 52.03 ± 11.02, 16.55% were Mongolian. After 3.59 ± 2.34 years follow-up, we documented 12 527 new-onset CVD cases. The incidence density of CVD was 184.44 per 1000 person-years. Hypertension, arrhythmia, ischemic heart disease were the most common subtypes, with incidence density of 97.26, 79.80, and 53.90 per 1000 person-years. The incidence density peaked in the first year, especially the first three months, and then decreased gradually. BC patients with new-onset CVD had higher mortality density (33.41 vs. 19.63 per 1000 person-years), and bear higher expenses burden of average annual costs for outpatients (2349.20 vs. 2319.08 CNY) than those without. Patients residing in lower GDP areas had higher all-cause mortality density (35.37 vs. 31.45 per 1000 person-years), but higher average annual for hospitalization (18770.60 vs. 15827.69 CNY) than their counterpart. As for CVD subtypes, BC patients with heart failure and arrhythmia showed the top 2 highest mortality density and economic burden.</p><p><strong>Conclusions: </strong>Among BC survivors in Inner Mongolia, hypertension and arrhythmia were the most common CVD subtypes, especially in the first three-month after BC diagnosis. Those with arrhythmia, heart failure, or from lower-GDP areas showed poorer prognosis. Results highlighted the urgent need for cardio-protective strategies for BC patients, especially at the first three-month post-diagnosis, for those from economically disadvantaged regions, targeting hypertension, arrhythmia and heart failure.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal dynamics of cardiac biomarkers in therapy‑related cardiotoxicity: a prospective cardio‑oncology cohort study.","authors":"Lidia Anca Kajanto, Dana Lucia Stănculeanu, Anca Chisoi, Nicolae Dobrin, Anita-Cristina Ionescu, Ioan Sîrbu, Ion Alexandru Popovici, Pundiche Mihaela, Ionut Bulbuc, Andreea Diana Kajanto, Bogdan Cîmpineanu, Adrian Neluțu Mitroi, Georgeta-Camelia Cozaru","doi":"10.1186/s40959-026-00538-3","DOIUrl":"10.1186/s40959-026-00538-3","url":null,"abstract":"<p><strong>Background: </strong>Cardiotoxicity associated with antineoplastic therapies remains an important clinical challenge in modern oncology. Early identification of subclinical cardiac injury may improve cardiovascular surveillance and long-term outcomes in cancer patients.</p><p><strong>Methods: </strong>This prospective observational cohort study included 90 adult patients with breast cancer, lymphoma, or lung cancer receiving potentially cardiotoxic therapy. Patients with clinically manifest heart failure, severe arrhythmias, advanced renal disease, recent acute myocardial infarction, untreated severe valvular disease, or other major cardiovascular comorbidities were excluded. High-sensitivity cardiac troponin T (hs-cTnT), NT-proBNP, and soluble ST2 (sST2) were measured at baseline, during treatment, at therapy completion, and at late follow-up. Non-parametric tests were used for repeated-measures and subgroup comparisons.</p><p><strong>Results: </strong>Significant temporal variations were observed for all biomarkers. hs-cTnT increased from 5 [3-8] ng/L at baseline to 15 [10-25] ng/L at T2, while NT-proBNP increased from 120 [80-190] pg/mL to 210 [150-320] pg/mL. sST2 demonstrated a delayed elevation and remained increased at follow-up. Distinct biomarker patterns were observed across malignancy subgroups, with higher hs-cTnT increases in breast cancer, more prominent NT-proBNP elevation in lymphoma, and higher sST2 values in lung cancer.</p><p><strong>Conclusions: </strong>Serial biomarker assessment may provide complementary information on myocardial injury, ventricular stress, and fibrotic remodeling during cancer therapy. The observed biomarker trajectories are suggestive of different biological processes involved in therapy-related cardiotoxicity, but they should be interpreted in conjunction with imaging findings and clinical outcomes.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular event burden in women with breast cancer treated with CDK4/6 inhibitors: a retrospective matched cohort study.","authors":"Veerle Leenaerts, Nicholas Cauwenberghs, Hans Wildiers, Patrick Neven, Tatiana Kuznetsova, Lucas Van Aelst","doi":"10.1186/s40959-026-00536-5","DOIUrl":"10.1186/s40959-026-00536-5","url":null,"abstract":"<p><strong>Background: </strong>Cyclin-dependent kinase (CDK) 4/6 inhibitors improve outcomes in hormone receptor-positive, HER2-negative breast cancer, but real-world data on cardiovascular (CV) toxicity are limited.</p><p><strong>Methods: </strong>In this single-centre retrospective matched cohort study, women with breast cancer treated with a CDK4/6 inhibitor at University Hospitals Leuven between 2016 and 2022 constituted the index cohort. Age- and BMI-matched women without active cancer, selected from the population-based FLEMENGHO study, constituted the reference cohort. CV events were identified from medical records, and follow-up in the reference cohort was truncated to the maximum follow-up duration of the index cohort to improve comparability.