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Cardiovascular toxicity risk stratification in cancer patients: an unmet need in cardio-oncology
Session:
SESSÃO DE POSTERS 56 - CARDIONCOLOGIA DE PONTA I
Speaker:
Isabel Moreira
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Cartazes
FP Number:
---
Authors:
Isabel Martins Moreira; Marta Catarina Bernardo; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; Alzira Nunes; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong> Cardiovascular toxicity (CVT) risk stratification is crucial before initiating potentially cardiotoxic anticancer therapies. While the HFA-ICOS Cardio-Oncology risk assessment tool is recommended by ESC guidelines, its validation is not yet robustly established.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> This study aimed to evaluate the accuracy of the HFA-ICOS tool in predicting cancer therapy-related CVT (CTR-CVT) in a cohort of cancer patients.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong>: A retrospective study was conducted on patients referred to cardio-oncology outpatient clinic in our center between May 2021 and July 2024. Baseline cardiovascular risk (BCVR) was assessed using the HFA-ICOS tool. CTR-CVT and cancer therapy-related cardiac dysfunction (CTRCD) were defined according to 2022 ESC Cardio-oncology guidelines. Demographic, clinical, echocardiographic, and laboratory data were analyzed. The predictive capacity of the HFA-ICOS tool was evaluated using ROC curves and their respective area under the curve (AUC).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> Of a total of 135 patients referred to cardio-oncology outpatient clinic, only <span style="color:black">57 (42.2%) were eligibly classified by HFA-ICOS tool: </span>26.3% low, 49.1% intermediate, 17.5% high and 7.1% very high risk. These patients were mostly female (50.9%), with a mean age of 66.2±11.5 years. Breast cancer was the most prevalent (42.1%), followed by hematological (31.6%) and gastrointestinal malignancies (17.5%), with a significant proportion of patients with metastatic disease (42.9%). <span style="color:black">Regarding chemotherapy regimens, 47.4% were exposed to anthracyclines and/or anti-HER-2 therapies, 24.6% to multiple myeloma therapies and 17.5% to vascular endothelial growth factor (VEGF) inhibitors.</span> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">CTR-CVT occurred in 50.9% of patients, mainly in the form of CTRCD. <span style="color:black">CTRCD was observed in 18.5% of the patients (27.3% mild, 40.9% moderate and 31.8% severe), mostly asymptomatic (68.2%).</span> Therapy suspension was required in 28% of cases, with a complete recovery rate of 44% during follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">ROC curve analysis demonstrated poor predictive power of HFA-ICOS for CTR-CVT development (AUC: 0.558, p=0.457, 95% CI 0.405-0.710). There were no significant differences in all-cause mortality (21.4% vs 34.9%, p=0.347) or hospitalization (57.1% vs 71.4%, p=0.322) between patients with low vs high BCVR.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> In this cohort, HFA-ICOS tool exhibited a limited predictive ability for CTR-CVT development, and BCVR did not correlate to adverse events. These findings highlight the need for enhanced risk stratification tools to improve prevention and surveillance strategies in cancer patients.</span></span></p>
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