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Morbidity and mortality in cardio-oncology clinic patients – who’s the guilty one: is it the heart, the cancer or the patient?
Session:
CO 26 - Populações especiais
Speaker:
Mariana Saraiva
Congress:
CPC 2021
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Saraiva; Nuno Craveiro; Ana Rita Moura; Bruno Castilho; Ana Rita Veiga; Isabel Monteiro; Luz Pitta; Vitor Martins
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> The purpose of cardio-oncology (CO) is to prevent and treat cardiovascular (CV) comorbidities in cancer patients (pts), improving quality of life and survival. Nevertheless, despite both oncology and cardiology efforts, an important burden of disease still lingers, with multiple hospital admissions, for CV and non-CV causes, and high mortality. A deeper knowledge of this population might help improve these pts’ follow-up and prognosis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>evaluate the prognosis of pts under CO surveillance and find predictors of adverse prognosis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> retrospective study of a population followed in CO consultation. Primary endpoint: hospital admission for CV and non-CV causes or death during follow-up. Statistical analysis of demographic, clinical, echocardiographic, laboratorial data was made.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>we included 78 patients, mean age 66.08±1.16 years, 59% female, with mean follow-up of 19.9±16.7 months. About half (51.3%) had breast cancer, followed by gastrointestinal tract (19.2%) and haematological (9%) malignancies, with a significant proportion with advanced disease (38.5% were metastatic). Prevalence of CV risk factors was high (hypertension in 74.4%, dyslipidaemia in 44.9%, type 2 diabetes mellitus in 19.2%), but also coronary artery disease (CAD) (23.1%) and atrial fibrillation (AF) (19.2%). A diagnosis of cardiotoxicity was made in 19.2%, mainly in the form of left ventricular systolic dysfunction.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At baseline, 16.7% of patients had a left ventricular ejection fraction (LVEF) under 50% and 37.7% a reduced global longitudinal strain (GLS). All of them were treated with different types of chemotherapy and 49.4% of pts with radiotherapy. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The overall mortality rate during follow-up was 21.8% and 46.2% of pts had ≥1 hospital admission. The same proportion (46.2%) of patients reached the endpoint, mostly male pts (p=0.001), with metastatic disease (p=0.001), receiving radiotherapy (p=0.039). Moreover, hypertension (p=0.046), CAD (p=0.047), AF (p=0.019), lower baseline LVEF (p=0.001) and GLS (p=0.004) increased the likelihood of reaching the endpoint. These pts also had more frequent consultations (p=0.024). There was no difference regarding the diagnosis of cardiotoxicity (p=0.076) or measurement of cardiac biomarkers. Pts with breast cancer were significantly less likely to have an adverse event (p=0.003) and had longer time to endpoint (breast cancer 22.25±3.67 months vs other than breast cancers 12.08±1.95 months, p= 0.016).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After multivariate regression analysis, male gender (p=0.046), metastatic disease (p=0.049), AF (p=0.047), baseline LVEF (p=0.017) and more frequent consultations (p=0.007) remained independent predictors of the outcome. </span></span></p> <p style="text-align:justify">Conclusion: in this complex population, multiple factors contribute to an adverse prognosis, either related to the patient, the cancer or to CV disease, suggesting benefit from a holistic approach.</p>
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