</p><p><strong>Results: </strong>Among 536 matched pairs, the index cohort had a significantly higher observed incidence of CV events than the reference cohort (67.7 vs 17.2 per 1,000 person-years; P < 0.0001), including the cardiac composite (28.0 vs 9.6 per 1,000 person-years; P < 0.0001). Venous thromboembolism (11.6% vs 0.75%) and atrial fibrillation/flutter (4.7% vs 1.5%) were more frequent in the index cohort. Coronary events, stroke, and heart failure did not differ significantly. After adjustment for measured baseline CV risk factors, index-cohort membership remained associated with higher risks of CV events (HR, 3.63; 95% CI, 2.57-5.13) and cardiac events (HR, 3.25; 95% CI, 1.97-5.35).</p><p><strong>Conclusions: </strong>Women with breast cancer receiving CDK4/6 inhibitors had a substantially higher observed burden of venous thromboembolism and atrial arrhythmias than the age- and BMI-matched population reference cohort without active cancer. These findings support cardiovascular awareness in this population. However, the comparison cannot isolate a drug-specific effect because active malignancy, previous cancer therapies, baseline differences, and surveillance intensity may also contribute.</p><p><strong>Trial registration: </strong>This retrospective single-centre matched cohort study was approved by the Ethics Committee UZ/KU Leuven (approval numbers s68763 and s64406). As a retrospective observational study, prospective trial registration was not required.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk after cancer in patients with ischemic heart disease or peripheral artery disease.","authors":"Torben Bjerregaard Larsen, Ricco Noel Hansen Flyckt, Margrethe Bang Henriksen, Claus Lohman Brasen, Torben Frøstrup Hansen, Flemming Skjøth","doi":"10.1186/s40959-026-00520-z","DOIUrl":"10.1186/s40959-026-00520-z","url":null,"abstract":"<p><strong>Background: </strong>Patients with ischemic heart disease (IHD) or peripheral artery disease (PAD) represent a high-risk cardiovascular phenotype. When cancer is diagnosed in this population, clinical attention may shift toward treatment of the malignancy, potentially leading to under-recognition of pre-existing cardiovascular disease and its associated risks. Real-world data describing early cardiovascular outcomes after cancer diagnosis in this subgroup are however limited. The objective was to describe 1-year risks of cardiovascular death, major adverse cardiovascular events (MACE: ischemic stroke, systemic embolism, myocardial infarction, and hemorrhagic stroke), and venous thromboembolism (VTE: pulmonary embolism, and deep vein thromboembolism) after cancer diagnosis and to compare these risks across cancer sites within this high-risk vascular population.</p><p><strong>Methods: </strong>Using nationwide Danish registries, we identified 91,253 patients with IHD and/or PAD who developed a first primary cancer between 2002 and 2022. One-year cumulative incidences of cardiovascular death, MACE, and VTE were estimated using competing-risk methods. Multivariable Cox regression models were used to identify clinical predictors of cardiovascular outcomes.</p><p><strong>Results: </strong>Within one year of cancer diagnosis, 33% of patients died. The cumulative incidence of cardiovascular death was 2.4%, MACE 2.8%, and VTE 1.8%, with substantial variation across cancer types. Neurologic, respiratory, and digestive tract cancers were associated with the highest cardiovascular risk. Prior cardiovascular comorbidity strongly predicted adverse outcomes. Statin therapy was associated with lower cardiovascular mortality (hazard ratio [HR] 0.66) and fewer MACE events (HR 0.84).</p><p><strong>Conclusions: </strong>Cancer patients with pre-existing IHD or PAD experience a high burden of early cardiovascular and thrombotic events with marked variation across cancer types. These findings underscore the need for integrated cardio-oncology care and support continued use of guideline-directed cardiovascular preventive therapies during cancer treatment.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning and plasma growth differentiation factor-15 (GDF15) for early risk stratification of heart failure progression in a long-latency doxorubicin cardiomyopathy model.","authors":"Kaui P Lebarbenchon, Anjali Kumar, Brian Ladle, Christopher B Douville, Kathy Gabrielson","doi":"10.1186/s40959-026-00523-w","DOIUrl":"https://doi.org/10.1186/s40959-026-00523-w","url":null,"abstract":"<p><strong>Background: </strong>Anthracycline-induced cardiotoxicity is a major cause of late heart failure (HF) in cancer survivors. Yet early identification of individuals at risk for accelerated cardiotoxic progression remains a clinical challenge. This study leveraged a rat model of long-latency doxorubicin cardiotoxicity to identify early features associated with progression to a prespecified 7-month HF endpoint and to develop a machine learning risk-stratification framework.