SPC365

Cardiotoxicity assessment according to current Cardio-Oncology guidelines in a population of female breast cancer patients

Session: Comunicações Orais - Sessão 05 - Doença cardiovascular na mulher
Speaker: Cátia Oliveira

Congress: CPC 2023
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.2 Cardiovascular Disease in Women
Session Type: Comunicações Orais
FP Number: ---
Authors: Cátia Oliveira; Ana Pinho; Luís Santos; Pedro Palma; Sara Maia; Guilherme Ferreira; André Cabrita; Catarina Marques; Ana Filipa Amador; João Calvão; Tânia Proença; Miguel Carvalho; Carla Sousa; Mariana Paiva; Filipe Macedo

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Background: </span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#1c1d1e">Assessment of cardiovascular complications in oncologic patients exposed to cardiotoxic therapies has been affected by a lack of uniformity in definitions and management. Our aim was to characterize and evaluate the risk of </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">cancer therapy-related cardiac dysfunction<span style="background-color:white"><span style="color:#1c1d1e"> (CTRCD)&nbsp;in a population of breast cancer patients (pts) exposed to chemotherapy (QT), considering the new published guidelines.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> A retrospective cohort of female breast cancer pts referred to Cardio-Oncology outpatient clinic between January 2017 to November 2021&nbsp;was analyzed. Baseline cardiotoxicity&nbsp;risk was defined according to HFA/ICOS assessment tool and <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span> was defined according to 2022 ESC Cardio-Oncology guidelines criteria. Pts were evaluated with echocardiogram, high sensitivity troponin I (hs-cTn) and BNP before treatment initiation and at 3, 6 and 12-months. As cardioprotective drugs we considered beta-blockers and renin-angiotensin-aldosterone system inhibitors.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> 382 pts were included: the mean age was 52,1&plusmn;11,8&nbsp;years old. Most pts were treated with anthracyclines (AC) (45%), followed by AC plus anti-HER2 therapy (AHT) (27%), AHT (17%) and other QT (11%). At baseline, the mean LV ejection fraction was 62,3&plusmn;0,2% and mean global longitudinal strain was -19,6&plusmn;0,4%. The median baseline hs-cTn was 1,9(IQR 1,9-2,6)ng/L and median BNP was 20,9(IQR 11,1-38,8)pg/L. &nbsp;Most of the pts had a low baseline cardiotoxicity risk; 40% of the pts were medicated with cardioprotective drugs prior to <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span>, mostly due to comorbidities. <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span> was observed in 43% of the pts: 40% mild; 3% moderate and 0,8% severe. Most were asymptomatic. Around&nbsp;20% of the pts were classified as having CTRCD&nbsp;according to the isolated biomarkers elevation criteria. 61% of pts with <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span> had full recovery at the end of follow-up.&nbsp;As for the long-term follow-up (14,8&plusmn;5,4 months), cumulative all-cause mortality was 2,1% and cumulative cardiovascular death was 0,3%. The risk of developing <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span> was 35% per pts-year.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> According to the new&nbsp;guideline&#39;s CTRCD criteria, our population had a significantly high susceptibility for CTRCD, even though most of the pts had a baseline low risk and 40% of the patients were medicated with cardioprotective drugs. However, a large part of CTRCD was classified as so based on the criteria of isolated biomarkers elevation. Further studies are needed to clarify if that criteria is clinically relevant and if it should be considered as <span style="background-color:white"><span style="color:#1c1d1e">CTRCD</span></span>.</span></span></span></span></p>