</p><p><strong>Methods: </strong>Doxorubicin-treated rats (both sexes, n = 32 doxorubicin treated and n = 22 saline) were monitored with monthly echocardiography and monthly plasma concentrations of growth differentiation factor-15 (GDF15) for up to 12 months. We defined the primary HF endpoint as the occurrence of severe systolic dysfunction (fractional shortening (FS) < 30%) by 7 months post-chemotherapy. A Logistic Regression (LR) model was compared to Random Forest (RF) and XGBoost (XGB) classifiers in distinguishing animals that reached this endpoint by 7 months from those with delayed or absent progression within that time frame. Model performance was evaluated by area under the ROC curve (AUC), Brier score, calibration plots, decision curve analysis (DCA), and DeLong tests for AUC differences. Feature importance was examined via permutation testing, SHapley Additive exPlanations (SHAP) values, and accumulated local effects (ALE) plots.</p><p><strong>Results: </strong>Using 1,000 repeated stratified 60/40 train-validation splits, models were retrained and evaluated on the corresponding held-out validation subsets. LR achieved a median AUC of 0.81, RF 0.97, and XGB 0.93. Pairwise DeLong tests were not statistically significant, so the numerically higher AUCs for RF and XGB should be interpreted as suggestive rather than definitive evidence of superior discrimination. The machine learning models showed lower Brier scores (approximately 0.06 vs. 0.12 for logistic regression) and higher estimated net benefit in decision-curve analysis within this dataset. A label-permutation test indicated that RF performance exceeded chance (p < 0.05). Risk groups defined by machine learning-predicted probability showed strong time-to-HF separation on Kaplan-Meier analysis (log-rank p < 0.0001).</p><p><strong>Discussion: </strong>Key predictors included early elevation in plasma GDF15 levels, early decline in FS (ΔFS), body weight, and sex. In this doxorubicin cardiotoxicity animal model, RF and XGB showed numerically higher discrimination than logistic regression, while sensitivity analyses indicated that GDF15 and ΔFS retained predictive signal beyond sex alone.</p><p><strong>Conclusion: </strong>These findings support further study of multi-parameter early monitoring and predictive modeling for risk stratification of accelerated cardiotoxic progression in animal models and, ultimately, in appropriately validated clinical cohorts.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical myocardial changes after hematopoietic stem cell transplantation: limited predictive value of early biomarkers and strain imaging.","authors":"Ana Carolina Oliver, Federico Superchi, Roberto Superchi, Matilde Canabal, Carolina Errecarte, Ricardo Mosquera, Ada Caneiro, Silvia Pierri, Sebastian Galeano, Eloisa Riva, Laura Bello, Regis Gai, Silvana Jubin, Pablo Muxi","doi":"10.1186/s40959-026-00522-x","DOIUrl":"10.1186/s40959-026-00522-x","url":null,"abstract":"<p><strong>Background: </strong>Cardiotoxicity is a relevant late complication after hematopoietic stem cell transplantation. Early identification of subclinical myocardial injury could allow preventive interventions, yet the optimal diagnostic approach in this setting remains undefined.</p><p><strong>Objectives: </strong>To evaluate the incidence of subclinical myocardial damage through cardiac biomarkers and echocardiography in adult HSCT recipients, and to determine their association with subsequent clinical cardiotoxicity.</p><p><strong>Methods: </strong>This prospective, single-center study enrolled 158 adult patients undergoing HSCT between 2017 and 2020. NT-proBNP, troponins, and CK-MB were measured at baseline, post-infusion, day 14, and day 30. Echocardiography was performed at baseline and day 30. Subclinical myocardial damage was defined as the presence of asymptomatic myocardial injury during chemotherapy, as evidenced by new biomarker elevation and/or a relative decline > 15% in global longitudinal strain from baseline. Clinical cardiotoxicity was assessed at 1 year.</p><p><strong>Results: </strong>During the first 100 days, 79.7% of patients exhibited NT-proBNP elevation, whereas troponins and CK-MB remained unchanged. A ≥ 15% GLS reduction occurred in 14.6% of cases, without correlation to NT-proBNP changes (p = 0.3). Subclinical myocardial damage was detected in 83.5% of patients and was associated with older age and females but not with prior anthracycline exposure or conditioning regimen. At 1 year, the cumulative incidence of clinical cardiotoxicity was 4.4%, with no predictive association with early biomarker or strain alterations.</p><p><strong>Conclusions: </strong>Subclinical myocardial alterations are frequent during the early post-HSCT period but lack predictive value for subsequent clinical cardiotoxicity. NT-proBNP elevation and GLS reduction likely represent transient myocardial stress rather than irreversible injury. Routine early post-transplant biomarker and strain monitoring may have limited clinical utility.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}